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Rheumatology’s Blind Spot: The Persistent Exclusion of Older Adults

Jiha Lee, MD

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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ACR Convergence 2025 Sheds Light on Disparities, Age-Related Trends, and Epidemiology in Autoimmune Rheumatic Diseases

ACR Press Release

At ACR Convergence 2025, new research explored critical disparities and epidemiologic trends shaping outcomes in autoimmune rheumatic diseases across diverse populations and age groups. Studies presented at the meeting highlighted issues ranging from kidney transplant outcomes in lupus to medication disparities in rheumatoid arthritis and demographic patterns in systemic sclerosis and axial spondyloarthritis.

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New Insights into Pregnancy Outcomes and Maternal-Fetal Health in Rheumatic Diseases

ACR Press Release

At ACR Convergence 2025, the American College of Rheumatology presents new research illuminating critical challenges and advances in pregnancy outcomes for women living with rheumatic diseases, including axial spondyloarthritis, antiphospholipid syndrome, and lupus.

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Pre-ACR25 (10.24.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and info reports the day before ACR 2025

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Real-world Indian cohort of 290 axSpA patients, generic tofacitinib achieved low/inactive disease in 89% after 25 months. Most adverse events were mild (e.g., transaminitis 14.5%) and manageable. No serious infections or MACE reported. A cost-effective alternative to bDMARDs in https://t.co/JBHfNq7kYt

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Urinary proteomics reveals promising biomarkers for ankylosing spondylitis. PIK3IP1 & SDC1 levels were significantly elevated in AS patients, showing strong diagnostic performance (AUCs: 0.852 & 0.875). Combined with AMY1A, the multiplex panel reached an AUC of 0.973. Abstract https://t.co/YUulKFqj8V

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
New biomarkers 14-3-3η multiplex autoantibody assay improves axSpA diagnosis, especially in HLA-B27– patients. Combined with CRP & HLA-B27, detection rose to 99% (training) & 91.4% (evaluation). In HLA-B27– cases, 14-3-3η lifted detection to 70.6% & 55%. Abstract 0531 @RheumNow

Antoni Chan MD (Prof) synovialjoints ( View Tweet)

Using ChatGPT to diagnose axSpA, in 10 low back pain cases, it outperformed clinicians in diagnostic precision (75% vs. 60%) and sensitivity (85% vs. 80%), completing the task 5x faster. Specialty framing (e.g., Rheum vs Neuro) didn’t affect accuracy. Abstract 0530 @RheumNow https://t.co/YMMC4XIX9m

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
A systematic review by Dr. SRamiro et al evaluated efficacy of b/tsDMARDs on peripheral axSpA Majority on bDMARDs (TNFi, n=24; IL-17, n=13) Most of the SMDs were small --> b/tsDMARDs showed small to moderate effects on peripheral arthritis & enthesitis. #ACR25 @RheumNow Abs0588 https://t.co/yGXcqhZ1Uv

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sheila RHEUMarampa ( View Tweet)
ASAS recommends standardised reporting for 20 key outcomes in axSpA trials, 10 for all studies, 10 specific to DMARD trials. Formats include mean (±SD), mean change, and categorical thresholds for ASDAS, ASAS-HI, and extra-musculoskeletal manifestations. 85% of ASAS members https://t.co/VQwPaTRIOl

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Accdg to this retro analysis of their prospective cohort study from Toronto, 47 pts (10%) had D2M axSpA of whom 14 had tx-refractory dse. D2M pts - longer symptom duration; ⬆️ASDAS, BASDAI, BASMI, BASFI & ⬆️CRP 💡Consider non-dse factors in D2M pts #ACR25 @RheumNow Abs0547 https://t.co/MUUyyELbw8

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sheila RHEUMarampa ( View Tweet)

Singla et al. In secukinumab phase 3 trials, fungal (inc candida) infections uncommon. 5.51 for sec vs 3.39 for PBO per 100PY. @RheumNow #ACR25 Abstr#585 https://t.co/g78zUsxD5a

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Richard Conway RichardPAConway ( View Tweet)
Damen et al. 10-year follow-up of CRESPA study. Treatment withdrawl trial in early peripheral SpA. 38% in drug free remission. 82% in remission. @RheumNow #ACR25 Abstr#568 https://t.co/KOVW5pSbJg

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Richard Conway RichardPAConway ( View Tweet)
DESIR cohort of early axSpA: ✳️Factors assoc w/ D2M axSpA - female sex, ⬆️ASDAS-CRP ⬆️BASFI ⬆️ASQOL at baseline. ✳️ Low prevalence of pts meeting D2M definition (15 pts - 8.4% bDMARD-treated) #ACR25 @RheumNow Abs0544 https://t.co/fBUh3myKcz

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sheila RHEUMarampa ( View Tweet)
Ramiro et al. No significant differences seen between men and women in response to upadacitinib in AxSpA at week 14 or 52. Differs from data on TNFi/IL17i in this regard. Looks to me like men respond a bit quicker and better though... @RheumNow #ACR25 Abstr#589 https://t.co/2m7mrgcG0z

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Richard Conway RichardPAConway ( View Tweet)
In a nationally representative NHANES sample, inflammatory back pain (IBP) was not associated with HLA-B27 positivity or elevated CRP, regardless of IBP criteria used (e.g., Berlin 8a: OR 0.88, p=0.876). IBP alone may be insufficient for identifying axSpA-related immunogenetic or https://t.co/82NjVU171z

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
AI-enhanced MRI integrating STIR and T1-weighted MRI with BME data reflecting both inflammatory and structural changes, enabling the AI model to predict clinical diagnoses of axSpA with accuracy of 82%. Successfully identified axSpA patients who did not meet the ASAS criteria for https://t.co/dLlGj0ZFpj

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
5–10% of axSpA [ts jave comorbid IBD. Southern Swedish study 152 (r- & nr-) axSpA pts found elevated fecal calprotectin (≥ 50 mg/kg) & this was assoc. w/ more damage w/ higher mSASSS values for all axSpA (adj OR 2.2) & in r-axSpA (adj OR 2.9) https://t.co/Hi1lE4so1r https://t.co/YYCGYYasfL

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Dr. John Cush RheumNow ( View Tweet)
From the plenary to posters, RheumNow is your companion for ACR Convergence 2025. Expect: • KOL videos • Clinical trial highlights • Daily faculty recaps • Live streaming #ACR25 #Rheumatology #ClinicalTrials https://t.co/zZAwYINmC2
Dr. John Cush RheumNow ( View Tweet)
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