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GRAPPA vs. EULAR on Complex/Difficult-to-Manage Psoriatic Arthritis

Nelly Ziade

The “Difficult” framework has now reached PsA. At EULAR 2025, two independent definitions were presented: one by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and another by EULAR. This short review explores the similarities and differences between these definitions and discusses their potential implications for clinical practice and research, especially for the increasingly perplexed rheumatologist.

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Trends and Innovations from Barcelona (6.20.2025)

Jack Cush, MD

Dr. Jack Cush reviews highlights, trends and novel studies from EULAR 2025 in Barcelona from last week.

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Predicting Psoriatic Arthritis in Psoriasis: How Close Are We?

Nelly Ziade

Psoriatic arthritis (PsA) affects approximately 30% of patients with psoriasis (PsO), and diagnostic delays are associated with worse prognosis, making early detection crucial. At EULAR 2025, several studies highlighted progress in prediction strategies. Here's my review of three of them.

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EULAR 2025 – Day 4 Report

Jack Cush, MD

Saturday was the final day of EULAR, and included several lectures, but mostly late breaking abstracts and new EULAR guidelines - notably on Rheumatoid Arthritis and another on Interstitial Lung disease in connective tissue disorders. My favorite presentations included the following.

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Methotrexate and Leflunomide combination in RA/PsA: Is it safe?

Aurelie Najm, MD, PhD

I asked the EULAR twitter sphere how they feel about combination of methotrexate (MTX) and leflunomide (LEF). The opinions are differing so far, with 50% reporting prescribing this combination often while 50% are worried of side effects. Several abstracts presented this year are providing further data to help us make up our minds in RA and PsA.

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Secukinumab & Uveitis = Unclear? Post hoc study of 11 SEC RCTs finds lower uveitis risk in AxSpA (N 1980; SEC 150 1.29/100PYs vs 1.72/100PY in PBO), but not in PsA (N 2453; SEC 300 0.71/100PY vs  zero w/ placebo) https://t.co/Gv9HheBU7l https://t.co/SlnrLRwmmn

Links:

Dr. John Cush RheumNow ( View Tweet)
Predicting Psoriatic Arthritis in Psoriasis: How Close Are We? Psoriatic arthritis (PsA) affects approximately 30% of patients with psoriasis (PsO), and diagnostic delays are associated with worse prognosis, making early detection crucial. At EULAR 2025, several studies https://t.co/RLz1FoQxvc
Dr. John Cush RheumNow ( View Tweet)
Expanding the IL-17 Therapeutic Landscape IL-17 inhibitors are an effective therapeutic for a broad spectrum of inflammatory and autoimmune diseases and its blockade has revolutionized management of diseases such as psoriasis, psoriatic arthritis and SpA. https://t.co/Q7Thp1HJAL
Dr. John Cush RheumNow ( View Tweet)
Putting IL17i into ‘focus’ for SpA-associated uveitis The longest studied drug for uveitis in SpA has been monocolonal TNFi Abs. Reductions of acute anterior uveitis have been found with etanercept but less impressively than adalimumab, infliximab, and in my opinion less than https://t.co/AUEct0FxmU
Dr. John Cush RheumNow ( View Tweet)
Psoriatic Arthritis: Hit hard and Early Two studies found no significant benefit of early biologics over standard methotrexate treatment, but they did not focus on poor prognosis cases. The SPEED trial, funded by the NIHR, aimed to compare disease activity in 192 PsA patients https://t.co/pS9DdOOVCV
Dr. John Cush RheumNow ( View Tweet)
Deucravacitinib's Place in the PsA Treatment Algorithm? Dr. Eric Ruderman offers his perspective on where deucravacitinib will fit in the treatment algorithm and trials presented at the EULAR 2025 meeting in Barcelona, Spain. https://t.co/6Ozrvr5IMt https://t.co/w7FJs4wir9

Links:

Dr. John Cush RheumNow ( View Tweet)
Vector borne diseases that result in arthritis will rise with climate change/ flooding risk - Chikungunya - Dengue - Zika - West-Nile Virus @RheumNow #EULAR2025 @bella_mehta https://t.co/CCOYqTjaXE
Dr. John Cush RheumNow ( View Tweet)
From Domains to Decisions: Personalizing PsA Care with Data At EULAR 2025, Dr. Laura Coates (Oxford) took the plenary stage to reframe how we think about treating psoriatic arthritis. The message was clear: in 2025, PsA treatment is no longer about following a linear algorithm; https://t.co/tzgE7U4eSj
Dr. John Cush RheumNow ( View Tweet)
Imaging and Early Detection in Psoriatic Arthritis At EULAR 2025, there have been new developments in imaging in PsA. Two key poster presentations (POS0104 and OP0179) provide important insights into the role of imaging in the management and early detection of psoriatic https://t.co/41fgXj5WnN
Dr. John Cush RheumNow ( View Tweet)
Using Combination csDMARDs in PsA Dr. Eric Ruderman shares his insights on abstracts OP0093, OP0106, and POS0106, which discuss the effectiveness of combination csDMARD therapy, long-term outcomes of methotrexate and leflunomide, and a real-world treat-to-target strategy in https://t.co/Pv4YEyYShm
Dr. John Cush RheumNow ( View Tweet)
Seronegative Arthritis Breakthroughs Dr. Janet Pope discusses abstracts POS0015, "Zasocitinib (TAK-279) exhibits high levels of TYK2 inhibition and no inhibition of JAK 1/3 when compared with licensed TYK2 and JAK inhibitors" and POS0016, "Characterization of ORKA-002, a Novel https://t.co/7nmOWw11lb
Dr. John Cush RheumNow ( View Tweet)
EULAR 2025 – Day 2 Report Day 2 was a full agenda for those attending EULAR 2025 in Barcelona with sessions on the management of RA, Behcets, Lupus and Hand Osteoarthritis. Clinical overviews on MAS, Ehlers-Danlos, Difficult to treat RA and PsA offered a wide variety of options https://t.co/rys0pA6D6j
Dr. John Cush RheumNow ( View Tweet)
Sonelokimab in PsA Dr. Adela Castro reports on OP0096, 'Impact of sonelokimab, a novel IL-17A- and IL-17F-inhibiting Nanobody, on multidomain clinical outcomes in active psoriatic arthritis: results from the randomized, double-blind, placebo-controlled Phase 2 ARGO trial,' https://t.co/KmV6Rx4uFT
Dr. John Cush RheumNow ( View Tweet)
Psoriatic Arthritis: Hit hard and Early Two studies found no significant benefit of early biologics over standard methotrexate treatment, but they did not focus on poor prognosis cases. The SPEED trial, funded by the NIHR, aimed to compare disease activity in 192 PsA patients https://t.co/Vte0RSyszN
Dr. John Cush RheumNow ( View Tweet)
Combination treatments in Psoriatic Arthritis Psoriatic arthritis (PsA) is a complex inflammatory arthritis with multiple domains and associated comorbidities. Despite the advances in the treatment of PsA with biologic (bDMARD) and targeted synthetic (tsDMARD), less than half https://t.co/rSkoE236hR
Dr. John Cush RheumNow ( View Tweet)
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