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ACR 2025 Rheumatology Round Up
Drs. Jack Cush & Arthur Kavanaugh, two of rheumatology’s most trusted voices, provide a breakdown of the latest breakthroughs and hottest topics in rheumatology from the 2025 ACR Convergence meeting in Chicago.
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Hospitalization in Stills: Is it "Still" an infection?
Dr. Janet Pope discusses abstract 0163, "Trends in hospitalization and outcomes among patients admitted with Adult-onset Still’s disease in the United States: INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE (2016-2022)," https://t.co/3Z0U9XN3nx
Dr. John Cush RheumNow ( View Tweet)
@CarolineDiorio @ChildrensPhila @RheumNow Indeed, there are a lot of familiar HLH/MAS friends in the post-CAR-T CRS mix...
(indeed, rheum friends from many places)
@CarolineDiorio @ChildrensPhila in the #ACR25 BCRC pre-meeting @RheumNow https://t.co/OzWu3MV1FA
Links:
David Liew drdavidliew ( View Tweet)
I've always (very) simplistically considered post-CAR-T CRS and HLH/MAS in the same bucket, and there certainly are substantial similarities.
It raises the obvious question - can we borrow therapies?
@CarolineDiorio @ChildrensPhila in the #ACR25 BCRC pre-meeting @RheumNow https://t.co/2HkHxpl89u
David Liew drdavidliew ( View Tweet)
What dictates how severe CRS is following CAR-T?
(Often the critical question, and will especially be in the autoimmune space, where CAR-T is largely less time-critical)
@CarolineDiorio @ChildrensPhila in the #ACR25 BCRC pre-meeting @RheumNow https://t.co/u0w4lx7YVn
Links:
David Liew drdavidliew ( View Tweet)
CAR-T Cell Therapies Show Promise for Autoimmune Disease
Two pioneering studies presented at #ACR25 spotlight the potential of CAR-T cell therapies to transform treatment for SLE and other autoimmune diseases. These early findings suggest a new frontier in immune modulation and https://t.co/KdNWmVc4Qc
Dr. John Cush RheumNow ( View Tweet)
kids w
👇
Undifferentiated #systemic #autoinflammatory #disease
Rx #IL1i
N=33
=boys &girls 3.5 yrs Sx
Abst#2151
#ACR25 @ACRheum @RheumNow
There are many periodic fever syndromes
🤔some mutations are not yet discovered
Access to &use of
Anakinra
canukinumab
Rilonacept https://t.co/IyTx0nFxKC
Janet Pope Janetbirdope ( View Tweet)
The next VEXAS, but also maybe we can treat it?
IDH1/2
Another clonal hematopoesis known to cause heme malignancy, but also some inflamm sequelae (autoinflamm-like e.g. PMR/GCA)
& you can directly inhibit it
Wow. We will hear more
#ACR25 LB21 @RheumNow
https://t.co/WL2ai5zb8Q https://t.co/Yi31xkhLO9
Links:
David Liew drdavidliew ( View Tweet)
#ACR25 Abstr#LB21 Are they novel somatic variants beyond #VEXAS in driving inflammation in undiagnosed SAID?Unbiased enrichment analysis in 265 UBA1-negative adults identified IDH1/2 hotspot mutations. Cd be used to screen esp those with cytopenia. Sorry pix not allowed @RheumNow
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
The Power of Gamma Delta T Cell for Autoimmunity https://t.co/wIMu5r7b3D
More on T Cell engagers , this time with gama delta T cell ( tiny but mighty ). Kate Roslin talks about advantages of this protocol. (No cytokines thus less toxicity).
@Yuz6Yusof
@RheumNow
#ACR25
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
How does DADA2 present?
Ten studies provided data on a total 225 patients
1) skin findings
2) fever
3) stroke
4) cytopenias
@RheumNow #ACR25 Abst 1615 https://t.co/xZuTk6YFdJ
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
When MAS is suspected. Soluble IL2 receptor alpha and CXCL9 may be useful (however t cell lymphomas and viral infections like hepatitis may also have them)
#ACR25 @RheumNow
Key takeaways below https://t.co/wJv1dvwU88
Bella Mehta bella_mehta ( View Tweet)
Soluble IL2 receptors help assess macrophages behavior. Ferritin also asses the same in Macrophage activation syndrome.
ADA2 is the newer biomarker for hemophagocytic syndromes.
#ACR25 @RheumNow
Interferon gamma also a newer important target in MAS https://t.co/7sWwninBTM
Bella Mehta bella_mehta ( View Tweet)
Simultaneous measurements if S100, Ferritin and IL-18 increase diagnostic utility of these biomarkers in Stills disease.
@RheumNow #Acr25 https://t.co/3wmijNcpVY
Bella Mehta bella_mehta ( View Tweet)
Low percentage of glycosylated Ferritin was more specific for Stills disease but not used frequently in clinical practice.
@RheumNow #ACR25 https://t.co/wTK1eIcSKX
Bella Mehta bella_mehta ( View Tweet)
Biomarkers in Stills disease and MAS. #ACR25 @RheumNow
IL 6 may not be helpful compared to CRP, and IL 1 beta is difficult to measure
IL-18 seems to be the best one. https://t.co/u3oBTd4eaP
Bella Mehta bella_mehta ( View Tweet)
IL- 18 go together sometimes with glycolytic enzymes such as aldolase
Also MAS may not be a switch on and off mechanism.
Lastly MAS with Stills may have increased IL18 levels but not in other disease like SLE
#ACR25 @RheumNow https://t.co/BW1fD7usBT
Bella Mehta bella_mehta ( View Tweet)
What do we know about IL-18
Normal levels less than 500
Non specific 500 to 15000
Stills (quiet) 2000 to 10000
Mas/glares 20000 and more
@RheumNow #ACR25 https://t.co/ZAltAD5Q8V
Links:
Bella Mehta bella_mehta ( View Tweet)
AOSD And sJIA aren't the same disease!!!. Another take on this by Scott Canna..because the clinical syndrome might have somethings distinct!!
#acr25 @RheumNow
Bella Mehta bella_mehta ( View Tweet)
#0777 Big news for VEXAS! 🎯
The first validated disease activity index (VEXAS-DAI) has been developed via international Delphi consensus. A 12-domain, 40-point tool to standardise assessment & power trials in this complex syndrome. Validation underway! @RheumNow #ACR25 https://t.co/DSeHb7eNeV
Mrinalini Dey DrMiniDey ( View Tweet)


