Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease, affecting ~1% of adults (~22M in the EU). It accounts for ~10,000 disability-adjusted life years (DALYs) and societal costs of ~€55B annually. RA causes joint pain and stiffness, with potential extra-articular complications such as sicca symptoms and lung disease. Cardiovascular disease and cancer are common co-morbidities, contributing to disability, reduced quality of life, and increased mortality.
While effective treatments can reduce symptoms, joint damage, and improve outcomes, a subgroup—Difficult-to-Treat RA (D2T RA)—remains unresponsive to multiple therapies and accounts for ~20% of RA patients. This group drives a large share of RA’s socio-economic burden. Recently, the EULAR Task Force, led by Europe’s foremost rheumatology organisation, identified D2T RA as an urgent unmet need.
D2T RA is multifactorial: drug non-response, intolerance, misdiagnosis, comorbidities, non-adherence, and psychosocial factors all contribute. Predicting treatment response remains limited, and after first-line methotrexate, therapy decisions rely on trial-and-error. This may expose patients to ineffective or harmful treatments. A personalised approach, combining pharmacological and non-pharmacological strategies, is urgently needed.
To address this, two leading members of the EULAR Task Force (UMCU, MUV) have partnered with four top European rheumatology centres (KI, RS, iMM, LMU/KUM), an innovative SME (MDW), and the EULAR-PARE patient network to form the STRATA-FIT consortium. This unique initiative aims to identify and stratify D2T RA patients into clinically meaningful phenotypes based on distinct clinical profiles.
Moreover, early identification of RA patients at risk of progressing to D2T RA could enable preventive strategies and more effective treatment selection from the outset.
