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Introducing Polyrefractory RA: A New Frontier in Difficult-to-Treat RA
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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In 30 axSpA pts (mean age 42 yrs, BASDAI 3.5, BASFI 2.8, BASMI 2.0, chest expansion 4.5 cm), an 8-wk individualized exercise (cardiorespiratory + trunk strength via cardiopulmonary exercise testing [CPET] & David Back Concept [DBC] devices) ↓ trunk strength deficit 14.1% & https://t.co/505cCEOzu1
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
In 4,121 SpA pts (mean age 45y; 61% male), composite scores w/ joint counts (DAPSA, DAS28, DAS44) best discriminated peripheral arthritis activity vs PGA & SJC alone. All scores had excellent construct validity; CRP weakest. Composite indices may optimize SpA assessment. https://t.co/oM97BEkkH5
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
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
Janet Pope Janetbirdope ( View Tweet)
Who/When to Treat Clinically Suspect Arthralgia
Dr. Jack Cush discusses risk stratification in Clinically suspect arthralgia; referencing EULAR2025 abstracts OP0004 (ALTO study) and OP0325 (long term Followup of ARRIA)
https://t.co/FCO80mdHLg https://t.co/sX9u8mUoak
Dr. John Cush RheumNow ( View Tweet)
#EULAR2025 Abstr#OP0281 Not just shredding the weight but now also the pain! Another potential benefit of GLP-1 agonists - reducing symptoms of patients with Fibromyalgia. Propensity matched analysis using TrinetX database showed reduction on opiates, fatigue and pain @RheumNow https://t.co/oh6ecJmM5e
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Depression and anxiety in PsA is higher and has more consequences than in general population
Swedish and Danish clinical registers 23000+ PsA pts
HR 1.4 specialised psychiatric out/ inpatient care vs. general pop
HR for psychiatric in patient care numerically higher but ns.
No https://t.co/qduMcwGK0S
Aurelie Najm AurelieRheumo ( View Tweet)
Prediction of PsA in PSO pts: does it work?
First predictive model using mainly clinical data and labs extracted from primary care
Performs well in the cohort it was trained w/ but not in validation cohort.
Often an issue with prediction models!
Needs more granularity than https://t.co/5cVgqfd4fX
Aurelie Najm AurelieRheumo ( View Tweet)
🔍MRI lesions in early axSpA vs non axSpA with chronic back pain:
-Data from SPACE cohort
-n 318 (214 axSpA vs 108 non-axSpA).
-Baseline imaging (CR and MRI) and at 2y f/u
-Minimal progression on CR in both early axSpA and non-axSpA CBP.
-On MRI, significant increase in the https://t.co/m5YOAiFUz1
Links:
Adela Castro AdelaCastro222 ( View Tweet)
PsA asso w/ higher risk of preterm births in women
Scandinavian registries
688 PsA pregnancies
8% preterm births vs. 4.5% general population OR 1.8
16.4% if bDMARD combination OR 4
3.1% if bDMARD monotherapy OR 0.7
bDMARDs combo probably a surrogate of high disease activity
Aurelie Najm AurelieRheumo ( View Tweet)
Among 200 #axSpA pts from Rheumazentrum Ruhrgebiet
🔴Performance tests (SPPB)
were associated with
🔴Global functioning and health (ASAS-HI and other PROs)
What does this mean?
Improving physical performance could enhance PROs & QOL
#EULAR2025
POS#
@RheumNow
@XBaraliakos https://t.co/P3Q5NDvtoj
Nelly ZIADE 🍀 Nellziade ( View Tweet)
What's the difference between PIPsA & NIPsA?
(Persistent Inflammatory confirmed by IMAGING
vs. Non inflammatory PsA)
🔹️Cross-sectional study
🔹️517 pts under b/tsDMARDs
🔹️10.3% D2T
🔹️57% PIPsA / 43% NIPsA
👇 Distinct phenotypes 👇
OP0176
#EULAR2025
@rheumnow https://t.co/YGHpbeE6ws
Nelly ZIADE 🍀 Nellziade ( View Tweet)
What happens to the prevalence of D2T PsA if we use different parameters in its definition?
Data from 5 Nordic registries including 13,872 patients showed a variation from 37% (less stringent) to 0.6% (more stringent)!
OP0177
#EULAR2025
@rheumnow https://t.co/QbF15t3Zrz
Nelly ZIADE 🍀 Nellziade ( View Tweet)
🚨Diagnostic delays are real in axSpA:
-Can lead to more extra-msk manfieststions (EMMs) in PsA and axSpA.
-Increases disease burden and productivity losses.
-EMMs can present before articular sx
-Uveitis and IBD associated with longer dx delays.
-Diagnosis has improved since https://t.co/rWMwG7Ewwe
Links:
Adela Castro AdelaCastro222 ( View Tweet)
A machine learning (ML) model using electronic medical record (EMR) data from 396,000 Mayo Clinic primary care patients identified undiagnosed psoriatic arthritis (PsA) with area under the curve (AUC) 79.6%. Key predictors: psoriasis, joint pain, tenosynovitis, https://t.co/VsYevnJEjK
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
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
Mrinalini Dey DrMiniDey ( View Tweet)
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 drdavidliew ( View Tweet)
🌍Patients w RMDs across 🇫🇷🇳🇱🇨🇭🇹🇷 face different barriers to physical activity:
💶Cost =barrier in 🇳🇱
⛈️Weather =barrier in 🇹🇷
🧑⚕️HCP support =key in 🇫🇷
🏃Active transport & knowledge =enablers in 🇨🇭
Tailored physical activity interventions needed.
@RheumNow #EULAR2025 #OP0382-HPR https://t.co/lk7fwDHDe7
Mrinalini Dey DrMiniDey ( View Tweet)
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
Links:
David Liew drdavidliew ( View Tweet)
PsO + recent arthralgia—but no PsA. Treat or wait?
🧠 18% developed PsA in 3 yrs, most in year 1
🔍 Predictors: tender joints, disability, enthesis erosion
Consider early rheum input for these patients
Abstract POS0299 @RheumNow #EULAR2025
Jiha Lee JihaRheum ( View Tweet)
