SynthesisRMD open2021
Pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis.
Synthesis in RMD open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
47 citing papers in PubMed, 6 syntheses or guidelines pooled it, 103 citations in OpenAlex.
- Therapeutic approaches for difficult-to-treat rheumatoid arthritis: a systematic literature review of current evidence.RMD open · 2026Pooled it
- Efficacy of pharmacological interventions and therapeutic exercises for rheumatoid arthritis: a systematic review and meta-analysis.Frontiers in pharmacology · 2025Pooled it
- Efficacy and safety of current therapies for difficult-to-treat rheumatoid arthritis: a systematic review and network meta-analysis.Journal of translational medicine · 2024Pooled it
- The effects of Tai Chi on physical function and safety in patients with rheumatoid arthritis: A systematic review and meta-analysis.Frontiers in physiology · 2023Pooled it
- EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis.Annals of the rheumatic diseases · 2022Guideline
- Pooled it
- Improving exercise adherence in ankylosing spondylitis through individualized education and follow-up: a pilot randomized trial.Irish journal of medical science · 2026Article
- Choosing the next option: a scenario-based roadmap for b/tsDMARD sequencing in rheumatoid arthritis.Clinical rheumatology · 2026Review
- Emerging trends in the management of difficult-to-treat rheumatoid arthritis: targeted treatments and non-pharmacological interventions.Rheumatology (Oxford, England) · 2026Review
- Pathogenic Drivers of Difficult-to-Treat Rheumatoid Arthritis: Synovium and Beyond.International journal of molecular sciences · 2026Review
- Predicting the progression of difficult-to-treat rheumatoid arthritis by a machine learning scoring system, from the FIRST registry.RMD open · 2026Article
- Unmet needs in patients with RA judged in remission by the rheumatologist: a semi-structured interview study.Rheumatology advances in practice · 2026Article
- Representation of underserved communities in non-pharmacological axial spondyloarthritis trials: a scoping review protocol.Rheumatology advances in practice · 2026Article
- Role of T cells and cytokines in the pathogenesis of rheumatoid arthritis.Biochemistry and biophysics reports · 2025Review
- Rheumatoid arthritis continues to increase in low-middle SDI and low SDI quintiles based on GBD 1990-2021.BMC rheumatology · 2025Article
- Article
- Early-onset difficult-to-treat rheumatoid arthritis: proposal of data-driven predictors and temporal threshold.Arthritis research & therapy · 2025Observational
- Evaluation of Nurse-Implemented Self-Management Interventions for Patients with Chronic Inflammatory Arthritis in Bulgaria.Journal of clinical medicine · 2025Article
- Physical and mental disability is evident 8 years after diagnosis in early rheumatoid arthritis despite contemporary medication and non-pharmacological interventions.Clinical rheumatology · 2025Article
- Prevalence and characteristics of adults with difficult-to-treat rheumatoid arthritis in a large patient registry.Rheumatology (Oxford, England) · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 5 institutions in 3 countries.
Funding
Abstract
objectivesTo summarise, by a systematic literature review (SLR), the evidence regarding pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis (D2T RA), informing the EULAR recommendations for the management of D2T RA.
methodsPubMed, Embase and Cochrane databases were searched up to December 2019. Relevant papers were selected and appraised.
resultsTwo hundred seven (207) papers studied therapeutic strategies. Limited evidence was found on effective and safe disease-modifying antirheumatic drugs (DMARDs) in patients with comorbidities and other contraindications that limit DMARD options (patients with obesity, hepatitis B and C, risk of venous thromboembolisms, pregnancy and lactation). In patients who previously failed biological (b-)DMARDs, all currently used b/targeted synthetic (ts-)DMARDs were found to be more effective than placebo. In patients who previously failed a tumour necrosis factor inhibitor (TNFi), there was a tendency of non-TNFi bDMARDs to be more effective than TNFis. Generally, effectiveness decreased in patients who previously failed a higher number of bDMARDs. Additionally, exercise, psychological, educational and self-management interventions were found to improve non-inflammatory complaints (mainly functional disability, pain, fatigue), education to improve goal setting, and self-management programmes, educational and psychological interventions to improve self-management.The identified evidence had several limitations: (1) no studies were found in patients with D2T RA specifically, (2) heterogeneous outcome criteria were used and (3) most studies had a moderate or high risk of bias.
conclusionsThis SLR underscores the scarcity of high-quality evidence on the pharmacological and non-pharmacological treatment of patients with D2T RA. Effectiveness of b/tsDMARDs decreased in RA patients who had failed a higher number of bDMARDs and a subsequent b/tsDMARD of a previously not targeted mechanism of action was somewhat more effective. Additionally, a beneficial effect of non-pharmacological interventions was found for improvement of non-inflammatory complaints, goal setting and self-management.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.