Scientific Publications
August 2026 | RMD Open
Published in RMD Open, this systematic literature review (SLR) – conducted by the STRATA-FIT consortium and building on previous EULAR work – synthesised evidence from 131 studies on therapeutic strategies for difficult-to-treat rheumatoid arthritis (D2T RA). The review addressed three clinical scenarios: patients with active disease and limited treatment options due to comorbidities; patients with active disease after ≥2 prior biologic/targeted therapies; and patients with poor quality of life despite low inflammatory activity. Key findings show that JAK inhibitors (JAKi) maintain efficacy even after multiple prior treatment failures, but require careful risk assessment given increased risks of infection, malignancy, and cardiovascular events. Evidence for non-pharmacological interventions remains very limited, representing a critical gap in D2T RA research.
Shams G, Dorgó AM, Ripepi C, Wettersand E, Malczuk E, Neumeister C, et al. Therapeutic approaches for difficult-to-treat rheumatoid arthritis: a systematic literature review of current evidence. RMD Open. 2026;12:e006860. https://doi.org/10.1136/rmdopen-2026-006860
Credits: Division of Rheumatology – MUW Vienna
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Funded by the European Union (grant agreement no. 101080243). Views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the European Union or the European Health and Digital Executive Agency. Neither the European Union nor the granting authority can be held responsible for them.
The project has also received funding from the Swiss State Secretariat for Education, Research and Innovation (SERI) and from Hungary’s National Research, Development and Innovation (NRDI) Fund.