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How to properly use steroids in early RA

Janet Pope, MD, MPH, FRCPC

Guidelines differ on the early treatment of RA – ACR suggests not to use glucocorticoids (GC) and EULAR updated recommendations for RA treatment presented at #EULAR2025 continued to suggest early treatment with MTX and glucocorticoids. We do know that it is not easy to get a significant minority of RA patients off of prednisone.

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2025 update of EULAR recommendations on lupus nephritis

Md Yuzaiful Md Yusof, MRCP(UK), PhD

At the 2025 EULAR congress in Barcelona, Prof Dimitrios Boumpas presented a summary of the updated EULAR recommendations on the management of lupus nephritis (LN). The most significant change in the treatment paradigm of LN is that the historic standard of care (SOC) (i.e.

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EULAR 2025 - Day 1 Report

Jack Cush, MD

Wednesday was Day One at EULAR 2025 in Barcelona. Thousands from around the world gathered, eager to reunite at this international educational forum. Below are a few of my favorites from Day 1.

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Belimumab in SLE with Mucocutaneous or Vasculitis Findings

Jack Cush, MD

A post hoc analysis of a belimumab (BEL) inn systemic lupus erythematosus (SLE) study showed lupus mucocutaneous and vasculitic manifestations improve with BEL and standard care.

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2025 ACR Guideline for the Treatment of SLE

Jack Cush, MD

The ACR has released its 2025 Systemic Lupus Erythematosus (SLE) treatment guidelines and consensus-based good practice statements, applicable to children and adults with SLE. 

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Sometimes you hear: “PMR dose steroids don’t really matter” Errrrr… (You wouldn’t accept this steroid exposure in any other disease. Never) #EULAR2025 POS0139 @RheumNow https://t.co/o6w2RpaGBj

Links:

David Liew drdavidliew ( View Tweet)
#EULAR vs #ACR #RA #recommendations Do you agree that #ERA pts should receive #glucocorticoids @RheumNow #EULAR2025 @eular_org

Janet Pope Janetbirdope ( View Tweet)

Management of AAV: 1.High dose GC f/b reduced dose taper ‼️caution in pts w/severe renal dz and RTX induction. 2. RTX effective for induction and maintenance, best for relapses. 3.PLEX: in RPGN pts if accesible ⚠️ risk for infection. 4.Avacopan: for faster GC weaning. No https://t.co/kfZ4gM38KG

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Adela Castro AdelaCastro222 ( View Tweet)
Pearls on EGPA: 1. GC are mainstay for mild dz 2. Organ threatening/relapsing➡️CYP (RTX alternative) 3. W/o organ threatening➡️ anti-IL-5/IL-5R. 4. IL5i are less effective for ENT 5. Consider sx for nasal polyps. #EULAR2025 @RheumNow https://t.co/zoJEWxafsN

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Adela Castro AdelaCastro222 ( View Tweet)
“That is why this task force continues to say: nothing is better than methotrexate and glucocorticoids to start” - Josef Smolen, on RA treatment #EULAR2025 @RheumNow https://t.co/AbkgWS8tvH

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David Liew drdavidliew ( View Tweet)
#EULAR new #RA #recommendations J Smolen presents justification for #MTX +#glucocorticoids at onset do you agree? Diff from #ACR #EULAR #Recommendations II #EULAR2025 @RheumNow https://t.co/wqCX5HA87q

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Janet Pope Janetbirdope ( View Tweet)
Recommendations for RA management at #EULAR2025 - MTX [or other csDMARDs] and steroids still remain the first line- nothing beats that! - ofcourse minimize steroids! - rather than stopping meds at remission, reducing doses may be a better solution. Not much changed. @RheumNow https://t.co/NK5ejsgjWV

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Bella Mehta bella_mehta ( View Tweet)
#EULAR2025 Abstr#OP0324 Cohort study of #lupus nephritis in Greece showed Earlier GC Discontinuation (D/C) & flare protection post-D/C is associated with renal response, low disease activity & HCQ use at GC D/C. Membranous LN & recent diagnosis were assoc w early GC D/C @RheumNow https://t.co/agFgyG5eaS

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
What kills in GCA? Greek national prospective cohort, small numbers and no doubt some channeling bias, but: Steroids (absence of DMARD use) is more of a factor than CV disease in GCA mortality. With new options, all GCA pts should be on something #EULAR2025 POS0960 @RheumNow https://t.co/Wmvf6tEvaF

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David Liew drdavidliew ( View Tweet)
Stabilize the pts with HLH with steroids when still trying to figure out the diagnosis of #HLH/ #MAS Many drugs can be used...but important to balance infection risk with immunosuppression These are critical pts. Be vigilant.. #EULAR2025 @RheumNow https://t.co/id4ae3SWtj

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Bella Mehta bella_mehta ( View Tweet)
Treatment strategies for steroid free management of #relapsingpolychondritis 56 patients from a single center #POS0149 #EULAR2025 @RheumNow https://t.co/d4I56opS02

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Bella Mehta bella_mehta ( 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)

Single center study of 1538 #SLE pts found 2.2% w/ lupus mesenteric vasculitis (LMV) - 39 LMV episodes in 31 pts - 2/3 had Nausea, vomiting, diarrhea & abdominal pain (~15% peritoneal irritation) & had active Dz (renal, Skin, Heme). LMV responded to steroids & https://t.co/vXCpbiC60P
Dr. John Cush RheumNow ( View Tweet)
Early RA or undiff. arthritis (UA) shows initial hi-dose steroids have significantly better earlier outcomes, but lower doses have fewer early side effects. IMPROVED used high dose GC (60 mg/d tapered to 7.5 mg in 7wks). tREACH used lower dose GC (15 mg/d tapered in 10 wks to https://t.co/TkrGPb6EBZ
Dr. John Cush RheumNow ( View Tweet)
Steroids in Lupus Nephritis: No Free Lunch https://t.co/yPQuZcnRLH https://t.co/V8GZoslSqV

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Dr. John Cush RheumNow ( View Tweet)
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