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we re getting better at understanding different types of refractory ra (d2t ra) we see differences with refractory ra subtypes:
pirra (persistently inflamm on uss), and
nirra (non-inflamm) hopefully moving to data-driven rx approaches for d2t ra? op0134 #eular2023 
Rheumatologist and clinical pharmacologist, world traveller pretences on the upswing, sometimes journal podcast host. All opinions my own