Evaluation of difficult-to-treat rheumatoid arthritis using EULAR definition: Prevalence and clinical determinants from a single-center cross-sectional study

In 2021, the European Alliance of Associations for Rheumatology (EULAR) introduced standardized criteria to define difficult-to-treat rheumatoid arthritis (D2T RA). This study aimed to examine the prevalence and clinical features of D2T RA within a real-world cohort. This study included 72 RA patients followed at Gazi University Rheumatology Clinic for a minimum of one year between May 2021 and August 2022. Data on sociodemographic parameters, disease activity, therapeutic history, and functional status were collected. All participants were assessed using validated instruments for fibromyalgia (2016 American College of Rheumatology criteria), neuropathic pain (DN4), mood symptoms (HADS), pain catastrophizing (PCS), and physical function (HAQ). The overall prevalence of D2T RA was found to be 6.9%. Compared to the non-D2T group, patients meeting D2T criteria exhibited longer disease duration, higher inflammatory activity, reduced functional capacity, and greater exposure to B-cell–targeted therapies. These findings underscore the critical role of individualized treatment strategies in managing D2T RA.