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APLAR 2025: What’s New in RA Management?

d Aurelie Najm, MD, PhD

The unveiling of the updated 2025 recommendations for RA treatment, presented by Josef Smolen in the plenary session on the first day of the conference, sparked attention. Although not yet formally published, these updated recommendations represent a refined consensus that simplifies decision-making while reinforcing the importance of treat-to-target principles in RA.

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Addressing Disparities and Unequal Burdens in ILD

d Deji Adegunsoye, MD, PhD, FACP, FCCP

Interstitial lung diseases (ILDs) represent a complex spectrum of conditions that share one  unifying truth: they are almost always serious, progressive, and life-altering. But for many patients,  the burden of disease does not fall evenly. We are increasingly learning that where you live, who  you are, and the resources available to you, can strongly influence how ILD develops and  worsens. Understanding these disparities is not about pointing fingers. Rather, it is about uncovering opportunities to deliver better, fairer care.

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Multimorbidity predicts flares in rheumatoid arthritis

d Jack Cush, MD

A study from Olmstead county and the Mayo Clinic shows that multimorbidity  and social factors predict higher rheumatoid arthritis (RA) flares and lower remission rates.

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September to Remember (9.5.2025)

d Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from RheumNow. This week - unemployment, diagnosing Sjogren's and a lot of ILD.

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Study of 607 systemic sclerosis (SSc) pts finds Pulm arterial HTN (PAH) in 77 (12.7%). While early immunosuppression didnt reduce odds of PAH (OR 0.74, p=0.495), early mycophenolate was protective(OR 0.12; p=0.048). Only HCQ use signif. improved survival (HR 0.04; p= 0.004). https://t.co/DbsJVZ16Zd
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Lung Cancer in Rheumatoid Arthritis and Interstitial Lung Disease A matched cohort study from the Veterans Health Administration shows that RA patients have a >50% increased risk of lung cancer, a 3-fold higher risk of lung cancer in RA-ILD. https://t.co/Gjn2M2CNAO https://t.co/DPgDQsCWK9

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Combined Therapy in Rheumatoid Arthritis Interstitial Lung Disease RA-ILD is a major therapeutic evidence gap in treatment, affecting 8% of patients. It was often under-diagnosed, leading to more severe cases and inflated mortality rates. Despite advancements, RA-ILD, https://t.co/sSzMvDUMf5
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Retrospective Korean study of #RA & ILD pts (n 151) - ILD duration & UIP pattern significantly affected prognosis. 62% were non-smokers, DAS28=4.9, UIP in 60%. @4 years, ILD progressed in 58%; mortality=21%. MTX did not affect progression or mortality. https://t.co/1XNcWsAuea https://t.co/QLod6uj2Dj

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Elevated serum levels of interleukin-18 discriminate Still's disease from other autoinflammatory conditions. Sera from 53 mSAID, 220 guSAID, 49 controls show IL-18 signif increased in Still's Dz; free IL-18 levels were selectively higher in Still's disease. https://t.co/8IWXWZmWgE
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🌐 ILD Treatment Guidelines – LIVE Webinar 📅 Sept 9 | ⏰ 7PM EST An expert panel reviews ACR & EULAR guidance and looks ahead at emerging therapies. Speakers: Drs. Sindhu Johnson, Anna-Maria Hoffmann-Vold, Scott Matson & Jack Cush, Moderator https://t.co/2F3sOjqHtr #ILD https://t.co/KaVL1pUdCh

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Anti-MDA5 DM is assoc w/ rapidly progr ILD & mortality risk. 26 MD5+ DM pts (age 56.6 yrs; 7/26 male) Sxs: Gottrón’s (81%), ILD (73%), periungual erythema (69%), heliotrope (61%), V-sign (42%), arthritis (42%), weakness (38%), mechanic’s (35%), Raynaud’s (19%). 7/19 RP-ILD died https://t.co/WFwavo32rB
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Crepitus Does Not Predict Earlier/Worse OA Young adults who experience grinding or clicking sounds in their knees post-surgery may be alarmed, but new research from La Trobe University suggests these sounds may not signal early-onset osteoarthritis. https://t.co/bu8dgzcqdv https://t.co/CnSjv6cor9

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QD Clinic: Be Careful What You Look For Dr. Bryant England, University of Nebraska, presents this QD Clinic, as part of RheumNow's Rheum to Breathe: ILD campaign, presented throughout the month of September 2025. https://t.co/avxw86CGqu https://t.co/5SH3p05Rlf

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Higher Medical Costs with Corticosteroid Use Rheumatoid arthritis (RA) health insurance claims database study from Japan shows that RA patients initially treated with glucocorticoids (GCs) and disease-modifying antirheumatic drugs (DMARDs) experienced greater medical costs and https://t.co/ETWX9yH11w
Dr. John Cush RheumNow ( View Tweet)
This week’s Grand Rounds featured Dr. John Cush, Executive Editor @RheumNow, with an outstanding talk on “Seronegative vs Seropositive RA,” spotlighting differences in disease course, alternative etiologies & treatment response.

HSS Physician-in-Chief HSS_PIC ( View Tweet)

Turkish study of Childhood-onset arthritis (n 1713; age 6.8 yrs). Most Dx: JIA 50% (most oligo), FMF 16% (recurrent oligo), vasculitis 14% (most IgA vasculitis; 94% oligo), reactive arthritis 9% (monarthritis) & acute rheumatic fever 5% (polyarticular& migratory), SLE 5% (oligo https://t.co/HkiPT0hsr7
Dr. John Cush RheumNow ( View Tweet)
EULAR & European Respiratory Society have published clinical practice guidelines for ILD assoc w/ connective tissue diseases (SSc, RA, SjD, IIM, SLE, MCTD). 2 publications included Dz specific ILD management algorithms; use of Hi Res CT over Lung Bx; ILD risk factors

Dr. John Cush RheumNow ( View Tweet)

Long term outcomes of secukinumab in Children & Adolescents w/ Psoriasis (n=84). 80% completed 4 yrs of Rx w/ either low dose [N 31] & high dose [N 36]) with sustained PASI 75/90/100 results at week 208 [SEC LD: 96%/89%/52%; SEC HD: 88%/82%/73%]. No deaths; No dose-dependent https://t.co/y059SJTxP1
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A case–time-control study of French National Health Insurance database w/ 34 241pts Rx w/ IL-17(R)A inhibitor (2016-2021) (for PsO, PsA, AS, JIA) found no significant association betw IL-17(R)A inhibitors & MACEs over 6 months compared to TNFi Rx pts. https://t.co/fJuPFYKnSr https://t.co/Vscnsq0DTA

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Prospective study of 171 suspected Sjogrens (130 dx w/ SjD) pts compared Dx accuracy - Labial gland Bx best Dx efficacy (AUC 0.90), followed Ro/SSA (AUC 0.79), Omeract score (AUC 0.78). Salv gland US grade 3 strongly predicted +Bx (AUC 0.77) & correlated w/ salivary flow ~-0.5

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