Table 1.
Definition of D2T patients
| EULAR definition of D2T rheumatoid arthritis | Potential definition of D2T psoriatic arthritis |
|---|---|
| 1. Treatment according to European League Against Rheumatism recommendation and failure of ≥ 2 b/tsDMARDs (with different mechanisms of action)a after failing csDMARD therapy (unless contraindicated)b | 1. Treatment according to European League Against Rheumatism recommendation and/or GRAPPA recommendations and failure of ≥ 2 b/tsDMARDs (with different mechanisms of action)a after failing csDMARD therapy (unless contraindicated)b |
| 2. Signs suggestive of active/progressive disease, defined as ≥ 1 of: | 2. Signs suggestive of active/progressive disease, defined as ≥ 1 of: |
|
a. At least moderate disease activity (according to validated composite measures including joint counts, for example, DAS28-ESR > 3.2 or CDAI > 10) |
a. At least moderate disease activity (according to validated composite measures including joint counts, for example, DAPSA > 14 or not achieving the Minimal Disease Activity criteria (MDA) |
| b. Signs (including acute phase reactants and imaging) and/ or symptoms suggestive of active disease (joint related or other) | b. Signs (including acute phase reactants and imaging) and/ or symptoms suggestive of active disease (joint related or other) |
| c. Inability to taper glucocorticoid treatment (below 7.5 mg/ day prednisone or equivalent) | c. Rapid radiographic progression (with or without signs of active disease)c |
| d. Rapid radiographic progression (with or without signs of active disease)c | d. Well-controlled disease according to above standards, but still having PsA symptoms that are causing a reduction in quality of life |
| e. Well-controlled disease according to above standards, but still having RA symptoms that are causing a reduction in quality of life | |
| 3. The management of signs and/or symptoms is perceived as problematic by the rheumatologist and/or the patient | 3. The management of signs and/or symptoms is perceived as problematic by the rheumatologist and/or the patient |
| All three criteria need to be present in D2T RA | All three criteria need to be present in “D2T” PsA |
b biological, CDAI clinical disease activity index, cs conventional synthetic, DAS28-ESR disease activity score assessing 28 joints using erythrocyte sedimentation rate, DMARD disease-modifying antirheumatic drug, mg milligram, RA rheumatoid arthritis, ts targeted synthetic
aUnless restricted by access to treatment due to socioeconomic factors
bIf csDMARD treatment is contraindicated, failure of ≥ 2 b/tsDMARDs with different mechanisms of action is sufficient
cRapid radiographic progression: change in van der Heijde-modified Sharp score ≥ 5 points at 1 year