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EULAR 2025 – Day 3 Report
Highlights from today included presentations on imaging in vasculitis, a debate on whether to treat high risk pre-clinical RA, and EULAR Recommendations on a) Treatment of interstitial lung disease (ILD); b) Physical Activity in people with arthritis; and c) EULAR disease activity score for antiphospholipid syndrome and d) the management of SLE nephritis. Below are a few others that caught my eye today.
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Introducing Polyrefractory RA: A New Frontier in Difficult-to-Treat RA
At a EULAR 2025 session titled “What makes ‘Difficult-to-treat RA’ so difficult to treat? And what can we do?”, Drs. Paula David and Dennis McGonagle introduced the emerging concept of polyrefractory rheumatoid arthritis (RA), a term now being used to describe a subset of patients who have failed to respond to five or more biologic or targeted synthetic DMARDs. This new classification, derived from recent multinational registry data, represents a significant step in refining our understanding and management of the most treatment-resistant forms of RA.
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“That is why this task force continues to say: nothing is better than methotrexate and glucocorticoids to start”
- Josef Smolen, on RA treatment
#EULAR2025 @RheumNow https://t.co/AbkgWS8tvH
Links:
David Liew drdavidliew ( View Tweet)
The key changes for the new 2025 EULAR recommendations on RA treatment
#EULAR2025 @RheumNow https://t.co/dp5LnoFdpW
David Liew drdavidliew ( View Tweet)
#EULAR new #RA #recommendations
J Smolen presents justification for
#MTX +#glucocorticoids at onset
do you agree?
Diff from #ACR
#EULAR #Recommendations II
#EULAR2025 @RheumNow https://t.co/wqCX5HA87q
Janet Pope Janetbirdope ( View Tweet)
#EULAR2025 @eular_org update
#Recommendations #Rheumatoid #Rx
prof Smolen
subtle diff between former guidelines
MTX+GC
👇
D/C GCs rapidly
👇
If inadequate response
👇
Other csDMARDs are OUT ❎
✅go to bDMARD or tsDMARD*
TsDMARD after safety assessed
@RheumNow RecommendatnII https://t.co/yUrLdk6Eg1
Janet Pope Janetbirdope ( View Tweet)
Presenteeism and absenteeism in RA aren’t just about joints. In this UK study, comorbid anxiety, depression, and OA drove lost productivity.
Treating RA is not enough —holistic management matters.
POS0403 @RheumNow #EULAR2025
Jiha Lee JihaRheum ( View Tweet)
#RA #recommendations #update
Some recommendations were merged
For sure some regions will consider
#Combination #csDMARDs or
Switch to another
👇🤔
#sulfasalazine
#leflunomide
Depends on access, pt preference, disease activity/severity
#EULAR2025 @RheumNow @eular_org https://t.co/QDPcHhvQiV
Janet Pope Janetbirdope ( View Tweet)
Tapering in RA?
In SORAIRO (n=149), pts in remission on ozoralizumab+MTX:
🧪 49% became MTX-free
⏱ 80% spaced OZR to q8w
CDAI ≤10 maintained in >90% if baseline remission + albumin >3.8
LB0006 @RheumNow #EULAR2025
Jiha Lee JihaRheum ( View Tweet)
#EULAR2025 Abstr#POS1293 Our cohort study support non-medical switch from Rituximab originator to Biosimilar(RTX-B) or btw RTX-Bs in connective tissue disease. No difference in response/B-cell depletion pre- & post-switch.Only 10% stopped RTX at 5-year.Better than in RA @RheumNow https://t.co/ERPgwQ3gZB
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Recommendations for RA management at #EULAR2025
- MTX [or other csDMARDs] and steroids still remain the first line- nothing beats that!
- ofcourse minimize steroids!
- rather than stopping meds at remission, reducing doses may be a better solution.
Not much changed.
@RheumNow https://t.co/NK5ejsgjWV
Bella Mehta bella_mehta ( View Tweet)
In RCT of RA pts in remission/low disease activity, spacing ozoralizumab (next gen TNFi) or reducing MTX led to more flares vs continued tx; but most pts in remission at baseline maintained LDAS.
Remission matters for subsequent Tx reduction.
@RheumNow #EULAR2025 #LB0006
Mrinalini Dey DrMiniDey ( View Tweet)
The relation between RA, comorbidities and presenteism
NRAS survey 891 RA pts
75% had at least one comorbidity
Absenteeism more likely if
One OR = 1.68 or Two OR = 2.26 comorbid conditions
In particular
Anxiety OR = 2.39
Depression OR = 1.75
Osteoarthritis OR = 1.85
Back
Aurelie Najm AurelieRheumo ( View Tweet)
RA is worst with temperature rising/ climate change.
However SpA has the opposite effect!
Climate change session at #EULAR2025 @RheumNow https://t.co/eKVXnfdEzD
Bella Mehta bella_mehta ( View Tweet)
What do we do when we see Rx signed of CPPD in RA pts? Do these pts have different trajectory?
Rx Retro study 388 patients RA
18% at least one sign CPPD
ns diff between seeonegative and seropositive pts
RA+CPPD group was
-older
-higher comorbidity score
-more likely to be https://t.co/DaW5DZoDzF
Aurelie Najm AurelieRheumo ( View Tweet)
Low disease activity more difficult to achieve in vulnerable populations.
All rheumatic diseases - #RA #PsA #AS
initiating DMARDs takes longer in these population
#EULAR2025 @RheumNow https://t.co/voIivshKRt
Bella Mehta bella_mehta ( View Tweet)
👁️Uveitis in axSpA:
-Up to 40% can present before SpA dx
-NMA of 44 RCTs showed tx with TNFi, JAKi and IL-17i protective effects against uveitis
-Low rates of uveitis in axSpA pts on BIME trials suggests its possible beneficial effects.
#EULAR2025
@RheumNow https://t.co/mPuSMnD1Zs
Links:
Adela Castro AdelaCastro222 ( View Tweet)
1/3 of #ERA pts poor
Outcomes despite controlled disease!
2 #RCT with T2T in early #RA
#CARERA
👇
persistent impact
⬆️TJC, comorbidities
⬇️SJC, CRP, global, HAQ,
F>M
⬆️disease durat’n
▶️
⬆️ b/tsDMARDs despite =diseaese vs others
?overRx
OP0330 #EULAR2025 @RheumNow
@eular_org
Janet Pope Janetbirdope ( View Tweet)
KORAIL cohort: new RA-ILD progression model (inc. DLCO, ILD pattern/extent, anti-CCP, ± KL-6) stratified risk with high sensitivity & specificity. Adding KL-6 boosted AUC to 0.75.
A step toward personalised care in RA-ILD.
@RheumNow #EULAR2025 #OP0328 https://t.co/AHqNFw40gk
Mrinalini Dey DrMiniDey ( View Tweet)
E3N cohort 78000+ women >30yrs follow up
698 incident RA cases)
In non smokers, RA asso w/
-tall at birth HR=1.55
In smokers, RA risk associated w/
-prematurity HR=1.63
-in utero exposure to tobacco HR=1.83 (ns)
#EULAR2025 @RheumNow POS0226 https://t.co/xC3k3kiKsZ
Aurelie Najm AurelieRheumo ( View Tweet)
