1. Treatment “failure” in difficult-to-treat rheumatoid arthritis may reflect inadequate efficacy, intolerance, or both, each with different clinical implications.
2. The current European Alliance of Associations for Rheumatology definition is helpful but groups biologically distinct patient profiles together.
3. Stratifying patients by efficacy vs. toxicity could improve clinical decision-making.
4. Assessing disease activity is limited by impractical imaging requirements and subjective symptom reporting.
5. A more streamlined, clinically practical definition may better identify and manage difficult-to-treat rheumatoid arthritis.

Source: RMD Open