Reference: June 2025 | Issue 6 | Vol 11 | Page 8
Despite major advances in rheumatoid arthritis (RA) treatment over the past three decades, a significant minority of patients fail to respond to multiple disease-modifying therapies.
Addressing how best to classify and manage this group was the focus of a talk by Prof Dennis McGonagle, Professor of Investigative Rheumatology at the University of Leeds. His overview of refractory RA focused on two types of patients.
The first type are patients for whom multiple targeted therapies lack efficacy and who have persistent inflammatory refractory RA (PIRRA). The second are those with supposed refractory RA who have continued disease activity that is predominantly independent of objective evidence of inflammation – non-inflammatory refractory RA (NIRRA).
These two types of disease are not mutually exclusive, but identifying the predominant condition is important, as it informs distinct treatment and management approaches, Prof McGonagle stated. He discussed various risk factors, such as obesity and smoking, and the findings from his own research on a cohort of 1,600 refractory RA patients.
When assessing possible refractory RA patients, he stressed the importance of taking a very careful detailed history, and determining if pain and other symptoms are constant or intermittent. Prof McGonagle recommended refining combination therapies and working closer with other disciplines, such as haematology, to address all of the associated factors which are impacting the patient’s disease activity.
