Every rheumatoid arthritis patient hopes to get satisfactory treatment results, but the fact is not so optimistic, some patients’ results are just not good, why is that? Because you are suffering from refractory rheumatoid arthritis. What kind of arthritis is considered to be refractory rheumatoid arthritis? Refractory RA is defined as those who have been treated with a combination of two or more DMARDs for at least six months with unsatisfactory results, accounting for 10-20% of the total RA population. It is generally considered that patients with the following conditions are likely to develop refractory RA: 1) HLA-DR4+, 2) high activity index, 3) persistently elevated CRP and high titer RF, 4) extra-articular manifestations such as subcutaneous nodules, vasculitis, thrombocytosis and anemia, 5) failure to receive reasonable anti-rheumatic therapy at an early stage, and 6) progressive cartilage and bone destruction on joint X-ray. The joint X-ray shows progressive cartilage and bone destruction. For this type of refractory RA, conventional treatment is not possible, how to treat the disease to achieve remission, rheumatologists at home and abroad have made a lot of exploration, is introduced as follows: 1, the choice of new immunosuppressants: In recent years, Leflunomide as a new type of immunosuppressant in the treatment of RA is increasingly widely used. Cyclosporine A alone or in combination with other DMARDs also has good efficacy in some refractory RA. 2, the application of biological agents: such as soluble TNF-α receptor fusion protein Etanercept, the domestic trade name of Yicep, anti-TNF monoclonal antibody, the trade name of the class gram they in the treatment of refractory RA to achieve encouraging results. In recent years, CTX shock (400mg, 1 time in 2 weeks, or 800mg, 1 time in 2-4 weeks) treatment has been reported at home and abroad to achieve satisfactory results in refractory RA. 4.The application of steroid corticosteroids can play a “bridging” role to induce remission of the disease as soon as possible. 5.Immunosorbent therapy. In 2002, the annual meeting of the American Rheumatology Association included immunosorbent therapy as one of the treatment methods for RA in the revision of RA treatment guidelines. 6.Hematopoietic stem cell transplantation, which is actually a kind of intensive immunosuppressive therapy, has positive near-term efficacy for refractory RA, but the long-term efficacy is yet to be further observed.