POS1083 DIFFICULT TO TREAT INFLAMMATORY ARTHRITIS: MAKING THE DEFINITION MORE PRECISE AND TIME FRAMED

Background Management of difficult to treat (D2T) inflammatory arthritis requires meticulous evaluation for the presence or absence inflammation support pharmacological and non-pharmacological management strategies. The challenge arises from finding that D2T has been linked a variety characteristics. EULAR Task Force recently defined rheumatoid as patients having persistency symptoms and/or signs despite failure at least two biological targeted synthetic disease modifying anti-rheumatic drugs with different mechanisms action. However, proposed definition was based on just one assessment moment time, during which flare up may not be reflective actual activity status. Objectives To address unmet needs derive comprehensive, yet precise, approach define who are “Difficult-to-Treat”. Methods Five key clinical questions including 20 domains were identified by core scientific committee. Literature Review team performed systematic review summarize evidence advocating definition, management, well benefits harms available pharmacologic non-pharmacologic therapies. Subsequently, recommendations formulated. level determined each section using Oxford Centre Evidence-based Medicine (CEBM) system. A 3-round Delphi process conducted. All rounds conducted online. Consensus, consequently, become recommendation, would achieved if 80% participants reached agreement (score 7-9). consensus direction strength recommendations. Results work an inclusive in 4 pillars: “persistent continues cause significant burden standard treatment perceived treating rheumatologist patient”. Two extra factors have suggested added definition. These “disease burden” “time-frame” “Continuous difficulties in: Achieving target, controlling progression, sustained elevation acute phase response over 3 months period attributed joint disease, lack functional restoration poor quality life good symptomatic control, compliance due to: unacceptable tolerability non-adherence rejection option. Time frame as: persistent (active/progressive disease”) documented according validated composite measures counts 2-readings, 3-months apart. Level high range 8.17-8.83). Conclusion this study revealed time factor is vital consider persistent, hence meet Adding “continuous another dimension D2T, more holistic toward patient rather than observing through prism index disease. REFERENCES: NIL. Acknowledgements: Disclosure Interests None Declared.