EULAR 2025 – Day 3 Report Save

Highlights from today included presentations on imaging in vasculitis, a debate on whether to treat high risk pre-clinical RA, and EULAR Recommendations on a) Treatment of interstitial lung disease (ILD); b) Physical Activity in people with arthritis; and c) EULAR disease activity score for antiphospholipid syndrome and d) the management of SLE nephritis (look for these here or follow us on X/twitter).  Below are a few others that caught my eye today.

The ARIAA Trial - Long-term RA Prevention with Abatacept (ABA)

• Abstract OP0325. The ARIAA trial was presented over 3 years ago and showed when 6 months of ABA was given to ACPA+ arthralgia patients, A significant delay to RA progression was seen out to 18 months. In this trial 98 patients with CSA, who are ACPA+ with arthralgia and MRI evidence of inflammation were randomized to receive 6 months of either placebo or ABA subcutaneously. With 6 months of treatment, RA developed in 35% of placebo and only 8% of the ABA. ABA was discontinued and 12 months later ABA was still superior to PBO in the development of chronic RA (35% ABA vs. 57% placebo). The current study is a long-term, follow-up of this cohort who has been followed for a median of 5.3 years.  Even with one 6-month course of ABA, 5 years later the ABA group was RA free for around 10 months more than the placebo group. They also found certain clinical variables that predicted progression to RA or not. These protective variables included painful joints, pain VAS, physician global, ESR, CRP, RF, and HAQ. Age, sex, and MRI findings were not predictive. Hence, ACPA+ CSA patients are less likely to progress to RA if there is a paucity of pain, systemic inflammation and functional difficulty.

Myositis in the ICU

• POS1051 was presented by Holzer et al. This retrospective study of 23 idiopathic inflammatory myositis patients admitted to the intensive Care unit ICU (2014 - 2022). Patients were admitted for interstitial lung disease, muscle involvement, manifest as dysphagia, myocarditis or weakness. The median ICU stay was 32 days, but the bad news was there were 14 patients who required mechanical ventilation and there were five deaths (bleeds, infections). These patients were sick, hard to manage, diagnoses and have poor outcomes. On admission, 87% were taking steroids along with immunosuppressives - further compounding their morbid and mortal risks. The author's warned of features such as dysphagia, pulmonary or muscle or cardiac involvement, associated with high-risk outcomes.