What question did this study set out to answer?

This study aims to compare various definitions of difficult-to-treat rheumatoid arthritis (D2T-RA) and explore how timing affects patient classification.

August 3, 2026The Journal of Rheumatology

Defining Difficult-to-Treat Rheumatoid Arthritis in Routine Care: Comparative Performance of Published Criteria and Description of Early and Late D2T-RA Phenotypes

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Authors

RARahaf Zyad AttarUniversity of Ottawa MMMohammad MovahediToronto General Hospital ACAngela CestaUniversity Health Network

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Implication

Randomized trial compares D2T-RA definitions and identifies temporal stratification for better patient outcomes.

Key Points

This study aims to compare various definitions of difficult-to-treat rheumatoid arthritis (D2T-RA) and explore how timing affects patient classification.
Used data from the Ontario Best Practices Research Initiative (OBRI) real-world RA registry.
Evaluated 4 adapted EULAR D2T-RA definitions among patients initiating advanced therapy.
Analyzed prevalence, agreement, and developed a temporal system distinguishing early vs late D2T-RA.
215 out of 1121 patients (19%) met D2T-RA criteria by at least one definition.
Definition 2 identified 12.7% prevalence, the highest among all definitions, while Definition 4 showed 5.5%.
The agreement between definitions varied widely, with the highest (κ = 0.87) between definitions 1 and 2.

Cite This Study

Attar et al. (2026) studied this question.

synapsesocial.com/papers/6a70402f75942ff7265e4ec9 https://doi.org/10.3899/jrheum.2026-0447.182

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Defining Difficult-to-Treat Rheumatoid Arthritis in Routine Care: Comparative Performance of Published Criteria and Description of Early and Late D2T-RA Phenotypes

Discussion

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Implication

Key Points

Cite This Study

Defining Difficult-to-Treat Rheumatoid Arthritis in Routine Care: Comparative Performance of Published Criteria and Description of Early and Late D2T-RA Phenotypes

Discussion

Member takes

Implication

Key Points

Cite This Study

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