Prof van Lear defines Difficult to Treat (D2T) RA: Failed >2 b/tsDMARD w/diff't MOA after failing csDMARD AND signs of active/progressing disease: DAS28 ESR >3.2 or CDAI>10, high ESR/CRP, imaging, Sx's causing low QoL, pred>7.5 mg/d, rapid xray progression #EULAR2022 @rheumnow