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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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.
Mimics of ANCA-associated vasculitis: How can we tell?
With increased disease awareness and more regular, accessible testing for anti-neutrophil cytoplasmic antibodies (ANCA), ANCA-associated vasculitis (AAV) has become an increasingly recognized clinical entity in rheumatologic https://t.co/LYRk0rHlzx
#1725 Functional NOTCH4 variants contribute to vasculopathy & fibrosis in SSc, particularly in African-American patients
NOTCH4 hyperactivation disrupts angiogenesis & drives EndoMT; inhibition (including with FDA-approved Nirogacestat) restores vascular repair @RheumNow #ACR25
Brian Jaros, MD
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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
David Liew
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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
Brian Jaros, MD
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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
#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
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
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
Brian Jaros, MD
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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
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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
Gabriela Martinez Zayas, MD
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The differential diagnosis for CNS vasculitis is BROAD. Keep in mind it’s mimics @RheumNow #ACR2025 https://t.co/ASWr6zm5eQ
David Liew
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In case there was any doubt:
GCA leads to ischemic vision loss
PMR does not
#ACR25 ABST0753 @RheumNow https://t.co/mCS9B4Flgl
David Liew
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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
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
Brian Jaros, MD
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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
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
Richard Conway
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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
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


