The aim of this study is to observe the clinical efficacy and safety of telitacicept combined with baricitinib in the treatment of D2TRA patients

Inclusion Criteria:

• 1. Age 18-85 years
• 2. Diagnosed with refractory rheumatoid arthritis according to the 2021 EULAR (European Alliance of Associations for Rheumatology) diagnostic criteria
• 3. The traditional disease-improving rheumatic drug treatment is ineffective, and the use of two or more biological/targeted disease improving anti-rheumatic drugs is ineffective, and telitacicept combined with tofacitinib is required treated patients
• 4. Voluntarily provided written informed consent

Exclusion Criteria:

• 1. Exclusion of patients with severe diseases of major organs (e.g., heart, liver, or lungs)
• 2. Patients with malignancies, hematological disorders, or other autoimmune diseases (excluding rheumatoid arthritis)
• 3. History of allergy/hypersensitivity to the study medications (Telitacicept or Tofacitinib)
• 4. Active tuberculosis or active infectious diseases requiring systemic treatment
• 5. Pregnancy, lactation, or refusal to use contraception during the study
• 6. Failure to complete the prescribed Telitacicept + Tofacitinib regimen due
• to:Non-adherence or Severe adverse reactions
• 7. Other conditions contraindicating participation per investigator judgment

Patients with refractory rheumatoid arthritis