Progress in clinical diagnosis and treatment of persistent inflammatory and non-inflammatory subtypes of rheumatoid arthritis
Ma Yuanyuan
Li Xiaoyan
Yan Ni
Abstract：Rheumatoid arthritis(RA)is a chronic,systemic autoimmune disease characterized by erosive arthritis.With the application of biological agents and targeted synthetic disease-modifying antirheumatic drugs,as well as the promotion of"treatment to target"strategy,the treatment of RA has made significant progress,and most patients can achieve disease remission or low disease activity.However,there are still a significant number of patients with persistent disease activity or refractory symptoms despite receiving multiple drug therapies with different mechanisms of action,which are called refractory RA or refractory inflammatory arthritis.In recent years,the European League against Rheumatism has proposed the concept and definition of refractory RA,which provides a clearer definition for this patient group.The refractory RA patient population is heterogeneous.The causes of persistent symptoms may include persistent inflammatory activity,and may also involve non-inflammatory factors,such as central sensitization,concurrent fibromyalgia,and psychological factors.In order to guide clinical diagnosis and treatment more accurately,some scholars have proposed that refractory RA should be further divided into persistent inflammatory refractory RA(PIRRA)and non-inflammatory refractory RA(NIRRA).The aim of this review is to systematically review the progress in the diagnosis and treatment of refractory RA,with a focus on the definition,characteristics,diagnosis,treatment and future research directions of PIRRA and NIRRA subtypes.
Keywords：Refractory rheumatoid arthritisDiagnosisClassificationTreatment
Publication Date：2026-01-18
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：5( 142-146 )