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The pain that inflammation does not explain in SpA and PsA

Antoni Chan, MD, PhD

Clinicians often come across the scenario of a patient with well-controlled spondyloarthritis where the ASDAS in the low disease activity range, CRP normalised, joints clinically quiet. However, the patient returns to the clinic still reporting significant pain. Their rheumatologist adjusts the biological, waits, returns. The pain persists.

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Beyond the Scale: Do GLP-1RAs Offer More Than Weight Loss in PsA?

Nelly Ziade

Over 70% of patients with PsA struggle with excess weight, amplifying synovio-entheseal inflammation and blunting biologic response. The rapid uptake of GLP-1RAs in rheumatology has raised an urgent mechanistic question: are clinical gains in PsA driven purely by weight reduction, or do these agents carry intrinsic anti-inflammatory properties? EULAR 2026 offered six abstracts that together illuminate, without fully resolving, this question.

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Diet as a DMARD? The Evidence Is Still Hard to Swallow

Aurelie Najm, MD, PhD

Dietary interventions are rarely taken as seriously as pharmacological therapies in rheumatology. Yet patients ask about them constantly, and an increasing number of studies suggest that nutrition may influence disease outcomes. Two randomized controlled trials presented at EULAR 2026 add to this growing literature in PsA and RA. However, before we start prescribing Mediterranean diets, the data deserve a closer look.

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🔬 Does synovial biopsy-guided treatment outperform standard care in PsA? YES - 68% vs 45% DAPSA remission/LDA in 45pts OP071 #EULAR2026 @RheumNow https://t.co/cLCR7I8QAm

Links:

Nelly ZIADE 🍀 Nellziade ( View Tweet)
"the further I look back, the further I can see the future" Dennis McGonagle quoting Winston Churchill to describe his approach to understanding What is New in PsA at #EULAR2026 @eular_org @RheumNow https://t.co/ayInzzb9lO

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Aurelie Najm AurelieRheumo ( View Tweet)
🔍Can early TNFi beat step-up csDMARDs in pSpA? SPARTACUS RCT (n=97) says YES 60% vs 33% remission at 24 wks #EULAR2026 @rheumnow #OP0107 https://t.co/1odtcRdTLQ

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Nelly ZIADE 🍀 Nellziade ( View Tweet)
💉 IXE+TZP beat IXE alone in obese PsA? YES - TOGETHER-PsA RCT 33.5% vs 20.4% ACR50 at week 36 in 271 patients OP069 #EULAR2026 @RheumNow @DrLauraCoates @AlexisOgdie https://t.co/orvAe38alc

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Nelly ZIADE 🍀 Nellziade ( View Tweet)
🥗 Does diet improve PsA? DIPSA RCT: Mediterranean/DASH/Standard all improved DAPSA in 92pts Weight loss drove outcomes OP070 #EULAR2026 @RheumNow https://t.co/k5y7bvDbDQ

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Nelly ZIADE 🍀 Nellziade ( View Tweet)
HLA-Cw6: a marker of more severe and difficult to manage psoriatic arthritis? POS0484 #EULAR2026 @RheumNow https://t.co/MIYZxuYT4v

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Nelly ZIADE 🍀 Nellziade ( View Tweet)
Psoriatic arthritis #PsA sessions raised important topics on intercepting arthritis in psoriasis, treating obesity as a disease target, synovial biopsy to guide treatment, molecular imaging to reveal subclinical disease. More tomorrow. #Rheumatology @RheumNow #EULAR2026

Antoni Chan MD (Prof) synovialjoints ( View Tweet)

Biopsy-guided treatment in PsA: match the drug to the tissue pathotype with 68% in LDA/remission vs 48% standard of care at 6 months. In myeloid CD117+ patients, mean DAPSA reduction at 6 months: IL-17i: −13.5, IL-23i: −12.8, TNFi: −7.5. Synovial biopsy with myeloid CD117+

Antoni Chan MD (Prof) synovialjoints ( View Tweet)

It's unclear whether GLP-1agonists inmpvove PsA from weight loss or other MoA 74 PsA patients on GLP-1RA vs 74 matched controls (BMI + disease activity matched) After adjusting for BMI change PROs still improve cDAPSA (-0.4/mo) DAPSA (-0.6/mo) and pain but not SJC, TJC or CRP https://t.co/dcaU2jwbKJ

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Aurelie Najm AurelieRheumo ( View Tweet)
Guselkumab gets FDA Nod for X-ray Protection The U.S. Food and Drug Administration (FDA) has approved Johnson & Johnson's supplemental Biologics License (sBLA) to include evidence in the guselkumab (Tremfya) label for the inhibition of progression of structural joint damage in https://t.co/tlH7WM5gil
Dr. John Cush RheumNow ( View Tweet)
Izokibep IL-17A Affibody PsA 343 pts RCT PBO crossover wk16 52 wks data ACR50 50–57% ACR70 36–42% PASI100 64% MDA 47–52% No diff between QW vs Q2W AE Injection-site reactions, URTIs most common No new safety signals Looks like any other IL17Ai to me #EULAR2026 #OP073 https://t.co/WiHT8Plitn

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Aurelie Najm AurelieRheumo ( View Tweet)
Can we intercept PsA? Retro study 394 PSO pts 17 yrs follow-up 86 PsA TNFi linked to higher PsA incidence vs IL- MoA TNFi 45% vs IL-17i 14% vs IL-23i 10% vs IL-12/23i 11% After adjustment IL-17i HR 0.35 IL-23i HR 0.17 Needs prospective confirmation! #OP072 #EULAR2026 https://t.co/88RaukjLjY

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Aurelie Najm AurelieRheumo ( View Tweet)
At Week 52 with izokibep in #PsA PASI90: 63–69%; PASI100: 55–64%; MDA: 47–52%. The small-molecule format may enable deeper tissue penetration. Novel anti-IL-17 approach. Abstr#073 @RheumNow #EULAR2026 #Biologics https://t.co/IaJ1gyECZu

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Izokibep (novel small IL-17A inhibitor, 18.6 kDa) maintained efficacy to Week 52 in active #PsA with ~50% of patients achieving ACR50 and nearly half reaching MDA. Sustained durable response with no new safety signals Abstr#OP073 @RheumNow #EULAR2026 https://t.co/Y6fTirE886

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
22% of psoriasis patients developed #PsAover 17 years of follow-up. PsA occurred in 44% of TNFi-treated vs only 9–14% of those on IL-23i or IL-12/23i. Time to discuss "preventive biologics" in PsO? Prospective controlled trials are needed Abstr#072 @RheumNow #EULAR2026

Antoni Chan MD (Prof) synovialjoints ( View Tweet)

In a 17-year real-world psoriasis cohort, patients on IL-17i had 75% lower odds and IL-23i patients had 84% lower odds of developing #PsA vs TNF inhibitors. Is biologic class selection a PsA interception strategy? Prospective controlled trials are needed Abstr#072 @RheumNow https://t.co/jpdZjGK7VV

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
DIPSA RCT: diet in PsA 92 pts 3 arms Mediterranean vs DASH low-calorie vs standard advice Primary takeaway: amount of weight loss matters more than diet! -All groups lost modest weight 1–2.5 kg -All improved similarly in DAPSA -4 to -6 wk 24 -No differences for disease https://t.co/U0cxtdl2Yb

Links:

Aurelie Najm AurelieRheumo ( View Tweet)
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