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Methotrexate and Leflunomide combination in RA/PsA: Is it safe?
I asked the EULAR twitter sphere how they feel about combination of methotrexate (MTX) and leflunomide (LEF). The opinions are differing so far, with 50% reporting prescribing this combination often while 50% are worried of side effects. Several abstracts presented this year are providing further data to help us make up our minds in RA and PsA.
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Toward Long-Term Prevention of Rheumatoid Arthritis: Are We Closer?
As earlier diagnosis and treatment of rheumatoid arthritis (RA) have resulted in greatly improved clinical outcomes, the focus of current research has now shifted to preventing the development of RA altogether. At EULAR 2025, several oral presentations explored this objective, highlighting data from three key prevention trials: APIPRA, ARIAA, and TREAT EARLIER. Each trial targeted individuals considered to be “at-risk” for developing RA, investigating whether early immunomodulatory interventions could delay or prevent progression to classifiable RA.
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Increased Risk of VTE in RA: Lessons Learned from 40 Years of Data
Dr. Mrinalini Dey reports on abstract OP0070, "Trends in Incidence and Predictors of Incident Venous Thromboembolism in Patients with Rheumatoid Arthritis: A Population-Based Retrospective Cohort Study", https://t.co/JykR4Mxb9L
Dr. John Cush RheumNow ( View Tweet)
The Impact of Biologics on Methotrexate Adherence
Dr. Aurelie Najm reports on abstract POS0563, 'Methotrexate biochemical adherence significantly reduces in new starters of biologic/targeted DMARDs: Results from the Biologics in Rheumatoid Arthritis Genetics and Genomics Study https://t.co/t7DEsJW35v
Dr. John Cush RheumNow ( View Tweet)
RA Care Should be Guided by Need—Not Age
Dr. Jiha Lee reports on abstract POS0627, "Examination of Clinical Outcomes by Treatment Duration of Biologics and JAK inhibitors in Nonagenarian Rheumatoid Arthritis," at EULAR 2025 in Barcelona, Spain.
https://t.co/zKHXZSVLJy https://t.co/w6CkRy2yIA
Dr. John Cush RheumNow ( View Tweet)
2025 EULAR/ACR Risk Stratification Criteria for At-Risk Arthralgia
A collaborative EULAR/ACR expert panel has established criteria for arthralgia patients at risk (clinically suspect arthralgia) to progress to chronic rheumatoid arthritis (RA). Risk stratification of CSA https://t.co/STmuNO3c2Z
Dr. John Cush RheumNow ( View Tweet)
In the United States, IL-6R inhibitors have continued to help PMR patients get off steroids.
Hopefully more use and more options mean that, in the future, PMR patients get no more steroids than PsA or RA patients
#EULAR2025 POS0948 @RheumNow https://t.co/JT7gFDC5rl
David Liew drdavidliew ( View Tweet)
-Difficult to treat RA is a heterogeneous concept
-Risk fx: younger onset, high disease activity,erosive disease, comorbidities, depression.
-Study in a Spanish cohort with D2T 2/2 inefficacy showed Rituximab, JAKis, and IL-6i had longer survival (hence better tx options).
-The https://t.co/ZCZcX9FRfb
Adela Castro AdelaCastro222 ( View Tweet)
In BIODOPT study (RA, PsA, axSpA), disease activity-guided tapering of biologics (incl. biosimilars) maintained QALY (Δ0.008, NS) while lowering biologic costs (Δ€–1,979 [95%CI –3,798;–161]) & total hospital costs (Δ€–1,936 [95%CI –3,753;–119]) over 18mo. Supports https://t.co/CJUpfU2oRA
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Late-Onset Disease: Different Age, Different Rules?
We’re seeing more patients develop rheumatic diseases for the first time in their 60s, 70s, or beyond. But are these truly the same diseases we see in younger adults, or do they behave differently, shaped by age-related https://t.co/ubVRhhRGxG
Dr. John Cush RheumNow ( View Tweet)
#EULAR vs #ACR #RA #recommendations
Do you agree that #ERA pts should receive #glucocorticoids
@RheumNow #EULAR2025
@eular_org
Janet Pope Janetbirdope ( View Tweet)
ARIAA study: longer-term data now
High-risk ACPA+ clinically suspect arthralgias
abatacept for 6mo, then stop altogether
Really impressive long-term effect
also noting success of APIPPRA, abatacept flicks off some very early RA, at least for a while
#EULAR2025 OP0325 @RheumNow https://t.co/AeRrUKPPiK https://t.co/jtynyD0ioO
Links:
David Liew drdavidliew ( View Tweet)
Highlights @eular_org #EULAR2025
RCTs + in CTD/RA #ILD w #PPF LB0003
Lots of #CAR-T studies in #SARDs
Lots of bDMARDs in
#SLE
#APS
#IgG4
#SjD
Neurostimulation 👇
⬇️inflammation
⬇️pain
#RA
#fibromyalgia
#EULAR2025 @RheumNow @eular_org
Janet Pope Janetbirdope ( View Tweet)
Why do we need RA treatment recommendation updates? We keep on getting new data, for our keystone disease
so today Josef Smolen and colleagues present the new 2025 EULAR recommendations
#EULAR2025 @RheumNow https://t.co/OdHL8CAIKv
David Liew drdavidliew ( View Tweet)
67% of HCPs knew of EULAR’s CVD risk guidelines in RMDs—but few could apply them.
✅ Only 13% linked SLE control to CVD risk
🚫 0% picked correct BP/statin use in RA/AS/PsA
Barriers? Time, knowledge, and local guideline gaps.
POS0410-HPR @RheumNow #EULAR2025
Jiha Lee JihaRheum ( View Tweet)
“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)
