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Strike First: TNFi vs. Step-Up Therapy in Early Peripheral SpA
The approach to the treatment of peripheral SpA has been the same for a long time. The guidelines recommend starting with NSAIDs, escalate to conventional synthetic DMARDs, typically sulfasalazine or methotrexate and reserve biologics for patients who fail those. According to a new phase 3 trial presented at EULAR 2026, there may be a different way to approach this.
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Strike First: TNFi vs. Step-Up Therapy in Early Peripheral SpA
The approach to treating peripheral SpA has remained the same for a long time. The guidelines recommend starting with NSAIDs, escalating to conventional synthetic DMARDs, typically sulfasalazine or methotrexate, and https://t.co/iEqzp6FStv
Dr. John Cush RheumNow ( View Tweet)
Strike First: TNFi vs. Step-Up Therapy in Early Peripheral SpA
The approach to the treatment of peripheral SpA has been the same for a long time. The guidelines recommend starting with NSAIDs, escalate to conventional synthetic DMARDs, typically sulfasalazine or methotrexate and https://t.co/pG9dGSfgcP
Dr. John Cush RheumNow ( View Tweet)
Who does better in active #RA
b/tsDMARD naive?
Pt choice TNFi or JAKi
OR
Pt randomized to
TNFI or JAKi?
Strangely or not
PT choice did better
✅with satisfaction ~maybe expected
✅better retention on chosen #Rx
🤔unexpected
another arm in #RCTS?”
#EULAR2026 @RheumNow
OP0204 https://t.co/7qx5Rqq6a7
Links:
Janet Pope Janetbirdope ( View Tweet)
A bridge to uncertainty?
large #RCT of #baricitinib V #TNFi
In
Active #RA w #DVT/#VTE risk factor(s)
Sl more VTE, #infection #SIE on #Bar
NO increase #MACE
Sl ⬆️#malignancy
#VTE rate exceeded upper limit of a priori #CI
So is this good news or not?
#LB0009 @RheumNow #EULAR2026 https://t.co/CIfU7TL2TE
Janet Pope Janetbirdope ( View Tweet)
What’s new with the 2026 update of reco for vax in AIIRD?
Vaccinate as soon as possible
Non-live vaccines are safe
Hold MTX for upto 2wks to inc vax yield
Strong reco for RZV
Catch-up vax for HPV in SLE
Rotavirus vax for newborns exposed in utero to TNFi
@RheumNow #EULAR2026 https://t.co/RZbyvAcYRI
Links:
sheila RHEUMarampa ( View Tweet)
Is the risk of uveitis comparable between infliximab sc and adalimumab in patients with r-axSpA and prior AAU?
Yes! POS 1347
Multicenter randomised open-label trial
N=56
#EULAR2026 @RheumNow https://t.co/kP7ropPkpC
Nelly ZIADE 🍀 Nellziade ( View Tweet)
#EULAR2026 LB0009 It’s like opening Pandora’s box! 2 Open Label RCTs Baricitinib vs TNF-i in RA & =>1 VTE risk:
-VTE:Non-inferiority of BARI wasn’t met (in line with JAK profile)
-No increase in MACE/Cancer (opposed to Oral-Surveillance: TOFA & =>1 MACE risk) @RheumNow #EULARBest https://t.co/nNwtJ3LbkD
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
LB0001: Bimekizumab SUPERIOR to risankizumab on ACR50 in active #PsA 49.1% vs 38.4% (p=0.0078). First ever H2H biologic superiority on joints in PsA. #Bimekizumab @RheumNow #EULAR2026 https://t.co/6waepYs9RK
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#EULAR2026 LB0002 More great news for dual IL17A and -F blockade. An open label Phase II study of Sonelokimab, a novel IL-17A- and IL-17F-inhibiting Nanobody'-3 in #axSpA: clinical efficacy, improvement in PROM and imaging inflammation. Looking forward to the RCT phase @RheumNow https://t.co/Xtxa8fALzN
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Abstr LB0009
Baricitinib vs TNFi in RA patients enriched for VTE risk. 3,640 patients. 3.7 years median follow-up.
VTE: HR 1.61 (95% CI 0.97–2.66)
non-inferiority not demonstrated
MACE: HR 1.06 no cardiovascular excess
Serious infections: HR 1.32 (p<0.05)
@RheumNow https://t.co/NSNRJi9B4r
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Abstr LB0009
Baricitinib vs TNFi in VTE-enriched RA. 3,640 patients. 3.7 years.
Safety endpoints
VTE HR 1.61 non inferiority not met
Serious infections HR 1.32 (p<0.05)
MACE HR 1.06 reassuring
@RheumNow #EULAR2026 https://t.co/nR6TMowlYS
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
BARI vs TNFi in VTE-enriched #RA pts (RA-BRIDGE + RA-BRANCH, n=3,640, ~3.7 yrs follow-up): VTE non-inferiority not met (HR 1.61, CI 0.97–2.66).
But absolute rates low (2.5% vs 1.7%) and MACE was similar (HR 1.06). Serious infections ↑ with BARI. @RheumNow #EULAR2026 LB0009
Jiha Lee JihaRheum ( View Tweet)
#OP0209 #EULAR2026 SPECIFI-RA
Balinatunfib, oral selective TNFR1 inhibitor designed to preserve TNFR2 signalling in RA. Phase 2b trial missed primary ACR20 endpoint, but 200mg QD arm showed signals for higher ACR50, ACR70 and DAS28 low disease activity & reduced IL-6. @RheumNow https://t.co/emxNQy0cPx
Mrinalini Dey DrMiniDey ( View Tweet)
Data of #Rituximab
In #SARD-ILD
Small N of #RA-#ILD pts
I think data are sufficient as #RWE of #RTX in RA-ILD
✅benefits in other #CTD ILD
✅benefits in #rheumatoid #arthritis
#EVER-ILD #RCT
HOT #RA-ILD topic June 5
#EULAR2026
@RheumNow https://t.co/61MbsnNsaf
Links:
Janet Pope Janetbirdope ( View Tweet)
#OP0204 #EULAR2026 Shared decision-making in practice! BACH study tested “treat by choice” in RA. Patients preferred oral JAKi over SC TNFi (55% vs 45%)
Importantly, own choice led to higher treatment satisfaction, better drug survival & fewer adverse events. @RheumNow #EULARBest https://t.co/iI1n2OGzqY
Mrinalini Dey DrMiniDey ( View Tweet)
Key messages in the tx of ax/p-SpA:
>csDMARDs only effective in pSpA
>consider individualized treatment for bDMARDs and JAKis
>Cycling TNFi equally effective to switching
@RheumNow #EULAR2026 https://t.co/oeO3BxmYYo
sheila RHEUMarampa ( View Tweet)
What b/ts DMARDs are effective and not effective in axSpA?
Prof. Astrid van Tubergen presents this very informative summary slide summarizing treatment in axSpA.
@RheumNow #EULAR2026 https://t.co/5udGPB1Hrr
Links:
sheila RHEUMarampa ( View Tweet)
Not just ticking boxes!
Prof. Rudwaleit on the revised 2025 ASAS/SPARTAN criteria for axSpA
What’s new?
Providing a stem so criteria will be applied only if w/SpA dx, not just imaging
MRI:active inflamm + structural lesions
Some SpA features omitted
@RheumNow #EULAR2026 https://t.co/NCV0EFvjYa
Links:
sheila RHEUMarampa ( View Tweet)
Gecacitinib (pan-JAK inhibitor) vs placebo in radiographic #axSpA ASAS40 51.9% vs 12.9% (p<0.0001) at 16 weeks. ASAS20 69.2% vs 21.2% (p<0.0001). Pan-JAK inhibition showed efficacy in TNFi-experienced patients. Abstr OP0240 @RheumNow #EULAR2026
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
