#2-42E. Defining the Unresponsive: EULAR Consensus on Difficult-to-Manage and Treatment-Refractory Psoriatic Arthritis (ARD, 2025)

How do you accurately approach patients with Psoriatic Arthritis (PsA) who fail to respond to multiple lines of advanced therapy? This episode delves into the landmark EULAR points to consider and consensus definitions for difficult-to-manage (D2M) and treatment-refractory (TR) PsA, developed by a multidisciplinary international task force following a systematic literature review. Recognizing that unsatisfactory treatment response in PsA is multifactorial, driven by ongoing inflammation, comorbidities, and psychosocial factors, the crucial finding is the establishment of the first standardized definitions to distinguish D2M PsA, an umbrella concept, from TR PsA, the true drug non-responsive subgroup defined by persistent disease activity with objective evidence of active inflammation, while excluding other drivers. This distinction is vital for clinicians, offering a framework to accurately characterize complex patients, identify true biological non-response, and optimize personalized management strategies. However, it is essential to note that the supporting evidence obtained from the systematic literature review was limited and of heterogeneous quality, highlighting the need for future research. These consensus definitions pave the way for a more unified research agenda and improved clinical care for patients with challenging PsA.

Citation: Marzo-Ortega H, Harrison SR, Fragoulis GE, et al. EULAR points to consider and consensus definitions for difficult-to-manage and treatment-refractory psoriatic arthritis. Annals of the Rheumatic Diseases. 2025. DOI: 10.1016/j.ard.2025.10.002

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