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Immune Dimming or Immune Reset in RA: How Far Should We Go?

Aurelie Najm, MD, PhD

CD19-directed CAR T-cell therapy has rapidly moved into autoimmune disease, driven in large part by striking reports in SLE, where sustained drug-free remission has raised the possibility of a true immune reset. In RA, where multiple effective therapeutic classes already exist, the relevance of such deep immune interventions remains uncertain.

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EULAR flags

Day 3 EULAR Report

Jack Cush, MD

Day 3 was an interesting mix of posters, oral presentations, and review sessions on many practical subjects like osteoarthritis, large vessel vasculitis, systemic sclerosis, and pregnancy. Here are a few of my recommended abstracts from Friday at EULAR 2026.

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EULAR meeting room

Strike First: TNFi vs. Step-Up Therapy in Early Peripheral SpA

Antoni Chan, MD, PhD

The approach to the treatment of peripheral SpA has been the same for a long time. The guidelines recommend starting with NSAIDs, escalate to conventional synthetic DMARDs, typically sulfasalazine or methotrexate and reserve biologics for patients who fail those. According to a new phase 3 trial presented at EULAR 2026, there may be a different way to approach this.

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New JAK inhibitors in the axSpA treatment landscape

Mrinalini Dey, MBBChir, MA(Hons) Cantab., MRCP, FHEA

At EULAR 2026, two large phase 3 studies highlight that the JAK story in axSpA is still evolving rapidly, with different selectivity profiles and expanding global development programs continuing to push the field forward.

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TMP-SMX prophylaxis cuts PJP risk by 69% (RR 0.31) & mortality by 59% (RR 0.41) in immunosuppressed rheum dz pts —but ADRs are 26x more common. NNT=323, NNH=5. Risk-adapted approach recommended. #EULAR2026 POS1190 https://t.co/4yjD9CmySM
Dr. John Cush RheumNow ( View Tweet)
Extended-release febuxostat (HR091506) vs standard febuxostat in gout. 442 patients, 36 weeks. SUA <300 μmol/L at Week 36: 63.8% vs 40.7% (p<0.0001) A 23% difference on the most stringent urate target. Well tolerated and acceptable safety profile Abstr LB0008 @RheumNow https://t.co/PSrn7K5BVS

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#EULAR2026 LB0009 It’s like opening Pandora’s box! 2 Open Label RCTs Baricitinib vs TNF-i in RA & =>1 VTE risk: -VTE:Non-inferiority of BARI wasn’t met (in line with JAK profile) -No increase in MACE/Cancer (opposed to Oral-Surveillance: TOFA & =>1 MACE risk) @RheumNow #EULARBest https://t.co/nNwtJ3LbkD

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
https://t.co/LEnQbCB2Ff https://t.co/CtuFVbde6t

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Janet Pope Janetbirdope ( View Tweet)
Baricitinib did not demonstrate non-inferiority w/ TNFi for first VTE in the RA-BRIDGE and RA-BRANCH trials. Identifying high-risk pts and individualizing tx is paramount. LB0009 @RheumNow #EULAR2026 https://t.co/MSiBq0FnEq

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sheila RHEUMarampa ( View Tweet)
Abstr LB0009 Baricitinib vs TNFi in RA patients enriched for VTE risk. 3,640 patients. 3.7 years median follow-up. VTE: HR 1.61 (95% CI 0.97–2.66) non-inferiority not demonstrated MACE: HR 1.06 no cardiovascular excess Serious infections: HR 1.32 (p<0.05) @RheumNow https://t.co/NSNRJi9B4r

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Abstr LB0009 Baricitinib vs TNFi in VTE-enriched RA. 3,640 patients. 3.7 years. Safety endpoints VTE HR 1.61 non inferiority not met Serious infections HR 1.32 (p<0.05) MACE HR 1.06 reassuring @RheumNow #EULAR2026 https://t.co/nR6TMowlYS

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#EULAR2026 LB0006 Beyond conventional immunosuppressant, a multicentre RCT (N=145) in China showed mTOR-i Sirolimus + SOC met primary endpoint (SRI-4) vs PBO + SOC in #SLE. Favourable safety. Frequent AE: high cholesterol & low WCC. Unclear position in treatment pathway @RheumNow https://t.co/OiFp06467v

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
BARI vs TNFi in VTE-enriched #RA pts (RA-BRIDGE + RA-BRANCH, n=3,640, ~3.7 yrs follow-up): VTE non-inferiority not met (HR 1.61, CI 0.97–2.66). But absolute rates low (2.5% vs 1.7%) and MACE was similar (HR 1.06). Serious infections ↑ with BARI. @RheumNow #EULAR2026 LB0009

Jiha Lee JihaRheum ( View Tweet)

Do you routinely recommend #herpes #zoster #vaccination in all #immune #suppressed pts? #EULAR2026 @RheumNow #vaccination #guidelines

Janet Pope Janetbirdope ( View Tweet)

How many ‘cars’ are there? crowded #CAR-T ‘driving’ innovation at #EULAR2026 >90 abstracts w CAR-T in title Lessons learned Maybe #immune #reset is not always the goal ➡️vs ’#immune #dimming How long are effects? safety looks good PT selection is key Early, no damage @RheumNow https://t.co/6jii5MBJcJ

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Janet Pope Janetbirdope ( View Tweet)
JAK Safety Debate Continues: Stronger VTE signal, less clear cancer signal Few topics in rheumatology have reshaped prescribing behaviour as dramatically as the safety concerns surrounding JAK inhibitors following ORAL Surveillance and the subsequent FDA and EMA warnings. https://t.co/mvTRRL7srA
Dr. John Cush RheumNow ( View Tweet)
Large French nationwide cohort (n=56,591 SpA patients) showed that >6 months/year of targeted therapy exposure was associated with reduced overall cancer risk (wHR 0.86), especially for haematological malignancies (wHR 0.65). Reassuring long-term safety signal. Abstr OP0238

Antoni Chan MD (Prof) synovialjoints ( View Tweet)

#EULAR2026 POS0713 Is there a hope for BTK-inhibition in #SLE despite several previous failures? A Phase IIb RCT in China: primary endpoint (SRI-4) was met in Orelabrutinib vs PBO in dose-dependent manner. No new safety signal. Phase 3 RCT is underway @RheumNow https://t.co/4cJ8ezppTS

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Post marketing safety signals of anifrolumab from US FDA adverse event reporting system - herpes zoster significantly associated. Others include infusion reactions and intermittent hypersensitivity @RheumNow ##EULAR2026 #POS1067

Bella Mehta bella_mehta ( View Tweet)

JAK Safety Debate Continues: Stronger VTE signal, less clear cancer signal Few topics in rheumatology have reshaped prescribing behavior as dramatically as the safety concerns surrounding JAK inhibitors following ORAL Surveillance and the subsequent FDA and EMA warnings. Even https://t.co/wfQZn1hO3N
Dr. John Cush RheumNow ( View Tweet)
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