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Rheumatology’s Blind Spot: The Persistent Exclusion of Older Adults
As the population ages globally, rheumatologists are caring for an increasingly older patient population more than ever before. In RA alone, nearly 40 percent of patients are now aged 65 years or older. Yet the evidence guiding our treatment decisions continues to come from studies that rarely include them, giving rise to a fundamental question: do we really know how best to treat older adults with rheumatic diseases?
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New Research Demonstrates Impact of RISE Registry Data on Rheumatology Outcomes
ACR Press Release
New research presented at ACR Convergence 2025 highlights how the Rheumatology Informatics System for Effectiveness (RISE) registry—the nation’s largest collection of electronic health record data from rheumatology practices—is driving transformative improvements in quality, safety, and patient outcomes across rheumatic and musculoskeletal diseases.
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Implantable vagal stimulator led to benefit in TNF-inadequate responder RA in this sham-controlled double-blind RCT (RESET-RA study)
- 82% off b/tsDMARDs at 12mo
- also with benefit to control group after crossover at 3mo to an active device
#ACR25 1675 @RheumNow https://t.co/yYwWCKm6HF
David Liew drdavidliew ( View Tweet)
In the SERENA study (n=292), secukinumab reduced PsA incidence to 0.49/100 PY over 5 years in PsO patients with nail involvement, an ~82% drop vs historic non-biologic rates (2.7/100 PY). 98.3% remained PsA-free; PASI 90 achieved in 63%. Abstract#1463 @RheumNow #ACR25 https://t.co/ySOuFJiwge
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Beyond biologics: RA meets bioelectric medicine.
In RESET-RA, TNFi inadequate response or intolerant (n=124), vagus nerve stimulation led to significant & durable improvement
🔹 ACR20 3mo: 42% active vs 18% sham (p=0.0057)
🔹 Benefits through 12mo
@RheumNow #ACR25 A#1675
Jiha Lee JihaRheum ( View Tweet)
Short chain fatty acids (SCFA) and the relevant microbiome have been linked to RA development and severity.
Study of monozygotic twins, where only one has RA, two diff cohorts:
lower SCFA
lower SCFA microbiome
Biomarkers, or even therapeutic target?
#ACR25 ABST0442 @RheumNow https://t.co/HW1YfkfOG3
David Liew drdavidliew ( View Tweet)
Screening for ILD in RA patients:
CXR and PFTs by themselves are close to a waste of time.
When it comes to screening (high-risk) RA patients, it’s HRCT (or lung USS) or nothing really.
(in keeping with EULAR, ACR guidelines)
#ACR25 ABST1335 @RheumNow https://t.co/XBDxLwYsAT
David Liew drdavidliew ( View Tweet)
England et al. Predictors of progression RA-ILD - UIP pattern (HR 1.46), current (HR 1.98) and former (HR 1.60) smoking, age (HR 1.03). @RheumNow #ACR25 Abstr#1308 https://t.co/IvQo8Istta
Richard Conway RichardPAConway ( View Tweet)
Mease et al. What agent to use after failure of first TNFi in PsA. Real world study, 320 patients. Switching to upadacitinib led to better joint responses than second TNFi or IL17i @RheumNow #ACR25 Abstr#1453 https://t.co/SQnN0skw7r
Richard Conway RichardPAConway ( View Tweet)
What can we use to better predict MACE in RA patients?
ESPOIR cohort showed value of two cardiac biomarkers:
- hs-cTnT
- soluble ST2
Combined, predicted MACE even after adjusting for disease activity/traditional CV RF. We need something like this!
#ACR25 ABST1334 @RheumNow https://t.co/EUNDuuMaYD
David Liew drdavidliew ( View Tweet)
Loarce et al. Poor performance of CXR and PFT in diagnosing RA-ILD (compared to HRCT). Message is, if you think they have RA-ILD, you need to do CT. @RheumNow #ACR25 Abstr#1335 https://t.co/eeSTf72mvM
Richard Conway RichardPAConway ( View Tweet)
Getting RA patients into remission: have we plateaued?
@MayoClinic data: early and later into the biologic era, and still median time to RA remission is >3y
Surely we can aspire to more? Let’s target barriers to implementing better
#ACR25 @ElHasbaniG @MyasoedovaElena @RheumNow https://t.co/JLTuL5cIet
David Liew drdavidliew ( View Tweet)
Pope @Janetbirdope et al. Parenteral (IM and/or IA) superior to oral steroids in early RA. Better discontinuation of steroids with no difference in need for advanced therapies. @RheumNow #ACR25 Abstr#1355 #ACRbest https://t.co/OyvnzEGlLE
Richard Conway RichardPAConway ( View Tweet)
After At-risk RA, time to discuss At-risk PsA patients
ARP-PsA
Prospective cohort 1400+ pts
8.4% met ARP-PsA criteria (arthralgia + Fam Hx +Pso, not referred via Dermatology)
Risk factors:
Pso >15 years
Pso + Family Hx
US synovitis/enthesitis
At 1 yr follow-up 30% progressed https://t.co/ZY2ezh8nZN
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Kuzkina et al. Efficacy of IL-6i with olokizumab on depression in RA. There appear to be some benefit but anti-depressants still needed. Group 1 is olokizumab alone, other 2 groups have anti-depressants also. @RheumNow #ACR25 Abstr#1323 https://t.co/h2ExYQgKTL
Richard Conway RichardPAConway ( View Tweet)
Rural RA care looks different but not less intensive: DMARD and GC use matched urban rates, yet rural pts often managed by PCPs had twice the opioid use.
ACR's Rheum for Primary Care resource can help address access gap and improve RA care
@RheumNow #ACR25 Abstract#1025
Jiha Lee JihaRheum ( View Tweet)
NEREA registry study on mortality in progressive pulmonary fibrosis in SARD-ILD. 158 patients. Median survival 7.8 years. DMARD use associated improved mortality. @RheumNow #ACR25 Abstr#1024 https://t.co/rK1caGi2r4
Richard Conway RichardPAConway ( View Tweet)
Eat #fibre helps #rheumatoid #arthritis!
#RCT #RA w #MTX
Adding #super fibre
Mean #DAS28 3.8
7TJC, SJC2
Small N +RCT
Super fibre group
⬆️ #EULAR response
✅ improve #TH17 &TREG response
🤷♀️ tolerability and ease to use dietary super fibre
#ACR25 @RheumNow @ACRheum abst#LB15 https://t.co/ME6bsj4Ec7
Links:
Janet Pope Janetbirdope ( View Tweet)
#0850 Single-cell RNA-seq of RA synovium uncovers a new biomarker & therapeutic target: PHIF
Made by Tph cells, drives macrophage activation and mirrors disease severity.
Big step forward in understanding RA immunopathogenesis. @RheumNow #ACR25 https://t.co/KtyxU0Lqly
Mrinalini Dey DrMiniDey ( View Tweet)
GLP-1 RA meds: we are just starting to see their impact in rheumatoid arthritis. We know metabolic, CV risk in RA, but what to do?
RA pts in TriNetX, obese non-diabetic
GLP-1 RA reduced 1y CV events & also all-cause mortality
Soon will be near-standard
#ACR25 ABST0445 @RheumNow https://t.co/4ptAHdmf9q
David Liew drdavidliew ( View Tweet)
