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Rheumatology’s Blind Spot: The Persistent Exclusion of Older Adults
As the population ages globally, rheumatologists are caring for an increasingly older patient population more than ever before. In RA alone, nearly 40 percent of patients are now aged 65 years or older. Yet the evidence guiding our treatment decisions continues to come from studies that rarely include them, giving rise to a fundamental question: do we really know how best to treat older adults with rheumatic diseases?
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ACR25 - Day 1 Report
ACR 2025 began today in Chicago with throngs of rheumatologists, fellows, ARP members, APPs and pharma folk taking to the meeting halls and rooms for tons of novel content.
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PET and histologic discordance in aortitis
Of 5 aortitis patients who had PET/CT prior to aortic surgery with path, only 1 showed concordance (neg PET, neg biopsy)
4/5 patients had inflammatory biopsy with neg PET
Small # but PET is not perfect!
@RheumNow #ACR25 Abst 1620
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
PMR patients need healthcare professionals who know a bit about their disease.
Survey of US HCPs, amongst responders:
- 68% were not aware/unsure about PMR
- of those who were aware, knowledge was… not great (see below)
PMR needs everyone’s respect
#ACR25 ABST1617 @RheumNow https://t.co/SpyEnAW8lI
David Liew drdavidliew ( View Tweet)
ANCA status does not inform IL-5 agent response in EGPA patients
Terrier et al. analyzed the OLE of MANDARA and compared ANCA+ and ANCA- subgroups:
- similar rates of remission
- similar rates of GC withdrawal
- comparable relapse rates
@RheumNow #ACR25 Abst 1594
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
#ACR25 Abstr#1608 10! 10! Across the board. 2-yr data from RCT + Open Label showed frequency of both airway and non-airway features of #EGPA improved with Benralizumab/Mepolizumab. Provides assurance to use more in real-world @RheumNow https://t.co/i78xXojGja
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
56 pts w/tracheobronchial stenosis in GPA, highly frustrating disease manifestation
Not surprising to see severe dx & prior intralesional tx assoc with incidence (ie necessity) of tracheal dilation
Leflunomide protective? Have others seen this?
#ACR @RheumNow Abstr#1596 https://t.co/djJXnAkxnv
Mike Putman EBRheum ( View Tweet)
Case series of 5 patients with binutuzumab (CD20) in AAV
Short story short; it worked. Of course it worked. Obviously it worked. Everyone knew it would work.
Why aren't we doing more TRIALS with new/better B cell inhibitors in AAV?
#ACR25 @RheumNow Abstr#1601 https://t.co/H6Zz3Tf3xo
Mike Putman EBRheum ( View Tweet)
We need more biomarkers in GCA - what about fibrinogen?
Miller et al retrospectively compared CRP, ESR, and fibrinogen at different points in GCA dx
Fibrinogen (and ESR/CRP) only helpful prior to initiation GC with comparable performance
@RheumNow #ACR25 Abst #0750 https://t.co/q5gFxDMnTy
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Can tissue give us an underlying diagnosis in aortitis?
Dr. Kermani breaks down the autoimmune differential based on histopathology
@RheumNow #ACR25 https://t.co/twcH021dxS
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
The differential diagnosis for CNS vasculitis is BROAD. Keep in mind it’s mimics @RheumNow #ACR2025 https://t.co/ASWr6zm5eQ
Gabriela Martinez Zayas, MD MartinezZayasMd ( View Tweet)
In case there was any doubt:
GCA leads to ischemic vision loss
PMR does not
#ACR25 ABST0753 @RheumNow https://t.co/mCS9B4Flgl
David Liew drdavidliew ( View Tweet)
Leflunomide - a perennial question in GCA, that we still haven’t answered (as this meta-analysis shows), despite clear potential.
We are getting a clearer idea of the strengths/limitations of MTX in GCA, is it now time to get better clarity for LEF?
#ACR25 ABST0731 @RheumNow https://t.co/ycuvPx8Xdg
David Liew drdavidliew ( View Tweet)
Project from my group & rheum-bound resident Mary Peng!
As expected, ischemic vision loss for GCA compared to PMR (HR 5.4) and gen pop (HR 5.6) 😬
NO difference for PMR vs gen pop (aHR 1.10, 95% CI 0.86–1.41)
Reassuring for pts w/PMR!
#ACR25 @RheumNow Abstr#0753 #ACRBest https://t.co/HKzc7OOzmP
Mike Putman EBRheum ( View Tweet)
Phenotypes of GCA:
Pt dx by PET compared to TA biopsy were:
- younger
-longer disease before dx
-more frequent extremity claudication (still overall low)
-less cranial / TA sx
@RheumNow #ACR25 Abstract 0759 https://t.co/ilwa3eYmRq
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Cool study using vasculitis patient-powered reserach network (VPPRN)
"SNOT-22" tool captures sinonasal symptoms; associated with disease activity (expected) but also worse among pts even in remission
Very important impacter of QOL in AAV
#ACR25 @RheumNow Abstr0725 https://t.co/NQBW8VnYFS
Links:
Mike Putman EBRheum ( View Tweet)
Miller et al. Fibrinogen for GCA diagnosis and flare identification. Similar to ESR/CRP in diagnosis. For flares, lower sensitivity (79%) but better specificity (96%) @RheumNow #ACR25 Abstr#750 https://t.co/SIkAkEeYh1
Richard Conway RichardPAConway ( View Tweet)
Poster evaluating representation in trials of AAV and GCA
Results mirror those observed in other fields; need to keep advocating for trials in all populations!
#ACR25 @RheumNow Abstr#0720 https://t.co/gDj5IQMJOc
Mike Putman EBRheum ( View Tweet)
#ACR25 Abstr#776 2-Year SELECT-GCA RCT showed that #GCA patients receiving continuous UPA15 to 2-yr maintained their remission (69%) vs those who switched to PBO after in remission for ≥24 weeks (29%). Lower serious infection but higher herpes zoster in UPA15. One VTE @RheumNow https://t.co/FCTNqCVxiZ
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
No seasonal pattern in GCA!
We have also looked at this in our data and similarly found no trends
It sure feels like GCA comes in waves, but data does not bear this out
#ACR25 @RheumNow Abstr#0754 https://t.co/4y2elYmCRT
Mike Putman EBRheum ( View Tweet)
