• Drug resistance affects approximately 28.5% of RA patients, with higher rates for conventional synthetic DMARDs (34.7%) compared to biologics (22.3%).
• Key risk factors for drug resistance include longer disease duration, prior multiple DMARD use, and presence of anti-drug antibodies.
• Drug resistance is associated with worse clinical outcomes, including higher disease activity and increased radiographic progression.
• Therapeutic drug monitoring and early risk stratification are essential to optimize RA treatment and overcome resistance.