EULAR 2025 - Day 1 Report Save

Wednesday was Day One at EULAR 2025 in Barcelona. Thousands from around the world gathered, eager to reunite at this international educational forum. Below are a few of my favorites from Day 1. 

Rheumatoid Factor is Bad News for EGPA

• Abstract #POS0020. This report from Sorio at all describes 83 EGPA patients who were retrospectively studied and found that 46% were rheumatoid factor (RF) positive. This research emulated from their clinic observation that some EGPA patients who were RF+ tended to have more severe disease. In this cohort analysis, RF positive EGPA patients were more likely to have vasculitis relapses (39% vs 2% in RF neg.), higher CRP levels (49 vs. 11 mg/L), and more mononeuritis multiplex (53% vs. 13%). Overall, RF positivity was the greatest predictor of vasculitis relapse in EGPA patients. This is a new and important finding.

Palindromic Rheumatism and DMARD Use

• Abstract #OP0105 –PALABA was a multicenter study from Spain that compared two common DMARDs in the management of palindromic rheumatism (PR), a condition for which there aren't many good treatment options.  They enrolled and randomized 70 PR patients to receive either abatacept (ABA) or hydroxychloroquine (HCQ), at standard doses. Patients met PR criteria and were seropositive for RF or ACPA. The primary outcome was the development of rheumatoid arthritis (RA) at 2 years, which was seen in 28% on HCQ and only 9% on ABA (p = 0.042). Similarly, those on ABA had significantly less PR attacks compared to HCQ (56 vs 23%). These data suggest that palindromic rheumatism is yet another form of preclinical RA and should be treated as such. In this case, ABA appears to delay the onset of chronic RA and better control PR.

T2T Gout Lowers CV Risk

• Abstract #OP0005 - Cardiovascular outcomes in Treat to Target (T2T) gout. This was a Target emulation trial using two large data sets, with over 116,000 gout patients who were newly initiated on urate lowering therapy or not. The intervention group was defined as those achieving a serum uric acid of less than 360 umols/L within the first year of treatment with 5 years of follow-up looking for major adverse cardiovascular events (MAC). Patients were selected, cloned, and censored to yield matching groups. At the end of 5 years the T2T group had significantly better survival in both the UK (CPRD) and Swedish (Vega) cohorts with hazard ratios of 0.88 and 0.94 (both falling below one). Overall, the relative 5-year risk reduction was 6 to 11%.

Does Methotrexate work in PMR, or Not?

• Abstract #OP0064. At ACR 2024, we reported the results of the Mode study that suggested no clinical benefit when methotrexate was compared to placebo in 64 newly diagnosed PMR patients on glucocorticoids for less than 8 weeks. The data was convincing, supporting the views of many that MTX should not have a role in managing PMR. However, at EULAR 2025 the same investigators reported on the same patients, the same trial, but now with the reverse conclusions - now stating that methotrexate was efficacious newly diagnosed PMR. The authors reported their original analysis was faulty because of a misclassification error.  Their newly revised analyses resulted in a reversal of findings. In this study 64 recently diagnosed PMR patients were randomized to receive either methotrexate (MTX) 25my/wk or placebo for 52 weeks. Patients were allowed to be on prednisone 15 mg a day at the outset and were to have been weaned during the trial. The primary outcome was the number of patients with a PMR activity score of less than 10 who were also not taking systemic steroids. Ultimately, 30 received MTX and 28 placebo in this analysis. At the end of one year, 80% of MTX patients responded compared to 46% on placebo (p = 0.004). But while methotrexate was effective, there was no difference in total steroid exposure, suggesting many of these patients needed to receive steroids in this one-year study. Moreover, MTX had the same number of relapses as those on placebo.

So, which is it? Does methotrexate work in PMR or not?