Is there a higher risk of cancer that comes with the disease? Or with the treatments? So many confounding parameters, such as disease duration, disease state, and disease activity come into play. A promising session explored comorbidities in Rheumatoid Arthritis, in particular cancer and cardiovascular events. Here are my takeaways.
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Day 2 was a full agenda for those attending EULAR 2025 in Barcelona with sessions on the management of RA, Behcets, Lupus and Hand Osteoarthritis. Clinical overviews on MAS, Ehlers-Danlos, Difficult to treat RA and PsA offered a wide variety of options to rheumatologists. Here are a few interesting presentations from today.
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Connective tissue diseases (CTDs) and interstitial lung disease (ILD) represent a challenging intersection of systemic autoimmunity and progressive respiratory impairment. Research presented at EULAR 2025 continues to highlight the importance of CTD-ILD and the evolving landscape of therapeutic options for patients with autoimmune ILDs.
David Liew
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Is RA just one disease?
No, & increasingly more efforts to subgroup RA on diff levels
Simple approach - derived phenotypes map (independent of ACPA):
- to broad histopath
- to MTX response
Omics is good, but still need to do the simple stuff better!
#EULAR2025 OP0328 @RheumNow https://t.co/a8Vl7Kcjso
Janet Pope
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#neuromodulation in #rheumatoid #arthritis
What is it?
👇
Autonomic & immune system interaction
Who seeks this Rx?
desperate pts w pain
No Rx left
Interested in technology
#EULAR2025 @RheumNow @eular_org
#D2T #RA https://t.co/XWWFiUK6Em
Janet Pope
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#vagal & #splenic #nerves most studied
In #immune #system interaction
#PNS can detect #inflammation
use in #D2T #RA w active disease ?
Key factors in #neurostimulation - many
#EULAR2025 @RheumNow @eular_org
#D2T in #RA session https://t.co/tCgpGtI5z2
Janet Pope
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#Vagal #nerve #stimulation
Hand held device
#BDMARD failure
Plausible - improved pro inflammatory cytokines
wears off benefit if stopped
Attenuates in ~half over yrs
Open label uncontrolled
@RheumNow @eular_org #EULAR2025
Session D2T-RA https://t.co/98K5gwasHv
Janet Pope
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#RCT of #vagus #nerve #stimulation in #bDMARD-IR #RA Pts
RESSET RCT
+RA #RCT w #VNS
But low response with stat significance
ACR20 1/4 sham vs 1/3 VNS
Would add on to new SoC? 🤔
#EULAR2025 @RheumNow #eular_org
#D2T- RA-session https://t.co/tR1pLPBr74
David Liew
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So we used to get taught about bimodal age distribution of RA onset - young people and old people.
Actually, it’s early middle age where RA diagnoses have now grown globally over 30y - right in peak productivity
Global Burden of Disease data
#EULAR2025 OP0240-HPR @RheumNow https://t.co/8yyrex00yy
Janet Pope
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cool stuff at #EULAR2025
RESET #RCT - #vagal #nerve #stimulation #VNS vs sham in
#RA w 1or >1 #bDMARD-IR
N=242
D/C bDMARD,
on #csDMARD
#RA 12 yrs, 10SJC 12TJC
2.6 b/tsDMARD failure
Wk12 EULAR good/mod response
61v 42%
Sham▶️goes VNS ✅data=
@RheumNow @eular_org abst#OP190
Janet Pope
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#polyrefractory #RA
=
failed all classes in #rheumatoid #arthritis
+inflammatory #arthritis
Longer disease duration
Late RA Rx
+power Doppler in POCUS
⬆️no refractory
BMI
Fibromyalgia - pain
⬇️SJC, less DAS , rapid X-ray progression
#EULAR2025 @RheumNow #D2T #RA https://t.co/1sPwf3Qa3m
Janet Pope
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#Cancer is not ⬆️in JAKi vs #bDMARDs in
#rheumatoid #arthritis
When adjusted for #confounders
#JAKPOT data
Now you see it (unadjusted ⬆️risk)
Now you don’t (adjusted =#malignancy)
JAKi vs bDMARDs in RA
EULAR2025 @RheumNow @eular_org
#JAK it out! new perspective on JAKi https://t.co/wCQ3dHNAVa
Janet Pope
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#D2T #RA ~20%
#Polyrefractory 3%
Many reasons for d/c ing #Rx - D2T
AEs
Intolerance
Chronic pain
Etc
My approach is different depending on reasons why drugs were d/c
Ie ?obj inflammation vs pain or intolerance
@RheumNow @eular_org #EULAR2025
#whatmakes D2T RA difficult https://t.co/AL6TMVJIk9
Janet Pope
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Would you use #CAR-T in #polyrefractory #RA
#EULAR2025 @RheumNow @eular_org
POS0150: From 12 RA registries, JAKi starts fell by ~13% after FDA safety alerts.
Tofa & bari took biggest hits; upa growth slowed but offset losses.
Real-world prescribing adapts—but doesn’t abandon.
@RheumNow #EULAR2025 https://t.co/QZ5haW2vhX
Aurelie Najm
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Ultrasound for ILD detection in RA 🫁
Sens 88.6
Spe 92.8
NPV 91.4
PPV 90.7
While if abnormal or high suspicion, HRCT should be the reference, I see this as an interesting tool in clinics for quick screening
POS0180 #EULAR2025 @RheumNow https://t.co/pUy0ki7Y6S
Janet Pope
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#HOT topic
Lung 🫁 #ultrasound for #RA #ILD
#LUS B lines vs HRCT
Single site 🇫🇷 study
V sensitive & specific
🤔needs standardization & comparison in other groups
Abst#POS-180
#EULAR2025 @RheumNow @eular_org https://t.co/PwGE4rgk40
Bella Mehta
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Software enhances treat to target outcomes for #RA GoTreatIT
P0S0750 ##EULAR2025 @RheumNow https://t.co/GpihWr5KLA
Aurelie Najm
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Does having a synovitis in a specific joint predicts Rx damage in that same joint?
Yes
Can US synovitis predict Rx progression better than clinical synovitis at the joint level?
Not really
At 1 year, only US synovitis is, both B-mode and Doppler ass w/ Rx prog, in particular https://t.co/Wu6dDqIUYn
