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Late-Onset Disease: Different Age, Different Rules?
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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In propensity-matched RA cohort (n=2,449 each) on JAK inhibitors, adding a GLP-1 agonist reduced risk of: • Acute coronary syndromes (RR 0.65, p=0.0009) • DVT (RR 0.69, p=0.007) Overall CV events ↓ by 33% (RR 0.67, p=0.0007)
#EULAR2025 @RheumNow
Abstract#OP0069 https://t.co/jWI6tvri8O
Jiha Lee JihaRheum ( View Tweet)
Can RA be intercepted?
In the ALTO follow-up of the APIPPRA RCT (Cope et al), 1 year of abatacept delayed RA onset by up to 3 years in ACPA+/RF+ individuals. Effect strongest in those with mature autoantibody profiles.
Abstract#OP0004
@RheumNow #EULAR2025 https://t.co/N7YwtYod8w
Jiha Lee JihaRheum ( View Tweet)
RA pts have ↑ risk of DVT (HR 2.26) & PE (HR 1.61) vs controls in this 40-year, pop-based study. Nodules, obesity, high disease activity & early biologic use ↑ risk. Remission in year 1 halved PE risk. VTE risk persists despite therapeutic advances.
@RheumNow #EULAR2025 #OP0070 https://t.co/AaBi2o2cUw
Mrinalini Dey DrMiniDey ( View Tweet)
A PT-led vocational intervention for RA/axSpA with reduced work ability was likely cost-effective: ↓€4,324 in societal costs & +0.05 QALYs over 12m vs usual care (95% probability at €20k/QALY). Results suggest cost-effective compared to usual care.
@RheumNow #EULAR2025 #OP0007
Mrinalini Dey DrMiniDey ( View Tweet)
RA polygenic risk ≠ MI risk. In >8,700 Swedes w/ or w/o RA, higher genetic risk for RA wasn’t linked to higher MI incidence. Familial clustering of RA & MI likely driven by non-genetic factors. Traditional CV risk still key in RA care.
@RheumNow #EULAR2025 #OP0072 https://t.co/KN6Dg0ekt2
Mrinalini Dey DrMiniDey ( View Tweet)
Clinical determinants of multiple drug failure in D2T RA
2000+ RA cohort 250+ refractory
-Low financial status
-Cancer Hx
-CV comorbidities
-Chronic use of NSAID or GCs
Protective: Regular participation in leisure activities
#POS0030 @RheumNow #EULAR2025 https://t.co/qNHQoHCb80
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
REGULATE-RA and REGULATE-HS FIH CAR-Treg targeting Cit-P
Refractory RA (at least 3 MoA)
3 RA pts dosed & 3 Hidradenitis Suppurativa 0 SAE, DLTs or CRS
Grade 1 TEAs mainly, one Grade 2
Efficacy and PD analysis ongoing
#POS0034 #EULAR2025 @RheumNow https://t.co/Glw3NNFepF
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
If you successfully taper off DMARDs in RA patients in remission, do you risk bringing new joints in the mix?
Leiden post-hoc trial: these patients don’t do worse than those who never get off drug.
Drug-free remission tricky but new joints not a worry. #EULAR2025 @RheumNow https://t.co/QDxNRPN9f1
David Liew drdavidliew ( View Tweet)
First line TNFi in RA in 140+ pts vs Standard of Care
At 5 yrs outcome
OR drug free remission 2.2
But no longer significant at 10yrs
OR sustained remission 10yrs 1.91
OR single bioDMARDs 10yrs 2.64
Less 1% D2T
#Poster0027 #EULAR2025 @RheumNow https://t.co/sL2XCbxPbl
Aurelie Najm AurelieRheumo ( View Tweet)
Comparative efficacy of tofacitinib vs. adalimumab in RA - metanalysis of 9 RCTs, 24,643 pts finds Tofa signif superior to ADA for ACR20 (RR 1.28), HAQ-DI, VAS, but no difference in adverse events (RR 0.96) or DAS28-CRP improvement https://t.co/5mVY2Qvdms https://t.co/czxnlYHEAl
Dr. John Cush RheumNow ( View Tweet)
Ph 2 open label RCT TOFA in RA-ILD 52 wks
39pts 92% AE 8% 3 deaths FVC decline -69 ml
No diff between UIP, NSIP or antifibrotic
No control group
#POS0619 #EULAR2025 @RheumNow https://t.co/3lqEUfObG9
Aurelie Najm AurelieRheumo ( View Tweet)
Early PsA? Treat fast, treat hard.
The STAMP RCT showed that early secukinumab + MTX led to faster ACR50 and PASI90 responses vs standard care in a T2T strategy. By 12 months, outcomes were similar, but early SEC needed fewer escalations.
Abstract#OP0092
@RheumNow #EULAR2025 https://t.co/cAZTc9eN16
Jiha Lee JihaRheum ( View Tweet)
#OP0066 Danish registry study finds no increased risk of cancer recurrence with bDMARDs vs csDMARDs in RA patients with prior solid tumor in remission. IPTW-adjusted HR for any bDMARD: 0.92 (95% CI 0.38–2.21).
📉 TNFi, ,RTX also not associated with recurrence
@RheumNow #EULAR2025
Jiha Lee JihaRheum ( View Tweet)
In #InflammatoryArthritis, baseline depression was linked to ↑ presenteeism & ↓ QoL at baseline + 3mo, but not absenteeism. Data from 9-country study provide further evidence that mental health is key to supporting work outcomes in RA, PsA & axSpA.
@RheumNow #EULAR2025 #OP0028
Mrinalini Dey DrMiniDey ( View Tweet)
Worried about cancer risk with ts/bDMARDs in RA?
Real-world data from over 4,600 patients says: don’t be. No increased risk of cancer (incl. NMSC) for JAKi, IL6i, CD20i, or CTLA4-A vs TNFi in long-term registry follow-up.
Abstract#OP0065
@RheumNow #EULAR2025
Jiha Lee JihaRheum ( View Tweet)
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
Links:
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
Links:
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
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)
