Mechanisms underlying DMARD inefficacy in difficult-to-treat rheumatoid arthritis : a narrative review with systematic literature search
© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology..
Management of RA patients has significantly improved over the past decades. However, a substantial proportion of patients is difficult-to-treat (D2T), remaining symptomatic after failing biological and/or targeted synthetic DMARDs. Multiple factors can contribute to D2T RA, including treatment non-adherence, comorbidities and co-existing mimicking diseases (e.g. fibromyalgia). Additionally, currently available biological and/or targeted synthetic DMARDs may be truly ineffective ('true' refractory RA) and/or lead to unacceptable side effects. In this narrative review based on a systematic literature search, an overview of underlying (immune) mechanisms is presented. Potential scenarios are discussed including the influence of different levels of gene expression and clinical characteristics. Although the exact underlying mechanisms remain largely unknown, the heterogeneity between individual patients supports the assumption that D2T RA is a syndrome involving different pathogenic mechanisms.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:61 |
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| Enthalten in: |
Rheumatology (Oxford, England) - 61(2022), 9 vom: 30. Aug., Seite 3552-3566 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Roodenrijs, Nadia M T [VerfasserIn] |
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| Links: |
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| Themen: |
Antirheumatic Agents |
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| Anmerkungen: |
Date Completed 08.09.2022 Date Revised 09.09.2022 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/rheumatology/keac114 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM337695725 |
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| 520 | |a © The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. | ||
| 520 | |a Management of RA patients has significantly improved over the past decades. However, a substantial proportion of patients is difficult-to-treat (D2T), remaining symptomatic after failing biological and/or targeted synthetic DMARDs. Multiple factors can contribute to D2T RA, including treatment non-adherence, comorbidities and co-existing mimicking diseases (e.g. fibromyalgia). Additionally, currently available biological and/or targeted synthetic DMARDs may be truly ineffective ('true' refractory RA) and/or lead to unacceptable side effects. In this narrative review based on a systematic literature search, an overview of underlying (immune) mechanisms is presented. Potential scenarios are discussed including the influence of different levels of gene expression and clinical characteristics. Although the exact underlying mechanisms remain largely unknown, the heterogeneity between individual patients supports the assumption that D2T RA is a syndrome involving different pathogenic mechanisms | ||
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| 700 | 1 | |a van der Goes, Marlies C |e verfasserin |4 aut | |
| 700 | 1 | |a Nagy, György |e verfasserin |4 aut | |
| 700 | 1 | |a Townsend, Michael J |e verfasserin |4 aut | |
| 700 | 1 | |a van Laar, Jacob M |e verfasserin |4 aut | |
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