title: Management of therapy-resistant rheumatoid arthritis.
abstract: During the last two decades, newly introduced therapeutic strategies have resulted in satisfactory modification of the disease course in the majority of the patients with rheumatoid arthritis (RA). Nevertheless, a definite number of RA patients remain therapy-resistant, and for this group more aggressive treatment may be required for preventing permanent disability and progressive joint damage necessitating surgical procedures. Therefore, management of therapy-resistant RA is one of the major challenges in modern rheumatology. RA patients who have not responded to conventional disease-modifying antirheumatic drug (DMARD) therapy are defined as refractory RA patients. However, a uniform description or definition for 'refractory' RA does not appear to be available. In this article we will deal with, and discuss, the term 'refractory RA' based on a MEDLINE database search using this term, currently available therapeutic options, data on therapy-resistant RA patients from an inception cohort of RA patients attending the Nijmegen University Hospital, management of extra-articular manifestations and future management strategies.
authors.affiliation: Department of Rheumatology, University Hospital Nijmegen, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Kroot
authors.forename: L B
authors.initials: LB
authors.lastname: van de Putte
authors.forename: P L
authors.initials: PL
authors.lastname: van Riel
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D004351:Drug Resistance; D006801:Humans; D017211:Treatment Failure
chemical_list: D018501:Antirheumatic Agents