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Late-Onset Disease: Different Age, Different Rules?

Jiha Lee, MD

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 biology, comorbidity, and the biases that influence medical decision-making? Several abstracts presented at EULAR 2025 challenge us to reconsider how we diagnose and treat rheumatic disease in older adults.

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2025 EULAR/ACR Risk Stratification Criteria for At-Risk Arthralgia

Jack Cush, MD

A collaborative EULAR/ACR expert panel has established criteria for arthralgia patients at risk (clinically suspect arthralgia) to progress to chronic rheumatoid arthritis (RA).

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MTX Fails Knee OA (6.6.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com

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Methotrexate Fails in Knee Osteoarthritis

MedPage Today

We'll be blunt: methotrexate flopped in a randomized placebo-controlled trial among patients with osteoarthritis (OA) of the knee.

Contrary to results from a previous trial in hand OA, the old-line disease-modifying anti-rheumatic drug (DMARD) failed to bring any improvement relative to placebo in either pain or an objective measure of joint inflammation after a year of treatment, according to Changhai Ding, PhD, MD, of Southern Medical University in Guangzhou, China, and colleagues.

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Moneyball Rheumatology (5.30.2025)

Jack Cush, MD

Dr. Jack Cush reviews the book/movie, "Moneyball" and a suggests moneyball strategy is needed to find next level responses for our patients.

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STAMP RCT early SEC vs. SoC 120pts Retention 58% vs 30% ACR 20, 50, 70 and MDA: better outcome at Month 3 but no difference at Month 6 Dactylitis no difference Of note here SoC was a tight T2T strategy! @RheumNow #OP0092 #EULAR2025 https://t.co/8zHs5CRFV5

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Aurelie Najm AurelieRheumo ( View Tweet)
What happens in pre-RA when you stop #abatacept after 1 yr Rx At 6 yrs approx 60% on #Placebo V 50% who initially got #ABA Prolonged damped effect of development of #RA NNT for 1 yr is ~10 with a range as low as 6 #EULAR2025 @RheumNow @eular_org Abst#OP0004 https://t.co/1VOEaZ00Ia

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Janet Pope Janetbirdope ( View Tweet)
Risk of #VTE in #rheumatoid #arthritis Is it better over last 25 yrs? 👎 Olmstead County population study of #RA Pts vs matched controls ⬆️VTE in RA ⬆️VTE w active RA But not change in rates of #DVT & #PE since 2000 Why? 🤔 Abst#OP0070 @rheumnow #EULAR2025 @eular_org https://t.co/eSyjfjVqtY

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Janet Pope Janetbirdope ( View Tweet)
UK Natl Early Inflammatory Arthritis Audit (5/18-11/19) compared 2120 PsA & RA (1:1). PsA had longer Sx to referral wait (112 v 89 days; HR 0.87), longer delay in Dx (HR 0.8), PsA less DMARD use at baseline (54% v 69%) & higher DAS28 results at 3 mos (+0.27) https://t.co/zyubhGxw47
Dr. John Cush RheumNow ( View Tweet)
POSTER HALL PRESENTATION: Sponsored by AbbVie Medical Affairs + Health Impact. 🔍Real-world outcomes in patients with RA remaining on first-line TNFi 📽️See Dr. Charles-Schoeman discuss subsequent outcomes in patients who did or did not achieve response at 3 or 6 months https://t.co/8RmcigG7SF
Dr. John Cush RheumNow ( View Tweet)
Otilimab, GM-CSF mAb, may have potential in #RA. Metanalysis of 4 RCTs, w/ 3933 RA pts had Moderate evidence for ACR20 response (vs PBO) at 90 mg (RR 1.50) & 150 mg (RR 1.39). but neither dose had signif different adverse events vs PBO. OTIL was less effective than tofacitinib. https://t.co/2WajWNnxE9
Dr. John Cush RheumNow ( View Tweet)
Positive results from Phase 2b RENOIR RCT of Rosnilimab, an agonist targeting PD-1+ T cells. 432 RA pts on MTX or csDMARDs, Rx w/ 6 mos of PBO vs ROS (100 or 200 mg q4wk or 600 mg q2wk). All 3 doses of rosnilimab achieved significant reductions DAS-28 CRP at Wk 12 https://t.co/g7lqQYXeJd
Dr. John Cush RheumNow ( View Tweet)
Extract of purple sweet potato ANTHOCYANINS (PSPA) studied in CIA animal model of #RA; Rats Rx w PBO or PSPA (10, 20, or 40 mg/kg) x14days. 40mg/kg dose reduced synovitis, altered gut microbiota (Akkermansia, Lactobacillus) decr RF & cytokines TNF-α, IL-1β, IL-6, IL-18) https://t.co/UjPFEuTU1S
Dr. John Cush RheumNow ( View Tweet)
Swiss Registry study of PsA outcomes when started on either TNFi (N 503) or IL-17i (n 341), latter w/ more severe PSO. IL-17i durability superior to TNFi (median 828 vs 445 d, P<.001), w/ less D/C in women (HR 0.57); but ACR 20 (14 v 33%) & ACR50 (7 v 24%) favored TNFi use https://t.co/R33bwSeB3E
Dr. John Cush RheumNow ( View Tweet)
Positive results from Phase 2b RENOIR RCT of Rosnilimab, an agonist targeting PD-1+ T cells. 432 RA pts on MTX or csDMARDs, Rx w/ 6 mos of PBO vs ROS (100 or 200 mg q4wk or 600 mg q2wk). All 3 doses of rosnilimab achieved significant reductions DAS-28 CRP at Wk 12 https://t.co/6nF8KPRK2f
Dr. John Cush RheumNow ( View Tweet)
UK Natl Early Inflammatory Arthritis Audit (5/18-11/19) compared 2120 PsA & RA (1:1). PsA had longer Sx to referral wait (112 v 89 days; HR 0.87), longer delay in Dx (HR 0.8), PsA less DMARD use at baseline (54% v 69%) & higher DAS28 results at 3 mos (+0.27) https://t.co/ObssKGcomq
Dr. John Cush RheumNow ( View Tweet)
Early RA or undiff. arthritis (UA) shows initial hi-dose steroids have significantly better earlier outcomes, but lower doses have fewer early side effects. IMPROVED used high dose GC (60 mg/d tapered to 7.5 mg in 7wks). tREACH used lower dose GC (15 mg/d tapered in 10 wks to https://t.co/TkrGPb6EBZ
Dr. John Cush RheumNow ( View Tweet)
Turkish study of 1263 primary care referrals to rheumatology found 35.7% with inflammatory rheumatic Dz (IRD), 17.7% osteoarthritis, and 11.2% regional pain syndromes. Another German study showed low risk of IRD if CRP <5 https://t.co/v5qYb7c7jP https://t.co/iq4NfcC3cH https://t.co/6lkTMSBUqc

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Dr. John Cush RheumNow ( View Tweet)
Hydroxychloroquine for Everyone Nearly 25 years ago, while lecturing on best therapies for rheumatoid arthritis (RA), I loudly stated that hydroxychloroquine was “useless” and, deservedly, I was “boo-ed” off stage. My point then was that rheumatologists needed to be aggressive, https://t.co/qKnObzr5ib
Dr. John Cush RheumNow ( View Tweet)
Why DORIS or LLDAS #remission 🤔 ⬇️mortality ⬇️damage ⬆️QoL Dr Nikpour at On Rheum Assoc Shows Remission > LLDAS no pred ✅ best @RheumNow https://t.co/tFcPrkd5Vd

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Janet Pope Janetbirdope ( View Tweet)
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