Highlights from today included presentations on imaging in vasculitis, a debate on whether to treat high risk pre-clinical RA, and EULAR Recommendations on a) Treatment of interstitial lung disease (ILD); b) Physical Activity in people with arthritis; and c) EULAR disease activity score for antiphospholipid syndrome and d) the management of SLE nephritis. Below are a few others that caught my eye today.
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At a EULAR 2025 session titled “What makes ‘Difficult-to-treat RA’ so difficult to treat? And what can we do?”, Drs. Paula David and Dennis McGonagle introduced the emerging concept of polyrefractory rheumatoid arthritis (RA), a term now being used to describe a subset of patients who have failed to respond to five or more biologic or targeted synthetic DMARDs. This new classification, derived from recent multinational registry data, represents a significant step in refining our understanding and management of the most treatment-resistant forms of RA.
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New work presented at the 2025 annual EULAR congress in Barcelona focuses on the recombinant zoster vaccine (RZV), which contains recombinant glycoprotein E – the major target of CD4+T-cells.
Bella Mehta
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Low disease activity more difficult to achieve in vulnerable populations.
All rheumatic diseases - #RA #PsA #AS
initiating DMARDs takes longer in these population
#EULAR2025 @RheumNow https://t.co/voIivshKRt
Adela Castro
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👁️Uveitis in axSpA:
-Up to 40% can present before SpA dx
-NMA of 44 RCTs showed tx with TNFi, JAKi and IL-17i protective effects against uveitis
-Low rates of uveitis in axSpA pts on BIME trials suggests its possible beneficial effects.
#EULAR2025
@RheumNow https://t.co/mPuSMnD1Zs
Janet Pope
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1/3 of #ERA pts poor
Outcomes despite controlled disease!
2 #RCT with T2T in early #RA
#CARERA
👇
persistent impact
⬆️TJC, comorbidities
⬇️SJC, CRP, global, HAQ,
F>M
⬆️disease durat’n
▶️
⬆️ b/tsDMARDs despite =diseaese vs others
?overRx
OP0330 #EULAR2025 @RheumNow
@eular_org
KORAIL cohort: new RA-ILD progression model (inc. DLCO, ILD pattern/extent, anti-CCP, ± KL-6) stratified risk with high sensitivity & specificity. Adding KL-6 boosted AUC to 0.75.
A step toward personalised care in RA-ILD.
@RheumNow #EULAR2025 #OP0328 https://t.co/AHqNFw40gk
Aurelie Najm
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E3N cohort 78000+ women >30yrs follow up
698 incident RA cases)
In non smokers, RA asso w/
-tall at birth HR=1.55
In smokers, RA risk associated w/
-prematurity HR=1.63
-in utero exposure to tobacco HR=1.83 (ns)
#EULAR2025 @RheumNow POS0226 https://t.co/xC3k3kiKsZ
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 https://t.co/Txvr62UpWZ
In CareRA pooled analysis, 1 in 3 early RA pts had persistent impact (pain, fatigue, HAQ) despite improved inflammation. Female sex, longer symptom duration & low CRP were predictive. Pts more often escalated to b/tsDMARDs → risk of overtreatment?
@RheumNow #EULAR2025 #OP0330
David Liew
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Some RA-ILD is less of a worry, some is critical. How do we stratify?
Great modelling work from Korea & @jeffsparks - model stratifying really well, even without KL-6.
We need to do this more, so we can go really hard early when we need to.
#EULAR2025 OP0329 @RheumNow https://t.co/i2djatO3F2
David Liew
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We can control inflammation in RA, but some pts still struggle with disease impact, despite improving with bDMARDs:
- lower inflamm
- higher comorbidities
Doesn’t necessarily map to fibromyalgia dx
Beyond Rx, this is the critical question
CareRA/2000
#EULAR2025 OP0330 @RheumNow https://t.co/Th3smMgtVb
David Liew
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Rheumatoid nodules are fascinating. If methotrexate nodulosis is a factor, why has their rate gone down when MTX use has gone up?
Environmental factors? Something else? It’s still a bit of a mystery - we still don’t know why
Christopher Edwards #EULAR2025 @RheumNow https://t.co/8LJYNRybve
David Liew
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Maybe the pathogenesis gives us a clue on how to target things?
Possibly the treatments which take down synovitis might not always help with nodules
Christopher Edwards #EULAR2025 @RheumNow https://t.co/T6QHCS8709
David Liew
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@RheumNow So rheumatoid nodule treatment might target some of that pathophysiology. Rituximab, abatacept, or JAKi?
And while surgery often isn’t great (plus they often grow back), definitely an option for some.
Christopher Edwards #EULAR2025 @RheumNow https://t.co/sFWnQN8uC4
David Liew
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Rheumatoid vasculitis: what to look for and how to find it
#EULAR2025 @AshimaMakol @RheumNow https://t.co/ZCUXgOr1dH
David Liew
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How to treat rheumatoid vasculitis
#EULAR2025 @AshimaMakol @RheumNow https://t.co/A8oqPd6bJx
David Liew
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Should we still be worried about lymphoma developing in RA patients?
Incidence has plummeted with modern therapy, although still a small risk. TNFi and other bDMARDs don’t seem to confer any real risk.
So what should our approach be?
Karin Hellgren #EULAR2025 @RheumNow https://t.co/9ZodpojSaz
Aurelie Najm
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KORAIL cohort
Prediction model for progression of RA-ILD at 3 years
A combination of classic clinical parameters incl DA , ILD pattern, ACPA KL-6 with AUC 0.75
HR=34 for progression in High risk group
Need validation in an external cohort
@RheumNow #EULAR2025 OP0329 https://t.co/LIvn1JCXPq
