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ACR 2025 – Day 2 Report
Here are 3 abstracts that caught my eye on Day 2 at ACR25. Notably these have takeaway messages that should support your current practices.
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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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IgG4 - Rare but Rx
Several studies #ACR25 @ACRheum were presented
Outcome measures
Rx
#steroids
#CD19 mAb #Inebilizumab
👍+RCT reduction of flares
BTKi
#Rilzabrutinib
#Zanubrutinib
#JAKi
+RCT of #tofacitinib +steroids vs pred
@ACRheum @RheumNow #ACR25
1163 LB02 0239 1172 https://t.co/xC3wgaN9bk
Janet Pope Janetbirdope ( View Tweet)
In RA, “strong bones” can give false reassurance.
Pts with higher baseline BMD had faster bone loss, often tied to GC use and less osteoporosis treatment. Undermanagement, not biology, may drive decline.
@RheumNow #ACR25 Abstract#2244 https://t.co/N421ESAUy9
Jiha Lee JihaRheum ( View Tweet)
Infection vs steroid sparing in PMR/GCA/AAV studies with steroid-sparing Rx
GiACTA (1, top right) aside,
- low infection rates
- the more steroid saved, the less the infection risk
Infection risk in vasculitis is driven by steroid, not DMARD
#ACR25 ABST2526 @RheumNow https://t.co/UprbxUQyQC
David Liew drdavidliew ( View Tweet)
#1727
360k+ postmenopausal women w osteoporosis: >1/3 untreated patients were at v high fracture risk, yet few received recommended anabolic or antiresorptive therapy.
Even among treated women at very high risk, >50% were still on oral bisphosphonates
@RheumNow #ACR25 https://t.co/9S66tAU68P
Mrinalini Dey DrMiniDey ( View Tweet)
#ACR25 Please find my video interview with Prof Edward Vital @edvital on their work on International Consensus of Glucocorticoid Tapering Guideline in #SLE #lupus Abstr#1526 @RheumNow
https://t.co/MnQdcdASkG https://t.co/b7GMcnFU2m
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
#ACR25 Abstr#1401 Sjogren’s #SjD is definitely not a benign disease! Real world study using US database showed high disease burden within 12 mths of diagnosis (i.e. healthcare resource use). GC use was high (~50%). Better therapy is needed to improve outcomes @RheumNow https://t.co/MI3vQ5LByr
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
~1 in 6 pts with #sarcoidosis May have #cardiac involvemt
1/3 respond to #MTX + #steroids
Followed by repeat #PET
Failures get
👇
#infliximab >#adalimumab
👇
#JAKi
Better survival >yrs ago
R heart involved ⬆️risk of MTX nonresponse
#ACR25 @RheumNow @ACRheum abst#1664 #ACRbest https://t.co/kYt9JRNSVH
Links:
Janet Pope Janetbirdope ( View Tweet)
Like PEXIVAS steroid taper, this is something we need an online resource to check each time. Its complicated, but feels "right". @RheumNow #ACR25 https://t.co/QAgSQB9XMQ
Richard Conway RichardPAConway ( View Tweet)
Pope @Janetbirdope et al. Parenteral (IM and/or IA) superior to oral steroids in early RA. Better discontinuation of steroids with no difference in need for advanced therapies. @RheumNow #ACR25 Abstr#1355 #ACRbest https://t.co/OyvnzEGlLE
Richard Conway RichardPAConway ( View Tweet)
Prednisone remains both lifeline and liability.
New PRED-SAFE SDM tool helps patients and clinicians navigate that tension—visualizing benefits and harms to guide tapering. In pilot testing, 93% had no residual decisional conflict.
@RheumNow #ACR25 Abstract#1052 #ACRbest https://t.co/CgQ75N7A1p
Jiha Lee JihaRheum ( View Tweet)
Post Hoc analysis from SELECT-GCA
Increased rate of herpes zoster for 26wk steroid-UPA 15mg (7.3% vs 4.2% 52wk steroid-plbo) but lower rate of SERIOUS infections (7.9% vs 12.7% 52wk steroid-plbo)
Zoster risk is real; steroids are the bigger problem
@Rheumnow #ACR25 Abstr#0895 https://t.co/IKzO2J4hLH
Links:
Mike Putman EBRheum ( View Tweet)
In this MTX+PNL vs TCZ+PNL in GCA study, we saw 5 pts on MTX+PNL get PJP, very surprising.
@EBRheum asked what I knew/hoped he’d ask: why did this happen?
PJP is v rare in GCA
(https://t.co/oPN0dpvG8Q) & with MTX in other diseases.
Worth interrogation!
#ACR25 ABST0891 @RheumNow https://t.co/rsbScryIFR
Links:
David Liew drdavidliew ( View Tweet)
#ACR25 Abstr#1526 Finally it’s here! Consensus-based guidance on GC #steroid tapering in patients with #SLE. Included considerations before tapering, tapering schedules and monitoring during tapering. Looking forward to the uptake and hearing patients’ views @RheumNow #ACRBest https://t.co/FFl2TFhtTa
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
CMV is a worry with high-dose steroids, especially in certain settings.
The risk is far from universal, though: in this Korean cohort treated with high dose pred, almost no-one without risk factors got it.
Meds are rarely the only infection risk factor
#ACR25 ABST203 @RheumNow https://t.co/zLYhLVKgYL
Links:
David Liew drdavidliew ( View Tweet)
A closer look in skin toxicity of GCs in RMDs
GC Toxicity Index, LONG TOX prospective cohort
Frequent:
-Easy bruising 35%
-Atrophy 22%
-Hirsutism 17%
-Acneiform rash 15%
-Erosion/Tear 12%
GC-related Neuropsychiatric toxicity highly associated with/ skin, something to look out https://t.co/NfxG8JkxSP
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Avacopan in the real world: we need to be braver
If we want to get steroid-sparing benefit in AAV, we need to trust it
claims data shows modest PNL reduction with avacopan
some manifestations are harder to taper in, but others we just need to be bolder
#ACR25 ABST0726 @RheumNow https://t.co/51nGdpR2db
David Liew drdavidliew ( View Tweet)
Schmidt et al. 2 year results of SELECT-GCA, upadacitinib in GCA. Remission 69% if upa continued vs 29% if stopped. 90% lower risk of flare, 1G less steroid @RheumNow
#ACR25 Abstr#0776 #ACRBest https://t.co/MgRo7kIgIw
Richard Conway RichardPAConway ( View Tweet)
#ACR25 New ACR Non-Renal #SLE lifecourse Guideline. 3 strong recommendations:
- HCQ routinely unless contraindicated
- Taper GC to =< 5mg/d
- Escalate therapy in any organ system if refractory to initial therapy
*Organ-specific: Conditional recommendations only
@RheumNow https://t.co/w9rfcvwGHy
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
