Interrogating and redefining ‘difficult to treat’ rheumatoid arthritis (RA) and mapping its traits to early RA

Summary

Around 1 in 100 people in the UK live with rheumatoid arthritis (RA), a condition that can lead to joint pain,
damage, and disability if not managed effectively. Although many treatments are available to treat RA, some
individuals continue to experience symptoms even after trying multiple drugs. The RA is then termed
'difficult-to-treat' (D2T) RA. It is not known how to treat D2T-RA.

The current definition of D2T-RA includes individuals in whom at least 2 modern treatments have not
worked, but also captures many factors that might lead to poor control - such as those who have other
medical illnesses or who may not understand the disease as well and be anxious about the treatment,
meaning they may not take it regularly.

This project will address 3 main areas: Firstly, we will use data from Bioresource to confirm the factors that
are already linked to D2T-RA and hopefully find new factors that might be linked . Secondly, we will test
whether these factors are present in patients who are newly diagnosed with RA. This could support trying
treatment approaches at the time of diagnosis to reduce the risk of developing D2T-RA later. Lastly, we will
try to improve the definition of D2T-RA patients, so that it is more accurate and can develop and test specific
treatments in this group of patients with hopefully, more success.

Completing this study will then link to a next study where we will recall patients and request blood samples
to identify specific blood markers of D2T-RA. This could help identify different ways of treating this stage of
RA.

Ultimately, this research will improve our understanding of D2T-RA and allow treatments to be tailored
matched to the type of D2T-RA groups of individuals have. This will mean people have a better quality of life.