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From Fitbit to first diagnosis: AI is rewriting the RA playbook

Mrinalini Dey, MD

Artificial intelligence isn’t a distant frontier anymore. It’s here, and it appears able to detect signs of rheumatoid arthritis, possibly before we can clinically detect it. Two studies presented at this year’s ACR meeting highlight just how close we may be to a future where algorithms flag disease before we can and monitor activity with minimal patient burden.

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New pieces added to the Pre-RA puzzle

Aurelie Najm, MD, PhD

We know that pre-RA is a definition that stands under a large umbrella, ranging from asymptomatic individuals with ACPA positivity to individuals with symptomatic pre-clinical synovitis. How can we predict the transition from the at-risk state to clinical RA outside the realm of clinical, conventional serological (RF/anti-CCP) or imaging (US/MRI synovitis) biomarkers?

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Bad Actor Cofactor (10.17.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports, discusses pediatric reports, pregnancy data, diet and nutrition and more.

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#0191 We found that in a large South London RA cohort, use of advanced therapy in moderate disease (DAS28 3.2-5.1) generally followed NICE guidance. Gaps often reflected telehealth limiting DAS assessment and patient hesitancy. Self-assessment tools may help. @RheumNow #ACR25 https://t.co/UMGtkfABHn

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Mrinalini Dey DrMiniDey ( View Tweet)

Albach et al. CAR T-cells in D2T RA. 6 patients. Safety looks ok. ACR20 in 4/6, ACR50 in 2/6. ACPA and RF disappeared. Results maybe not as positive as we might have anticipated? @RheumNow #ACR25 Abstr#471 https://t.co/TaEVWiWsNm

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Richard Conway RichardPAConway ( View Tweet)
tRNA-derived RNA (tDR-1), circulating microbial RNA Associated w/ reduction in risk of RA conversion in asymptomatic CCP+ individuals (60 vs. 120+ ctrls), ‼️ tDR-1 alone over performs prediction model w/ smoking shared episode and RF w/ AUC 0.86 What is the mechanism? tDR-1 https://t.co/fuyk4NeOyA

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Aurelie Najm AurelieRheumo ( View Tweet)
Ribeiro et al. Case series of combination bDMARD/tsDMARD in PsA from Toronto. 24 patients, median just over a year follow-up. Appear effective, especially for objective skin and joint measures. No major safety concerns but short follow-up to date. @RheumNow #ACR25 Abstr#565 https://t.co/Zk3odT2EX2

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Richard Conway RichardPAConway ( View Tweet)
#0775 Higher circulating microbial small RNA tDR-1 linked to lower risk of developing RA in CCP3+ individuals (AUC 0.86). tDR-1 downregulates interferon-response genes in vitro, suggesting microbiome-mediated anti-inflammatory mechanism in RA pathogenesis. @RheumNow #ACR25

Mrinalini Dey DrMiniDey ( View Tweet)

SLE & arthritis: Is there a difference? Abstract #0629: - Non-deforming (ND): 73% | Jaccoud’s: 19% | Rhupus: 8% - Vs ND, Rhupus had lower odds of type I IFN signature - Time to deformities: Jaccoud's ~2 yrs vs Rhupus ~5 yrs - RNP+ predictive of Jaccoud’s @RheumNow #ACR25

Akhil Sood MD, MS AkhilSoodMD ( View Tweet)

Why do some clinics excel at RA disease activity tracking while others struggle? In the VA, success came down to structure: RA-specific clinics, templates, and staff. Barriers? Time, missing labs, and workflow gaps. @RheumNow #ACR25 Abstract#0222

Jiha Lee JihaRheum ( View Tweet)

What can we learn from longitudinal peripheral blood multi-omic profiling in at-risk individuals? 50 RA converters vs. non converters from StopRA study Decision tree showing highest risk for conversion to clinical RA in Individuals w/ -CCP3 ≥108 units -T peripheral helpers https://t.co/jw53EB6tI6

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Aurelie Najm AurelieRheumo ( View Tweet)
#0774 Multi-omic profiling of anti-CCP3+ “at-risk” individuals reveals Tph & cytotoxic CD8+ expansions, altered gene/chromatin profiles and predictive model (AUC 0.77) for RA conversion PTPN22 locus accessibility & Tph ≥ 2.45% identify highest risk. @RheumNow #ACR25 https://t.co/JDSMkdmoGv

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Mrinalini Dey DrMiniDey ( View Tweet)
What's new in the Pre-RA world? Slowly unraveling mechanisms and biology associated to transition from CCP+ asymptomatic pre-RA state to clinical RA Here is my summary of a few abstracts presented at #ACR25 proposing biomarkers beyond the realm of clinical and classical

Aurelie Najm AurelieRheumo ( View Tweet)

6-week intensive smoking cessation prg studied in 94 RA daily smokers in remission or low Dz activity (DAS28-CRP=2.9). At 3 mos the intervention group had higher cessation rates; but had no effect on EULAR responses, TJC, or CRP (result actually favoured the controls) https://t.co/HPJYeyPCPQ
Dr. John Cush RheumNow ( View Tweet)
Phase 3b/4 head-to-head SELECT-SWITCH study tested Humira vs Rinvoq in 492 RA MTX pts failing a TNFi then Rx w/ ADA vs UPA x12 wks. UPA > ADA w/ DAS28-CRP < 3.2 (43% vs 22%; p<0.001) and also for DAS28-CRP < 2.6 (28% vs 14%). No new safety signals seen.https://t.co/EAJ9GglMjv https://t.co/uHTsdTPpWP

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Dr. John Cush RheumNow ( View Tweet)
Study from Czech ATTRA registry of 8,543 RA pts 641 (7.5%) met criteria for D2T-RA & 1,825 achieved remission (21%). D2T-RA predicted by machine learning models (accuracy 0.606–0.747, AUC 0.656–0.832). Predictors included CDAI, DAS28-ESR, TJC, HAQ, CRP, steroids https://t.co/PqgKzKhM6h
Dr. John Cush RheumNow ( View Tweet)
30% of RA pts have non-alcoholic fatty liver disease (NAFLD). In 170 pts on MTX or biologics (TNFi, IL-6i)- NAFLD was found in 36%. MTX & biologics were not linked to NAFLD or fibrosis -- BUT was signif assoc w/ metabolic syndr, BMI, Waist, ALT, and AST (all p < .001) https://t.co/MpkxjHEbxK
Dr. John Cush RheumNow ( View Tweet)
SAIL-RA: Finding ILD in Early RA Cohort study of early rheumatoid arthritis (RA) patients finds that interstitial lung disease (ILD) begins early in the course of RA, with certain factors enhancing this risk. https://t.co/nI0YuYd3YS https://t.co/YR3Gg1kr59

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Dr. John Cush RheumNow ( View Tweet)
Retrospective study of 423 seropositiv RA pts (SPRA) finds 21% with baseline ILD; over 10 yrs 31% had ILD. High monocyte counts signif higher in RA-ILD; whereas RF, CCP did not predict. Age & ILD predicted mortality - not monocytes, RF or CCP https://t.co/8H4wqZI3WQ https://t.co/dK9iHwj3cz

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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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