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Clinical and Therapeutic Challenges in Connective Tissue Disease and ILD
Connective tissue diseases (CTDs) and interstitial lung disease (ILD) represent a challenging intersection of systemic autoimmunity and progressive respiratory impairment. Research presented at EULAR 2025 continues to highlight the importance of CTD-ILD and the evolving landscape of therapeutic options for patients with autoimmune ILDs.
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#RCT of #vagus #nerve #stimulation in #bDMARD-IR #RA Pts
RESSET RCT
+RA #RCT w #VNS
But low response with stat significance
ACR20 1/4 sham vs 1/3 VNS
Would add on to new SoC? š¤
#EULAR2025 @RheumNow #eular_org
#D2T- RA-session https://t.co/tR1pLPBr74
Links:
Janet Pope Janetbirdope ( View Tweet)
So we used to get taught about bimodal age distribution of RA onset - young people and old people.
Actually, itās early middle age where RA diagnoses have now grown globally over 30y - right in peak productivity
Global Burden of Disease data
#EULAR2025 OP0240-HPR @RheumNow https://t.co/8yyrex00yy
David Liew drdavidliew ( View Tweet)
cool stuff at #EULAR2025
RESET #RCT - #vagal #nerve #stimulation #VNS vs sham in
#RA w 1or >1 #bDMARD-IR
N=242
D/C bDMARD,
on #csDMARD
#RA 12 yrs, 10SJC 12TJC
2.6 b/tsDMARD failure
Wk12 EULAR good/mod response
61v 42%
Shamā¶ļøgoes VNS ā
data=
@RheumNow @eular_org abst#OP190
Janet Pope Janetbirdope ( View Tweet)
#polyrefractory #RA
=
failed all classes in #rheumatoid #arthritis
+inflammatory #arthritis
Longer disease duration
Late RA Rx
+power Doppler in POCUS
ā¬ļøno refractory
BMI
Fibromyalgia - pain
ā¬ļøSJC, less DAS , rapid X-ray progression
#EULAR2025 @RheumNow #D2T #RA https://t.co/1sPwf3Qa3m
Links:
Janet Pope Janetbirdope ( View Tweet)
#Cancer is not ā¬ļøin JAKi vs #bDMARDs in
#rheumatoid #arthritis
When adjusted for #confounders
#JAKPOT data
Now you see it (unadjusted ā¬ļørisk)
Now you donāt (adjusted =#malignancy)
JAKi vs bDMARDs in RA
EULAR2025 @RheumNow @eular_org
#JAK it out! new perspective on JAKi https://t.co/wCQ3dHNAVa
Links:
Janet Pope Janetbirdope ( View Tweet)
#D2T #RA ~20%
#Polyrefractory 3%
Many reasons for d/c ing #Rx - D2T
AEs
Intolerance
Chronic pain
Etc
My approach is different depending on reasons why drugs were d/c
Ie ?obj inflammation vs pain or intolerance
@RheumNow @eular_org #EULAR2025
#whatmakes D2T RA difficult https://t.co/AL6TMVJIk9
Janet Pope Janetbirdope ( View Tweet)
Would you use #CAR-T in #polyrefractory #RA
#EULAR2025 @RheumNow @eular_org
Janet Pope Janetbirdope ( View Tweet)
POS0150: From 12 RA registries, JAKi starts fell by ~13% after FDA safety alerts.
Tofa & bari took biggest hits; upa growth slowed but offset losses.
Real-world prescribing adaptsābut doesnāt abandon.
@RheumNow #EULAR2025 https://t.co/QZ5haW2vhX
Jiha Lee JihaRheum ( View Tweet)
Ultrasound for ILD detection in RA š«
Sens 88.6
Spe 92.8
NPV 91.4
PPV 90.7
While if abnormal or high suspicion, HRCT should be the reference, I see this as an interesting tool in clinics for quick screening
POS0180 #EULAR2025 @RheumNow https://t.co/pUy0ki7Y6S
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
#HOT topic
Lung š« #ultrasound for #RA #ILD
#LUS B lines vs HRCT
Single site š«š· study
V sensitive & specific
š¤needs standardization & comparison in other groups
Abst#POS-180
#EULAR2025 @RheumNow @eular_org https://t.co/PwGE4rgk40
Janet Pope Janetbirdope ( View Tweet)
Software enhances treat to target outcomes for #RA GoTreatIT
P0S0750 ##EULAR2025 @RheumNow https://t.co/GpihWr5KLA
Links:
Bella Mehta bella_mehta ( View Tweet)
Does having a synovitis in a specific joint predicts Rx damage in that same joint?
Yes
Can US synovitis predict Rx progression better than clinical synovitis at the joint level?
Not really
At 1 year, only US synovitis is, both B-mode and Doppler ass w/ Rx prog, in particular https://t.co/Wu6dDqIUYn
Aurelie Najm AurelieRheumo ( View Tweet)
Tenosynovitis of 5th compartment independently associated w/ D2T RA in a cohort of 90+ pts compared to established RA
Erosions, Tenosynovitis and Synovitis non associated with D2T phenotype
Itād be interesting to see if this could predict D2T evolution in early RA pts
POS0185 https://t.co/faruOr3HhJ
Aurelie Najm AurelieRheumo ( View Tweet)
New dual-action RA drug?
OP0193: CPLā116 targets both JAK & ROCK.
In 12-wk RCT, highest dose improved DAS28-CRP, joint counts & pain, with clean labs.
Is this a future option for RA-ILD or patients with comorbid CVD risk?
#EULAR2025 @RheumNow
Jiha Lee JihaRheum ( View Tweet)
Ph 2 RCT CPL'116 dual inhibition JAK/ROCK
106 MTX IR pts
wk12 primary endpoint met (DAS28-CRP decrease) in 240mg arm vs. PBO
75% >= AEs, SAE 2: 1 MI, 1 bladder cancer
Authors suggest absence of lipids/LFTs disruption compared to other JAKs
Ph3 is awaited!!
#OP0193 #EULAR2025 https://t.co/TnnM410LfM
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Combination of LEF and MTX in RA: Yay or Nay?
#EULAR2025 @RheumNow
Aurelie Najm AurelieRheumo ( View Tweet)
OP0195: MTX+LEF isnāt commonly usedābut could it be a viable option after all?
In >1,100 RA pts, no link to liver fibrosis (FIB-4/APRI), modest ALT ā, and fewer hospitalizations.
real-world safety data worth a second look.
@RheumNow #EULAR2025
Jiha Lee JihaRheum ( View Tweet)
Premature death in RA still exists, and varies according to race/ethnicity demographic groups
Nationwide US CDC's MCoD database analysis
-Mortality rates
11x higher American Indians
3x higher Black or African American people
-Median age at death with RA
9-10 years younger https://t.co/FTRWPk7Wz0
Aurelie Najm AurelieRheumo ( View Tweet)
RA-related premature mortality highest in American Indians--> 3.6x odds of death in <65 vs White peers, w/ no improvement over 22 yrs. COVID widened the gap. Need to address structural & social drivers of early death in RA, & wider health disparities.
@RheumNow #EULAR2025 #OP0197
Mrinalini Dey DrMiniDey ( View Tweet)
