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      A new player is entering the IL-23 arena — and it’s a tablet! Icotrokinra (ICO), a first-in-class peptide that binds and blocks the interleukin-23 receptor (IL-23R), is showing encouraging efficacy and safety across a range of psoriasis (PSO) and psoriatic disease (PsD) studies.
      After several failures of therapies in Phase 3 trials of Sjogren’s disease (SjD) over many years, all hope is not lost! At this year’s ACR25 Convergence Conference in Chicago, not one but two drugs presented their efficacy and safety data in patients with moderate to severe disease activity as defined by ESSDAI score ≥ 5 points.
      At ACR Convergence 2025, abstract 1039 entitled, “Global Cost-Effectiveness and Equity in CAR-T Cell Therapy for Rheumatoid Arthritis” adds a critical dimension to the growing enthusiasm around cellular therapies in autoimmune disease.
      They say the easiest bit about GCA, like PMR, is the first week after you start steroids. Those fond memories belie the challenge of ongoing treatment in GCA. In a steroid-only world, there is only misery. Steroid-sparing therapies have changed this completely.
      Psoriatic arthritis (PsA) is a complex inflammatory disease often complicated by obesity, which not only worsens disease activity but also impairs treatment response. At ACR Convergence 2025, three compelling studies spanning pharmacologic, lifestyle, and longitudinal observational data converged on a central theme: weight loss is a powerful modulator of PsA outcomes, regardless of the intervention used.
      IgG4 is a rare autoimmune disease with excessive IgG4 immunoglobulins that can affect multiple organs yielding plasma cell deposition (inflammation) and fibrosis.There has been great progress in treatment. Traditionally, glucocorticoids were used and if ineffective, then an oral immunesuppressive (ex: Azathioprine, MMF) and, if needed, rituximab. Many patients can improve sufficiently on this regimen.
      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. Yet in practice, many of us continue to reach for upadacitinib when we face challenges in treatment, from rheumatoid arthritis to axial spondyloarthritis. 
      Day 3 in Chicago is hump day, the last big full day of presentations and posters.  The day began with an 8AM plenary session, which brings me to the first of my three notables from today:
      My favorite session at ACR Convergence is often the “Great Debate.” The debate this year also evaluated one of my favorite topics – ultrasound in giant cell arteritis (GCA). More specifically, it asked the question of whether biopsy or ultrasound should be the preferred modality for diagnosing GCA.
      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.
      Tweeting about an ACR presentation or poster is a skill and sometimes art -- one that is mastered by the RheumNow faculty roving the halls and floors for the best new insights at ACR Convergence 2025.  Below are several of the best abstracts from Day 3, as chosen by our outstanding faculty.
      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.
      The ACR Convergence 2025 in Chicago opens with engaging topics curated for the global rheumatologist. As a clinician, I always look forward to sessions that provide updates and practical key points that I can bring home and apply to my practice.
      Two new studies presented this year tackle a key question: can our initial treatment choices influence who ends up in the difficult-to-treat category?
      Axial spondyloarthritis (axSpA) remains a diagnostic challenge, particularly in its early stages before structural sacroiliitis is visible on imaging.
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