Management of therapy-resistant rheumatoid arthritis

During the last two decades, newly introduced therapeutic strategies have r esulted in satisfactory modification of the disease course in the majority of the patients with rheumatoid arthritis (RA). Nevertheless, a definite nu mber of RA patients remain therapy-resistant, and for this group more aggre ssive treatment may be required for preventing permanent disability and pro gressive joint damage necessitating surgical procedures. Therefore, managem ent of therapy-resistant RA is one of the major challenges in modern rheuma tology. RA patients who have not responded to conventional disease-modifyin g 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, c urrently available therapeutic options, data on therapy-resistant RA patien ts from an inception cohort of RA patients attending the Nijmegen Universit y Hospital, management of extra-articular manifestations and future managem ent strategies.