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Late-Onset Disease: Different Age, Different Rules?
We’re seeing more patients develop rheumatic diseases for the first time in their 60s, 70s, or beyond. But are these truly the same diseases we see in younger adults, or do they behave differently, shaped by age-related biology, comorbidity, and the biases that influence medical decision-making? Several abstracts presented at EULAR 2025 challenge us to reconsider how we diagnose and treat rheumatic disease in older adults.
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MTX Fails Knee OA (6.6.2025)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com
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Psoriatic Arthritis at Risk for Interstitial Lung Disease
A TriNetX EHR study shows that psoriatic arthritis, but not psoriasis, patients are at increased risk for interstitial lung disease (ILD).
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Should You Add MTX to a TNF Inhibitor in Psoriasis?
Target emulation trial shows adding methotrexate (MTX) to adalimumab (ADA) does not augment the effectiveness and persistence of adalimumab alone in treating plaque psoriasis in adults.
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📊 POS0574 @rheumnow #EULAR2025 Real-world data from SERENA shows sustained 5-year effectiveness of secukinumab in PsA. ✔️ 57% had no tender/swollen joints at Year 5 ✔️ PASI90 in ~48% ✔️ Stable low TJC, SJC & PtGA Durability confirmed even in prior biologic users. https://t.co/eNpboTRRu3
Jiha Lee JihaRheum ( View Tweet)
MONITOR-PsA (n=218):
•36.5% had >1 csDMARD
•Of those, 49.2% tried combination (combo) csDMARDs
•63.6% of combo csDMARD users in MDA at 48wks
•61.1% stopped due to side effects—not inefficacy
Real-world support for csDMARD combos where biologics delayed. Abstract#OP0093 https://t.co/3Anme39VXk
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Early PsA? Treat fast, treat hard.
The STAMP RCT showed that early secukinumab + MTX led to faster ACR50 and PASI90 responses vs standard care in a T2T strategy. By 12 months, outcomes were similar, but early SEC needed fewer escalations.
Abstract#OP0092
@RheumNow #EULAR2025 https://t.co/cAZTc9eN16
Jiha Lee JihaRheum ( View Tweet)
Combination therapies in PsA not so far away:
-Case series of 22 patients from large PsA cohort.
-Combination therapy in PsA used when difficult to treat skin and msk involvement.
-Deucravacitinib was the agent mostly used in combination with bDMARDs.
-No major serious adverse https://t.co/YUyvuaJcsE
Links:
Adela Castro AdelaCastro222 ( View Tweet)
Case series of 22 PsA pts treats w/ combination bioDMARDs & JAKi,TYK2i or APR
IL17i + JAKi 10.5 PY = 1 mild infectious stomatitis
IL23i + JAKi 3.7 PY = no AE
IL-17i + TYK2i 8.5 PY = 2 mild upper respiratory infections
IL-23i + TYK2i 8.3 PY = 2 mild URIs, 1 folliculitis
TNFi + https://t.co/Qg9HIwuslJ
Aurelie Najm AurelieRheumo ( View Tweet)
Can IL-17F signalling be modulated by treatment with TNFi?
In PsA pts non responders to previous TNFi, there was increased expression of IL17F-related gene signature. Suggesting a potential mechanism for the consistent level of clinical response observed with BKZ.
Abstract https://t.co/D6fvp18UTz
Links:
Adela Castro AdelaCastro222 ( View Tweet)
In #InflammatoryArthritis, baseline depression was linked to ↑ presenteeism & ↓ QoL at baseline + 3mo, but not absenteeism. Data from 9-country study provide further evidence that mental health is key to supporting work outcomes in RA, PsA & axSpA.
@RheumNow #EULAR2025 #OP0028
Mrinalini Dey DrMiniDey ( View Tweet)
Early intensive therapy in PsA.
STAMP RCT in early PsA:
•ACR50 at 3mo: 43% (early secukinumab) vs 22% (SoC)
•MDA at 3mo: 48% vs 25%
•PASI90 at 3mo: 60% vs 22%
By 12months: outcomes similar, but early secukinumab led to faster control and fewer therapy escalations. https://t.co/TKa5z24NQX
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Should we start strong in PsA?
In the SPEED RCT (Coates et al), both early TNFi and combo csDMARDs outperformed step-up care in moderate-severe PsA. TNFi showed the most sustained benefit through 48w.
Abstract#OP0089
@RheumNow #EULAR2025
Jiha Lee JihaRheum ( View Tweet)
UK Natl Early Inflammatory Arthritis Audit (5/18-11/19) compared 2120 PsA & RA (1:1). PsA had longer Sx to referral wait (112 v 89 days; HR 0.87), longer delay in Dx (HR 0.8), PsA less DMARD use at baseline (54% v 69%) & higher DAS28 results at 3 mos (+0.27) https://t.co/zyubhGxw47
Dr. John Cush RheumNow ( View Tweet)
Target trial emulation study data from British Dermatologists Biologics & Immunomodulators Register, compared 231 PSO Rx w/ MTX + Adalimumab against 1553 PSO on ADA. @1Yr MTX did not augment ADA only responses based on Rx survival (79% vs 78%) or PASI75 (49% vs 52%). https://t.co/Lrpuhfarsb
Dr. John Cush RheumNow ( View Tweet)
Psoriatic Arthritis at Risk for Interstitial Lung Disease
A TriNetX EHR study shows that psoriatic arthritis (PsA), but not Psoriasis (PsO), patients are at increased risk for interstitial lung disease (ILD).
https://t.co/2zuxF1PY3Q. https://t.co/r28dY3T8nO
Dr. John Cush RheumNow ( View Tweet)
Swiss Registry study of PsA outcomes when started on either TNFi (N 503) or IL-17i (n 341), latter w/ more severe PSO. IL-17i durability superior to TNFi (median 828 vs 445 d, P<.001), w/ less D/C in women (HR 0.57); but ACR 20 (14 v 33%) & ACR50 (7 v 24%) favored TNFi use https://t.co/R33bwSeB3E
Dr. John Cush RheumNow ( View Tweet)
UK Natl Early Inflammatory Arthritis Audit (5/18-11/19) compared 2120 PsA & RA (1:1). PsA had longer Sx to referral wait (112 v 89 days; HR 0.87), longer delay in Dx (HR 0.8), PsA less DMARD use at baseline (54% v 69%) & higher DAS28 results at 3 mos (+0.27) https://t.co/ObssKGcomq
Dr. John Cush RheumNow ( View Tweet)
PPACMAN Consensus Recs. for CV risk in PSO/PSA published for Rheums/Derms/PCPs
- check BP, Wt, Lipids, Cr.
- Look for HTN, DM, smoking, obesity, metabolic synd.
- Risk stratify w/ hsCRP, Lipids
- Lifestyle management https://t.co/MkgYopTNAX https://t.co/fplKbua9Z2
Dr. John Cush RheumNow ( View Tweet)
Target trial emulation study data from British Dermatologists Biologics & Immunomodulators Register, compared 231 PSO Rx w/ MTX + Adalimumab against 1553 PSO on ADA. @1Yr MTX did not augment ADA only responses based on Rx survival (79% vs 78%) or PASI75 (49% vs 52%). https://t.co/DSYNd9P5Om
Dr. John Cush RheumNow ( View Tweet)
