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Late-Onset Disease: Different Age, Different Rules?

d 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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SLE Preview: advances to achieve deep B-cell depletion

d Md Yuzaiful Md Yusof, MRCP(UK), PhD

The race is on for the first chimeric antigen receptor (CAR)-based therapy to be approved for the treatment of systemic lupus erythematosus. Its main principle is to induce deep B-cell depletion, with the hope to reset the B-cell aberrant immunity for a sustained clinical remission. At EULAR 2025 in Barcelona, several advances of CAR-based therapies will be presented.

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Intraarticular IL-1Ra Gene Therapy in Knee Osteoarthritis

d Jack Cush, MD

De la Vega et al. have published in Science Translational Medicine the efficacy of an IL-1Ra gene therapy in adults with knee osteoarthritis (OA).

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Transcranial Stimulation is Effective in Fibromyalgia

d Jack Cush, MD

A randomized, controlled clinical trial in fibromyalgia (FM) has shown the efficacy of transcranial direct current stimulation (A-tDCS) (along with exercise and pain neuroscience education [PNE]), in alleviating the pain. 

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Treatment of MAS, or the bête noire in Still's disease, presented at the Plenary session by Peter Nigrovic #Plenary room #EULAR2025 @RheumNow https://t.co/S4SG2VflNg

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Nelly ZIADE 🍀 Nellziade ( View Tweet)
#AI can be a valuable tool, but needs to be reliable. Lupus100 and #lupusGPT created with vetted sources, #Easylupus is condensed, even more easy to read It's better to ask your patients to use it as a reliable source! #EULAR2025 @RheumNow https://t.co/FbYYm1dB8E

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Bella Mehta bella_mehta ( View Tweet)
Debuting Fishbowl sessions at #EULAR2025 🔄💊 Lively audience engaging session in A1 on how drug prices influence treatment decisions; real-world tensions between cost, access, & physician autonomy. Transparent, interactive, and packed! @RheumNow | Location: A1 | #EULAR2025 https://t.co/jVbviLuTZK

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Jiha Lee JihaRheum ( View Tweet)
RheumNow’s expanded coverage of the #EULAR2025 Annual meeting is sponsored in part by Johnson & Johnson and UCB. All content chosen by RheumNow & its Faculty

Dr. John Cush RheumNow ( View Tweet)

#MTX in new #PMR?! RCT of #MTX was negative in early #PMR - no effect on #steroid #tapering ACR24 #1697 At #EULAR2025 👇 +RCT of #methotrexate in PMR <8wks #steroids #Rx MTX 25 mg/wk v #placebo N=64 ⬆️GC remission ✅80% v 46% ⬇️relapse w MTX 🤔 Abst0064 @RheumNow #EULAR2025

Janet Pope Janetbirdope ( View Tweet)

#EULAR2025 Opening Plenary C. Dejaco, the EULAR Congress chair presents the @eular_org congress in numbers: 4 days 300+ Invited speakers 170+ Scientific sessions 40 Oral presentations 8 Poster tours 12000+ Attendees @RheumNow https://t.co/hX1ABtSio2

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Aurelie Najm AurelieRheumo ( View Tweet)
#EULAR2025 Abstr#POS0677 I will be at Poster Area today (1530). Single centre (N=23): Rituximab vs Cyclophosphamide for #Sjogren-Neuropathy. No superiority but clinical response was more complete & longer retention numerically favouring RTX. Support trial of BCDT in SjD @RheumNow https://t.co/87e6yFMRkk

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Md Yuzaiful Md Yusof Yuz6Yusof ( 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)
135 pts w/ neurologic autoimmune dz (MS, GBS, myasthenia gravis) who had cancer & Rx w/ checkpoint inhibitors (ICI) showed exacerbations in SOME - 18% of MS pts, but 67%of MG, latter often w/ hospitalization (50%) or death (17%). GBS faired well w/ ICI Rx. https://t.co/RksC6QXce0 https://t.co/mYjzgxbcdQ

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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/zyubhGxw47
Dr. John Cush RheumNow ( View Tweet)
Rheums! Have a rheumatology question or case for Jack Cush? Record it here and we may feature it on an upcoming podcast. Tell us your name and where you practice rheumatology. https://t.co/f3nm9awojS https://t.co/dOaVZpDAWH

Links:

Dr. John Cush RheumNow ( View Tweet)
RheumNow’s expanded coverage of the #EULAR2025 Annual meeting is sponsored in part by Johnson & Johnson and UCB. All content chosen by RheumNow & its Faculty.

Dr. John Cush RheumNow ( View Tweet)

Single center Italian study of 414 JIA q6mos (for 2 yrs) used machine learning & 68 clinical variables to predict clinically inactive Dz (CID). Best predictive of CID at 2 yrs was 1) physician’s global assessment, followed by 2) active joint counts (using data from 0-12 mos) https://t.co/2SEH1a85Nj
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)
Retrospective multicentre study of 122 anti-synthetase syndrome pts - 14 (11%) had cancer associated myositis (CAM). The CAM SIR= 5.4 (elevated vs gen. pop. p < 0.0001). These pts were older, often +Hx cancer, lower CK levels, less weakness, worse survival. CAM cluster= older https://t.co/nuKg3P89a8
Dr. John Cush RheumNow ( View Tweet)
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