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Seeing more or seeing too much? Ultrasound vs MRI in preclinical RA

Aurelie Najm, MD, PhD

Imaging in the preclinical phase of RA is moving fast—arguably faster than our ability to interpret what we are actually seeing.

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Day 4 EULAR Report

Jack Cush, MD

The last day in London was exciting as both the Late-Breaking abstracts and new EULAR guidelines were presented.

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RA-ILD in the Age of Treat-to-Target: Put the Probe on the Chest

Jiha Lee, MD

At EULAR 2026, speakers of the session “Catching Your Breath: Unravelling RA Associated Interstitial Lung Disease (ILD)” noted RA-ILD is one of the few outcomes not improving in the biologic era. Three abstracts reinforce that message and make the case for a practical, low-cost screening tool that is already in most rheumatologists’ hands.

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Renal Biopsies in SLE Dr. Andrea Fava reporting from EULAR 2026 in London. https://t.co/naCyEAutbb https://t.co/XgdiXY3hiO

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Dr. John Cush RheumNow ( View Tweet)
New: Classification Criteria and Recommendations in SpA ASAS and SPARTAN have updated their key classification criteria for axSpA. EULAR has also recently revised its recommendations on the role of imaging in the diagnosis and clinical management of SpA. https://t.co/YOWfwTkbqp
Dr. John Cush RheumNow ( View Tweet)
MRI as a novel biomarker in lupus The clinical abstract sessions at #EULAR2026 on diagnostic tools in lupus showcased interesting studies, including the use of MRI, as potential non-invasive biomarkers. https://t.co/TK2gqSxAg5 https://t.co/5Qj8KXWgub

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Dr. John Cush RheumNow ( View Tweet)
@RheumNow article further exploring the roe of lung ultrasound for RA-ILD screening as shown through 3 #EULAR2026 abstracts https://t.co/smN8hg51nj

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Jiha Lee JihaRheum ( View Tweet)

🏠 Take Home Messages from the early #axSpA session 🔺 Earlier diagnosis is possible and better 🔺 Early axSpA is not synonymous to mild 🔺 Longitudinally, early axSpA is heterogeneous 🔺 MRI has transformed the field ❗️Beware of pitfalls #EULAR2026 @RheumNow https://t.co/IhGQSxssyd

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Nelly ZIADE 🍀 Nellziade ( View Tweet)
Thoracic U/S for #RA-ILD screening? Multicenter study (n=272, Argentina/Denmark/Belgium): 86% sensitivity and 94% NPV. Accessible, no radiation, integrates into clinic flow. Time to build TUS into routine RA-ILD pathways? @RheumNow #EULAR2026 POS1265 https://t.co/FGH5iUstxa

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Jiha Lee JihaRheum ( View Tweet)
🏠 Take Home Messages from the early #axSpA session 🔺 Earlier diagnosis is possible and better 🔺 Early axSpA is not synonymous to mild 🔺 Longitudinally, early axSpA is heterogeneous 🔺 MRI has transformed the field ❗️Beware of pitfalls #EULAR2026 @RheumNow

Nelly ZIADE 🍀 Nellziade ( View Tweet)

#EULAR2026 Recommendations: Vasculitis -Confirm diagnosis with imaging and biopsy - Start GC early but with taper plan - For major flare again confirm dx and restart GC - Consider IL-6 or UPA - MTX may be option if biologics not available @RheumNow https://t.co/DqLZtW630y

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Jiha Lee JihaRheum ( View Tweet)
CT imaging in RA Body composition changes beyond BMI 489 RA vs 397 ctrl RA asso w/ -increased subcutaneous fat -increased intermuscular adipose tissue -poorer muscle quality Looks like it represent “hidden obesity” with more by fat redistribution and myosteatosis #OP0348

Aurelie Najm AurelieRheumo ( View Tweet)

And now does MRI do better than US at predicting RA progression in at risk pts? Short answer: No likely too sensitive! 130 anti-CCP+ symptomatic pts 36.9% progressed BL US positivity predicted progression HR 2.8 MRI showed prevalence of subclinical disease synovitis >80%

Aurelie Najm AurelieRheumo ( View Tweet)

Detecting subclinica tenosynovitis in pts at risk for RA: who does it better US or DixonMRI? 65 pts RA CSA, US detected only ~23% of cases identified by Dixon US misses most! But are they “real” tenosynovitis? MRI (5-min, no contrast) higher sens US higher spe Shall we do https://t.co/stsMRdj9eY

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Aurelie Najm AurelieRheumo ( View Tweet)
Lung US for RA-ILD screening Comparison with diagnostic scores 147 RA pts (68 ILD on HRCT) Asymptomatic cohort Sens 95.4% Spe 77.7% Risk scores alone performed poorly. Combining US + risk scores boosted sensitivity to 100% → promising low-cost screening tool alongside HRCT. https://t.co/7C4zClaxry

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Aurelie Najm AurelieRheumo ( View Tweet)
Can AI read 20 years of RA X-rays? And how much faster/better than us? 20 years ESPOIR cohort 7500+ joints RADAR algorithm 94–95% accuracy compared with expert readers 99% spe 93% sens #OP0344 #EULAR2026 @RheumNow https://t.co/8hFHCY4SaY

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Aurelie Najm AurelieRheumo ( View Tweet)
Can AI spot RA inflammation from a thermal hand scan? Cohort 100 RA pts AI model analysing thermal images detected US PD+ wrist inflammation AUC 0.87 Main features wrist temperature & heat-pattern With all due validation could this be the next mass screening tool for RA? https://t.co/2AzXj5yQJI

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Aurelie Najm AurelieRheumo ( View Tweet)
The axSpA classification has been revised with the 2025 ASAS SPARTAN criteria. 5 abstracts at #EULAR2026 Abstr OP0236, OP0100, OP0239, POS0190 and POS1341. The single most important change in the 2025 criteria: MRI is now the highest-weighted variable and what counts as a https://t.co/xg4R4xRH2D

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
SPARTAN-SSR: New quantitative criteria: BME in ≥3 consecutive slices OR any two of (BME, Erosion, Fat lesion each in ≥3 SIJ quadrants) or ankylosis in ≥3 halves achieves 88-96% sensitivity and 90-98% specificity across 3 cohorts. Precision #axSpA imaging. Abstr OP0100

Antoni Chan MD (Prof) synovialjoints ( View Tweet)

Which imaging test has the highest carbon footprint??? Think wisely before prescribing 🩻 #EULAR2026 @RheumNow https://t.co/36Ej8smWRd

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Nelly ZIADE 🍀 Nellziade ( View Tweet)
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