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When you don’t use anti-fibrotics in RA-ILD

Richard Conway, MBBChBAO, PhD Nov 08, 2026

In the management of RA-ILD, we are in a curious situation where we have become polarised in two different directions: aggressive treatment of all patients with combination therapies of biologic agents and anti-fibrotic drugs, or a “wait and see” approach. It is in this setting that the results of Abstract 0448 piqued my interest.

#ACR26 @RheumNow Ab#0868 RENOIR Phase 2B Trial - translatanalysis of blood/syn tissue Rosnilimab targets PD-1 receptor in RA No change in total T cells, but potently reduces (>90% at highest doses) pathogenic T cells in blood cont 12w after dose, reduces pro-inflamm serum biomark https://t.co/pfwU3pXZ5z

Moura et al. (RISE GLP-1 RA/PsA cohort): Every 5% weight decrease after GLP-1 initiation was linked with lower pain and patient global scores in RA/PsA.@rheumnow #ACR2026 Abstract#0867

Moura et al. (RISE GLP-1 RA/PsA cohort): Among RA/PsA patients starting GLP-1 therapy, each 5% weight reduction was associated with a 0.30-point RAPID3 decrease and 14% greater odds of clinically meaningful improvement. @rheumnow #ACR2026 Abstract#0867 https://t.co/uJt28tVPhI

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Moura et al. (RISE GLP-1 RA/PsA cohort): When a patient on a GLP-1 says their joints feel better, how do we interpret RAPID3? Data link weight reduction with lower RAPID3 in RA/PsA. @rheumnow #ACR2026 Abstract#0867

GLP-1 weight loss improve RA/PsA symptoms? RISE (16.8K pts): each 5% ↓ weight ↓0.30 RAPID3 (MCID 3.5) ↑ odds of RAPID3 MCID (aOR 1.14; 95% CI 1.07-1.21). ↓ pain, PtGA > function Weight loss: potentially modifiable factor to improve PROs in RA/PsA. A#0867 @RheumNow #ACR26

Are we overlooking weight management in RA and PsA? #ACR26 Abstract 0867: Each 5% weight loss after GLP-1 RA initiation was linked to 14% higher odds of meaningful RAPID3 improvement. Beyond DMARDs: weight management deserves attention. Association ≠ causation. @RheumNow https://t.co/LY8wCO7w4g

It's time for the Plenary at #ACR26! First up, GLP1 data in IA: In 1880 RA/PsA patients with paired data, each 5% weight loss after semaglutide/tirzepatide was assoc with 14% higher odds of clinically meaningful RAPID3 improvement. #0867 @Rheumnow

#ACR26 @RheumNow Ab#0867 GLP-1 in RA/PsA McCormick, @RADoctor RISE pts initiating GLP-1 Rx, retrospective from 2018-2024. Bean BMI 35.4 at initiation, basleine RAPID3 13.8 Mean wt reduction 15.6 lb at 12mo, RAPID3 reduc 0.3 pt Each 5% decr in body wt assoc w aOR 1.14 https://t.co/kTrfEWmF0n

Moura et al. Weight loss follwoing GLP-1 associated with significant improvements in PROs inc RAPID3 in RA and PsA @RheumNow #ACR26 Abstr#0867 https://t.co/CVNkvWn8MZ

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Patients aren’t late. The diagnosis is. Indian cohort of 274 patients with SpA (208 axSpA, 38 PsA, 24 enthesitis-predominant): ⏱️ Symptom onset to first healthcare visit: median 30 days ⏱️ First visit to rheumatology: median 730 days ⏱️ Rheumatology to diagnosis: median 0 days https://t.co/0YEWNWyvb3

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IBD-SpA treatment: -Identify domain -Rule out other etiologies (ie. infection) when presenting with acute monoarthritis while pt on treatment for IBD. -Combination therapy may be necessary and no emergent safety signal. #ACR26 @RheumNow https://t.co/85Nmto4Wvr

Enteropathic SpA vs matched axSpA (38 each) on sacroiliac MRI: inflammatory lesions were similar, but erosions were more frequent in several joint regions (for example 31.6% vs 15.8%) and ankylosis in the upper posterior joint (9.9% vs 3.3%). Key finding: IBD associated https://t.co/IRfGrMnCkn

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Ph2 JASMINE study: High dose Nipocalimab 15mg/kg IV met primary endpt of achieving SRI-4 resp at wk 24 vs. PBO More pts in the high dose grp were able to reach a GC taper </=7.5mg/day vs. PBO No new safety signals, Nipo well-tolerated. @RheumNow #ACR26 ABS0875 https://t.co/y9kezwgGJ7

A national psoriasis registry 2002 to 2022: 2,251 biologic treated psoriasis patients without PsA, of whom 13.5% became difficult to treat after failing two biologic classes. Key finding: difficult to treat psoriasis was associated with a higher risk of incident PsA (adjusted HR https://t.co/KBZq4fAYem

https://x.com/synovialjoints/status/2119436181876183112/photo/1

Rheumatoid Dis in Art #ACR26 Pierre Renoir - painting w RA, dx at 47 yo Represents self-efficacy, exercises and assistive equipment Did not paint his pain or deformity, continued to paint @RheumNow https://t.co/w5Z7Er4vB8

Does GLP-1–associated weight loss improve PROs in RA/PsA? Abs 0867: Each 5% weight loss associated with: • RAPID3 ↓0.30 • RAPID3 MCID: aOR 1.14 (95% CI 1.07–1.21) • Pain ↓0.19 • PtGA ↓0.12 • Function ↓0.04 #ACR26 @RheumNow https://t.co/0axzbElFGU

https://x.com/AkhilSoodMD/status/2119429742751330590/photo/1

RA-ILD: what's the best b/tSDMARD? this Spanish multicenter observational cohort looked at abatacept vs JAKi - no difference so many analyses, the same feeling persists: disease control is what matters the method is of secondary importance at best ABST0838 #ACR26 @RheumNow https://t.co/qsEUfqCGLY

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With bDMARD taper, surely we need predictive biomarkers to go forward OPTIBIO trial🇪🇸 first 2y Biomarkers (VSIG4, anti-IFNg) actually predicts flare better than baseline DAS28 (and porque no los dos) We need to see more of this ABST0131 #ACR26 @RheumNow https://t.co/auAg5wl2CD https://t.co/Oktu1TNVSL

Stumble and had to sit down to recover? That is a fall!! Per WHO Fall = inadvertently coming to rest on the ground or a lower level) Falls underreported, and arthritis x2 the risk. Ask about falls and use <20-second tests to measure mobility objectively @RheumNow #ACR26 https://t.co/lzRSTdttew

https://x.com/JihaRheum/status/2119424522025664640/photo/1

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When you don’t use anti-fibrotics in RA-ILD

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