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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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ILD.colors

SAIL-RA: Finding ILD in Early RA

Jack Cush, MD

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.

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pregnant, pregnancy, mother, fertility

Pregnancy Management in Inflammatory Bowel Disease: A Global Consensus

Jack Cush, MD

Consensus guidance on the management of pregnancy in patients with inflammatory bowel disease (IBD) was simultaneously published in six international journals, including The American Journal of Gastroenterology.

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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

Links:

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)
Muscle mass & JAKi? 15 active RA pts (+ sarcopenia risk) Rx w/ tofacitinib - signif. improved @1 mo. @6 mos muscle mass signif improved (+242 cm3, +4%, p=0·017) {less w/ NSAIDs); w/ signif creatinine incr (0.06 mg/dl) & decr in serum IL-6, IL-1 & TNF. No change in CK, myoglobin, https://t.co/taY7DisMOS
Dr. John Cush RheumNow ( View Tweet)
Rheumatic and musculoskeletal disorders in musicians: Famous musicians/performers with Rheumatic dz and the most common disorders reviewed. https://t.co/FitQpg4KvC https://t.co/ch8V2WGJXm

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Dr. John Cush RheumNow ( View Tweet)
Single center study of pregnancy outcomes in 189 women (131 RA, 29 SpA, 29 PsA). Stats for RA/SpA/PsA -- Live births 76%/90%/69%; Preterm 16%/12%/7%; IUGR 31 RA, none in SpA/PsA.. C-Sections ~1/3. TNFi used in 12% RA, but higher in SpA (48%) & PsA (31%) https://t.co/wVWOlRR0c0 https://t.co/sChkDJMrUs

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Dr. John Cush RheumNow ( View Tweet)
Activity Trackers Can Predict RA Flares People with rheumatoid arthritis (RA) who experienced disease flares often showed changes in heart rate and physical activity captured by popular wearable devices 4 weeks before they became clinically apparent, a small study indicated. https://t.co/LjE0LkJTrB
Dr. John Cush RheumNow ( View Tweet)
Gender Complexities in Psoriatic Arthritis Treatment Outcomes Analysis of a German psoriatic arthritis (PsA) patients registry demonstrates sex-specific differences regarding clinical manifestation and treatment outcomes, especially with regard to drug discontinuations. https://t.co/zGtfpndod9
Dr. John Cush RheumNow ( View Tweet)
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