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PAH diagnosis and management in the context of CTD ILD

Aurelie Najm, MD, PhD

Pulmonary arterial hypertension (PAH) is a serious complication of connective tissue disorders. Approximately 25% of patients with PAH have an underlying CTD, making CTD-PAH the second most common cause of PAH. During the session on Management of Lung Complications in CTD at APLAR 2025, Prof. Dinesh Khanna and Masataka Kuwana provided an excellent overview of PAH diagnosis and management strategies the context of CTD-ILD.

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ERS/EULAR guidelines for CTD-related interstitial lung disease

Jack Cush, MD

The European Respiratory Society (ERS) and European Alliance of Associations for Rheumatology (EULAR) have published clinical practice guidelines for the evaluation and management of connective tissue diseases (CTD) associated interstitial lung disease (ILD) in two simultaneous publications in the European Respiratory Journal and Annals of Rheumatic Diseases.

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COLCHICORT Trial

Jack Cush, MD

The COLCHICORT trial in acute calcium pyrophosphate (CPP) crystal arthritis patients showed that colchicine was inferior to prednisone treatment and that responses were also influenced by other factors.

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Addressing Disparities and Unequal Burdens in ILD

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

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)

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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Prof. Eric Morand on the SLE T2T approach. Ultimate goal is remission but we know that not all patients achieve this state. Thru the T2T approach, low dse activity (LLDAS) is an acceptable target & a protective alternative goal @RheumNow #APLAR25 #Lupus https://t.co/vz7E5prps0

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sheila RHEUMarampa ( View Tweet)
Optimizing outcomes of pregnancy in #lupus: 📌 all patients should undergo preconception counselling 📌 close monitoring by a multidisciplinary team - a ⬇️ cerebroplacental ratio reflects placental dysfunction #APLAR25 @RheumNow @rheumarhyme https://t.co/RSyqgpRTG5

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sheila RHEUMarampa ( View Tweet)
@Lupusreference reviews clinical trials in LES, highlights key limitations of current outcome measures and propose a novel a clinical outcome in SLE based on « How patients feel function and survive Â» Very relevant to the human experience of having a chronic illness @RheumNow https://t.co/vM58C9KfQ3

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Aurelie Najm AurelieRheumo ( View Tweet)
Metanalysis of 7 studies (1979-2023) shows RA pts on vegetarian or vegan diets achieved no improvement in disease activity or physical function, but did have a small significant improvement in pain. Insufficient Data on Fatigue. Overall, low certainty https://t.co/jeh6gN5Byg
Dr. John Cush RheumNow ( View Tweet)
Multimorbidity predicts flares in rheumatoid arthritis 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. https://t.co/yGrvDttcEq https://t.co/45LMtvsFor

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Dr. John Cush RheumNow ( View Tweet)
Is it D2T RA or Clinical inertia? Concept introduced by Dr Kaneko, Japanese Keio RA cohort, followed for 5yrs 5% patients not fitting the D2T RA definition have MDA or HDA The drivers of persistent DA in RA: -overestimation of treatment effectiveness -avoidance of treatment https://t.co/0pkDaUFH4R

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Aurelie Najm AurelieRheumo ( View Tweet)
Peter Taylor on Pre-RA: If Pre-RA is too late for interception, shall we start screening general population? We have to remember RA is a RARE disease Pre-test of RA per year per person would be 0.00025% for primary prevention: A needle in a haystack? @RheumNow @APLAR_org https://t.co/LKGtz1P7sl

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Aurelie Najm AurelieRheumo ( View Tweet)

Peter Taylor describing the range of potential benefits of Interception strategies in Pre-RA: A) From Ideal: full interception B) To Good outcome: stratified intervention based on high risk population for delay/interception C) To ?Beneficial: attenuate severity of established RA https://t.co/6mqA9tV7ME

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Aurelie Najm AurelieRheumo ( View Tweet)
Can we prevent #rheumatoidarthritis? Dr. Gravallese shares this interesting slide that summarizes the different disease prevention trials in RA…..they have managed to delay disease onset but prevention is still in question. @RheumNow #APLAR25 @rheumarhyme @marklagacmd https://t.co/qhGYnNL5Ek

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sheila RHEUMarampa ( View Tweet)
Dr. Josef Smolen discusses 2025 EULAR updates for RA. He highlighted the importance of OP A - that tx should be a shared decision making between px and rheuma in order to ensure better care and disease control. @RheumNow #aplar25 #APLAR25 https://t.co/KOJbiK87TS

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sheila RHEUMarampa ( View Tweet)
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
Dr. John Cush RheumNow ( View Tweet)
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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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
Dr. John Cush RheumNow ( View Tweet)
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

Dr. John Cush RheumNow ( View Tweet)

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