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Imaging and Early Detection in Psoriatic Arthritis
At EULAR 2025, there have been new developments in imaging in PsA.
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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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In 631 axSpA pts (mean age 33y, 54% female) from DESIR cohort, high-dose NSAID use (ASAS NSAID index ≥50) not associated with incident hypertension (HR 1.01; 95% CI 0.98–1.02) over 72 months. NSAID anti-inflammatory effect may offset BP risk in axSpA. Abstract#POS0256 @RheumNow https://t.co/ELYWoJDyKJ
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
In 4,121 SpA pts (mean age 45y; 61% male), composite scores w/ joint counts (DAPSA, DAS28, DAS44) best discriminated peripheral arthritis activity vs PGA & SJC alone. All scores had excellent construct validity; CRP weakest. Composite indices may optimize SpA assessment. https://t.co/oM97BEkkH5
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
In phase II/III trial (NCT04481139), ivarmacitinib 4mg significantly improved PROs in active ankylosing spondylitis: total back pain VAS (-25.6 vs -17.0), night pain (-25.0 vs -14.3), stiffness (-24.5 vs -15.8), PtGA (-23.8 vs -13.3), ASQoL (-3.2 vs -2.4). Benefits seen even https://t.co/RcJ5vfdoHf
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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
In clinical practice, not all US enthesitis findings are SpA-specific. Enthesophytes/calcifications common in healthy pts. Inflammatory lesions (PD signal, erosions) at Achilles, distal patella & greater trochanter better distinguish PsA/axSpA. Target key sites to improve US https://t.co/jO61QjKfQp
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
In 581 PsA pts (EuroSpA), MRI showed axial SpA features in 31%: BME (69%), erosions (68%), fat lesions (58%). MRI-axPsA pts: younger (41y vs 46y), male (70%), HLA-B27+ (55%), ↑CRP (13 vs 7 mg/L). Radiographs identified sacroiliitis in 29%. MRI adds key detection. POS0297 https://t.co/nAw0BDAH22
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Using high-resolution peripheral quantitative computed tomography (HR-pQCT), patients with psoriatic arthritis (PsA) & psoriasis (PsO) show reduced cortical volumetric bone mineral density (vBMD) & thinner cortex vs controls. Bone mechanics impaired: reduced stiffness & failure https://t.co/ghH2cwOYJc
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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#Shingrix #vaccination is Impt in #SLE
HZ vaccination works in SLE, safe – 1yr still good humeral & cellular immunity
-attenuation over 1 yr re #immune #responses
No major flares
#shingles is ⬆️ in #lupus
👇
abnormal immune response
#pred, #MMF #IS
POS1005 #EULAR2025 @RheumNow https://t.co/o8lDXgOhE1
Janet Pope Janetbirdope ( View Tweet)
How does #HCQ work in #SLE
Stabilizes lysomal membranes?
#Lupus pts on HCQ monoRx & low #SLEDAI were followed
Single cell seq
HCQ cytokine sigs May vary over time
IFN & OXPosph pathways
#Hydroxychloroquine in #LN - #IFN I&II
#EULAR2025 @RheumNow POS0983 https://t.co/0gMQh9MNlg
Janet Pope Janetbirdope ( View Tweet)
#TDM for #HCQ warns of #toxic #levels in #CRF
v low GFR <30, <60, <90, >90
400mg/d all in low GFR toxic
200mg/d 25% in low GFR toxic
6mg/kg/d – low GFR is too ⬆️
adjust HCQ dose for pts with CRF
POS0987 #EULAR2025 @RheumNow @eular_org https://t.co/vg2b87LuiE
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Janet Pope Janetbirdope ( 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)
Who/When to Treat Clinically Suspect Arthralgia
Dr. Jack Cush discusses risk stratification in Clinically suspect arthralgia; referencing EULAR2025 abstracts OP0004 (ALTO study) and OP0325 (long term Followup of ARRIA)
https://t.co/FCO80mdHLg https://t.co/sX9u8mUoak
Dr. John Cush RheumNow ( View Tweet)
Procalcitonin can be used in the monitoring of infection, but is also high in Stills disease. 89 AOSD pts showed pts w high PCT had more pleuritis, MAS,^LFTs, & correlated w/ Dz activity, CRP, LDH, hi ferritin & normalized w bDMARD Rx. #EULAR2025 abstr #POS1118 https://t.co/NpRA9optd3
Dr. John Cush RheumNow ( View Tweet)
"H Syndrome" review of 23 French pts. Autoinflammatory dz due to variants of SLC29A3 gene. Multisystem histiocytic lymphoproliferative disorder of young adults- skin 2/3, sensorineural hearing loss, fever w/ endo & autoimmune dz. Best responses w IL6 inhib. #EULAR2025 Abst https://t.co/F7NGI4TkJS
Dr. John Cush RheumNow ( 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)
In real-world PsA, IL-23 inhibitors (guselkumab/risankizumab) showed clinical response in axial/mixed PsA. Best response seen in pts meeting ASAS axial SpA criteria (RR 7.64) & baseline ASDAS-CRP >2.1. Supports role of patient stratification in axial PsA. Abstract#POS0113 https://t.co/qowZZmJOpM
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#EULAR2025 Abstr#OP0281 Not just shredding the weight but now also the pain! Another potential benefit of GLP-1 agonists - reducing symptoms of patients with Fibromyalgia. Propensity matched analysis using TrinetX database showed reduction on opiates, fatigue and pain @RheumNow https://t.co/oh6ecJmM5e
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Efficacy and Safety of Xeligekimab in AS
Dr. Adela Castro reports on abstract OP0102 at the EULAR 2025 meeting in Barcelona, Spain
https://t.co/xpzeV0oZOr https://t.co/wmTnFbFcum
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Dr. John Cush RheumNow ( View Tweet)
Are we missing axial/SIJ lesions in PsA or are we misdiagnosing AxSPA + PSO pts for PsA?
5 register studies including 580+ pts w/ PsA/AxSPA+PSO
1/3 PsA routine care patients had SIJ MRI = SPA
29% Rx SII r-mNY criteria+
of which 38% MRI lesions AxSPA
@RheumNow #EULAR2025 https://t.co/DJljlm7T9m
Aurelie Najm AurelieRheumo ( View Tweet)
