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Upadacitinib: revisiting safety data in RA and GCA
For the last several years, conversations about JAK inhibitors have often started and ended with safety. The shadow cast by ORAL Surveillance has made clinicians more cautious and regulators more restrictive.
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Microbiome may hold key to methotrexate response in RA
Methotrexate (MTX) remains the cornerstone of rheumatoid arthritis (RA) treatment, yet it remains unclear as to how to predict who will respond to it. Two studies presented at ACR (Abstracts 2639 and 2643) suggest the answer may be hiding in the gut.
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Accelerated Aging in Rheumatic Disease: From Biology to Lifestyle Intervention
At ACR 2025, the session “27M02: Nutrition for Rheumatic Disease: Where Aging Biology, Sarcopenia, and Diet Intersect” invited the audience to view rheumatic disease through the lens of biological aging and to consider how nutrition and exercise can serve as integrative lifestyle interventions.
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A new approach in RA:
Rosnilimab targets & depletes PD-1–high pathogenic T cells, acting upstream of cytokine pathways. In Ph2b, all doses improved DAS28-CRP & ACR responses vs placebo, with durable efficacy & good safety.
@RheumNow #ACR25 Abstract#LB19 https://t.co/cIxi7NEu6C
Jiha Lee JihaRheum ( View Tweet)
#ACR25 Abstr#LB19 New T-cell therapy on the block! In Phase 2b RCT of #RA (~50% b/tsDMARD-IR), Rosnilimab, PD-1 agonist met its endpoint (DAS28-CRP) at WK12. Effective despite type of previous therapy. No safety concern/malignancy/death. To proceed to Phase 3 @RheumNow #ACRBest https://t.co/MecTYMpH0o
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Emery et al. Rosnilimab, selective T cell (PD-1high Tph/Tfh, Teff) monoclonal antibody in RA. Phase 2 RCT. 424 patients. 41% prior bDMARD. 69% CDAI LDA week 14. Week 12 ACR20 70%, ACR50 40%, ACR70 21%. @RheumNow #ACR25 Abstr#LB19 https://t.co/479q6COWvk
Richard Conway RichardPAConway ( View Tweet)
b/tsDMARD in RA + CKD (eGFR <60)
From >12K pts in CorEvitas:
- overall effective but 30% ↓ CDAI-emission (HR 0.71)
- Findings consistent across TNFi, IL-6i, ABA BCDT, JAKi
@RheumNow #ACR25 A#2640 https://t.co/UOP9ejZKoA
Jiha Lee JihaRheum ( View Tweet)
Secrets and Pearls in Rheumatology https://t.co/SwnlB8UbHO
@Janetbirdope pearls in rheumatology.
Sero negative inflammatory arthritis ? Or is it? Look at the toes for early signs of PsA.
In my clinic ITS inflammatory arthritis to determine etiology .
@RheumNow
#ACR25
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
#ACR25 Abstr#LB15 Tell #RA patients on methotrexate that eating high fibre diet is good for them! An RCT showed improved EULAR response vs PBO. Likely due to restoration of Th17/Treg balance @RheumNow https://t.co/NbwQFqJNho
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
CDAI appropriately guided therapy escalation in RA, but not for everyone. Treatment adjustments were less likely in pts with public or no insurance. Even data-driven care can fall short when access barriers persist.
@RheumNow #ACR25 Abstract#2616
Jiha Lee JihaRheum ( View Tweet)
Large Canada ICES dataset- DMARD use is not associated with adverse pregnancy outcomes. In pts with RA, SlE and other rheumatic diseases.
Abst#2627 #ACR25 @RheumNow https://t.co/T9Ll1FNjT7
Links:
Bella Mehta bella_mehta ( View Tweet)
#1748 Higher air pollution, esp PM2.5, linked to ⬆️RA disease activity and more flares in >1000 Korean patients. Each rise in PM2.5 significantly boosted DAS28, CDAI & joint counts.
Does cleaner air mean calmer joints?
@RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
US Electronic Health Record cohort 2000+pts
Incidence Heart Failure over 10 yrs 6.8%
HF asso w/
Older
Male
Lower eGFR
Hypertensive medication
Diabetes
TTMTS MTX, TNFi
Higher CRP
Probably surrogates for High Disease Activity...
How do we detect it?
Maybe not by using the https://t.co/s9SjEyk3WF
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Agrawal et al. Case study of tofacitinib + bDMARDs in refractory IA. 7 SpA, 2 RA, 1 JIA. Effective and safe. @RheumNow #ACR25 Abstr#2338 https://t.co/Y0B3W4csJX
Richard Conway RichardPAConway ( View Tweet)
In RA, “strong bones” can give false reassurance.
Pts with higher baseline BMD had faster bone loss, often tied to GC use and less osteoporosis treatment. Undermanagement, not biology, may drive decline.
@RheumNow #ACR25 Abstract#2244 https://t.co/N421ESAUy9
Jiha Lee JihaRheum ( View Tweet)
After melanoma, should RA patients stop DMARDs?
These VA data (n=644) showed no mortality signal, and trending to survival benefit with b/tsDMARDs
Provisos over methotrexate, invasive disease etc, but don’t hold off treating the RA because of melanoma
#ACR25 ABST2237 @RheumNow https://t.co/l9n1V6YVln
David Liew drdavidliew ( View Tweet)
Can a Fitbit track RA?
This Japanese clinic is using Fitbit data and have seen it correlate with CDAI across their RA clinic.
Maybe instead of asking about our patients mobility and sleep, we should be measuring it?
#ACR25 ABST2253 @RheumNow https://t.co/rg2SKgn7K2
David Liew drdavidliew ( View Tweet)
#1751 In early RA, higher disease activity, inflammation & older age linked to more ILD changes on machine-learning chest CT. Even subtle QCT abnormalities correlated with reduced lung function pointing to early inflammatory pathways in RA-ILD. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Are the clues of RA there in the EMR, before the diagnosis is made?
Jina off-the-shelf AI with subsequent retraining found the digital fingerprint of RA in @MayoClinic medical notes, years before formal diagnosis.
The clues are there
#ACR25 ABST2260 @MyasoedovaElena @RheumNow https://t.co/onGlKUmefd
David Liew drdavidliew ( View Tweet)
In the CLOSE-UP study of UPA in RA
- 61% in remission with responses sustained to 24 mo
- Benefit consistent irrespective of prior DMARD use
- No new safety signals
@RheumNow #ACR25 Abstract#2281
Jiha Lee JihaRheum ( View Tweet)
