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From Fitbit to first diagnosis: AI is rewriting the RA playbook
Artificial intelligence isn’t a distant frontier anymore. It’s here, and it appears able to detect signs of rheumatoid arthritis, possibly before we can clinically detect it. Two studies presented at this year’s ACR meeting highlight just how close we may be to a future where algorithms flag disease before we can and monitor activity with minimal patient burden.
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New pieces added to the Pre-RA puzzle
We know that pre-RA is a definition that stands under a large umbrella, ranging from asymptomatic individuals with ACPA positivity to individuals with symptomatic pre-clinical synovitis. How can we predict the transition from the at-risk state to clinical RA outside the realm of clinical, conventional serological (RF/anti-CCP) or imaging (US/MRI synovitis) biomarkers?
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Pre-ACR25 (10.24.2025)
Dr. Jack Cush reviews the news and info reports the day before ACR 2025
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Why do some clinics excel at RA disease activity tracking while others struggle? In the VA, success came down to structure: RA-specific clinics, templates, and staff. Barriers? Time, missing labs, and workflow gaps.
@RheumNow #ACR25 Abstract#0222
Jiha Lee JihaRheum ( View Tweet)
Managing lupus is complex. How do we ensure quality care?
Abstract #0218 convened 8 focus groups:
✅ Support for patient navigators
⚠️ Barriers: low resources, staff turnover
💻 Solution: EHR outreach workflow to flag missed visits & labs
@RheumNow #ACR25 https://t.co/BWaIMMEPit
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Damen et al. 10-year follow-up of CRESPA study. Treatment withdrawl trial in early peripheral SpA. 38% in drug free remission. 82% in remission. @RheumNow #ACR25 Abstr#568 https://t.co/KOVW5pSbJg
Richard Conway RichardPAConway ( View Tweet)
DESIR cohort of early axSpA:
✳️Factors assoc w/ D2M axSpA - female sex, ⬆️ASDAS-CRP ⬆️BASFI ⬆️ASQOL at baseline.
✳️ Low prevalence of pts meeting D2M definition (15 pts - 8.4% bDMARD-treated)
#ACR25 @RheumNow Abs0544 https://t.co/fBUh3myKcz
sheila RHEUMarampa ( View Tweet)
Abstract #0189: Rheumatologists are early adopters and high utilizers of #AI scribes.
📊 Adoption: 41%
🧑💻 Retention: 100%
💬 High utilizers (> 70% visits): 83%. The highest among IM subspecialties
🕒 AI scribes reduced EHR time across all measures.
@RheumNow #ACR25 https://t.co/TBurWUKhMl
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
This retrospective cohort analysis by Dr. Lihi Eder et al showed that among patients with PsA, those w/ high dse activity & high 3VAS scores were assoc w/⬆️ risk of atrial tachyarrythmias.
Main message: PsA conveys ⬆️CV risk; inflamm control is key!
#ACR25 @RheumNow Abs0522 https://t.co/7sRM7K4V1c
sheila RHEUMarampa ( View Tweet)
Come to our first #HealthLiteracy poster of #ACR25!
#0190
Cluster analysis >900 people with IA
Lowest health literacy cluster assoc w:
4× ⬆️anxiety/depression
2× ⬆️disease activity, vs highest HL
Higher HL assoc w older age & ⬆️comorbidities but fewer mental health Sx
@RheumNow https://t.co/iIRXaOl4qZ
Links:
Mrinalini Dey DrMiniDey ( View Tweet)
How does cMRI change over time in cardiac EGPA?
Cheng et al. retrospectively reviewed:
- 11 EGPA pt with LGE on initial cMRI
Despite treatment:
- 10/11 persistent LGE on 2nd cMRI
- 4/4 on 3rd
- 2/2 on 4th
Unclear use as a monitor of tx response
@RheumNow #ACR25
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
#ACR25 Abstr#0772. Should we be worried of #SLE patients with low uPCR 0.25-0.49? Kidney biopsy in N=28 + poor prognostic (Non-White, active serology or active sediment)
- 71% had LN (No class IV or Mixed)
- 46% actionable LN
Cost-effectiveness data needed.
#ACRBest @RheumNow https://t.co/Bt3fuA3aJh
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
AI-enhanced MRI integrating STIR and T1-weighted MRI with BME data reflecting both inflammatory and structural changes, enabling the AI model to predict clinical diagnoses of axSpA with accuracy of 82%. Successfully identified axSpA patients who did not meet the ASAS criteria for https://t.co/dLlGj0ZFpj
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Plenary session at #ACR25!
#0772 When should we biopsy in SLE?
In pts with uPCR 0.25-0.49 g/g + LN predictors, 69% already had LN (many Class III/V). Low C3/C4 were most important factors.
0.5 g/g cutoff may delay diagnosis and treatment. Time to rethink thresholds? @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
Early, low level proteinuria is a harbinger in SLE. ~50% with elevated UPCR but <0.5 had actionable LN on early bx.
Risk factor = low c3/c4
Urine biomarkers promising
#ACRBest #ACR25 @RheumNow https://t.co/WuNPKeqeid
Links:
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
From Dr. Petri at Plenary - even small amounts of proteinuria are a PROBLEM. Reduction of microalbuminuria by even 10% improves mortality! #ACR25 @RheumNow https://t.co/hjmH26vXIb
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Year in Review: Regency Trial showed that LN pts given obinutuzumab achieved CRR at 76 wks (46.4%) vs. PBO.
Take note: the Regency trial did not evaluate the extrarenal effects of Obinutuzumab in #SLE, thats for a diff study.
#ACR25 @RheumNow https://t.co/WJssU1DbzZ
sheila RHEUMarampa ( View Tweet)
#Sjogren disease is here to stay.
“The name has caught up to the science of SD and this can translate to better treatment outcomes for patients” - Dr. Bryant England
#ACR25 @RheumNow https://t.co/M4r0XXkswv
sheila RHEUMarampa ( View Tweet)
Rheum guidelines balance data & context.
Beyond evidence, factors like cost, equity & feasibility shape recs.
GRADE-ADOLOPMENT = global tool to adopt, adapt, or design local guidance for more rapid integration and with less $$$
@RheumNow #ACR25 #GlobalRheumSummitt https://t.co/Sfsqxsqpt4
Jiha Lee JihaRheum ( View Tweet)
Colchicine Ineffective in Long COVID
Management of long COVID has been perplexing with symptoms having functional and possibly inflammatory origins. Colchicine has been studied in long COVID and failed to improve functional capacity, respiratory function, or inflammatory https://t.co/9E3dvUFqJP
Dr. John Cush RheumNow ( View Tweet)
