ACR 2025 RA Topic Podcasts Compilation 5 Save

This is an ACR 2025 podcast coming to you from Chicago. Hope you enjoy it.

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Hi, it's David Lu here reporting from ACI twenty five. Lots on the, poster floor today on day two. Want to tell you just a little bit about RAILD screening. There's been a lot of attention about this. I think we've started to realize that a lot of us are doing it sub optimally, not screening enough people, especially high risk rheumatoid arthritis patients to screen them for the possibility of interstitial lung disease.

I think we know that HRCT is the gold standard, but some of us might be a little bit nervous about the ionizing radiation associated with it. So the temptation of course is that maybe we should be using respiratory function tests and chest x rays instead of going full throttle with the HRCT. Is that a good idea? Certainly the guidelines don't think so. And today I saw some data from Spain, Madrid, which really outlines what the performance of those tests are like.

So they cohort that they've done HRCT as well as respiratory function tests well as respiratory function tests and chest x rays at baseline. And to give you some idea of the numbers as to how good respiratory function tests and chest x rays are, we're talking about in all comers, 70% sensitivity, 50% specificity. If you look just at asymptomatic patients, we're talking about 57% sensitivity, 56% specificity. And if you go to the symptomatic patients thinking, well, maybe those are the ones with advanced enough disease that we might see them on chest X-ray, you're still only getting a 78% sensitivity and 30% specificity. Now, in a situation where we wanted to detect early so that we can potentially introduce antifibrotics early and introduce a whole gamut of IOD care early enough, I think that just simply isn't good enough.

Lung ultrasound certainly looks promising, may or may not have access to that, but right now, HRCT is the gold standard. And if we're going to be screening for RA, ILD, we shouldn't be mucking about with other tests, HRCT is what we should be looking at. For plenty more on RA, ILD, and all the rest, you know where to go. Rheumnow.com.

Hello. My name is Rinalini Day. I am a rheumatology and internal medicine fellow working in London in The UK, and I'm delighted to be reporting for RheumNow from ACR twenty twenty five here in Chicago. I am delighted to be joined today by professor Marwan Bukhari, who is a consultant rheumatologist at University Hospitals in Morecambe Bay in The UK and also a professor at Lancaster University. Thank you very much for joining me today, Doctor Bukhari.

No problem at all. Thank you. Thank you for asking me to comment about rheumatoid arthritis. I always like talking about it.

Yes, indeed. So, yeah, as you just said, we are gonna be looking ahead to what you feel are the highlights from this year's Congress in terms of rheumatoid arthritis. So what are you most looking forward to at the Congress this year?

I'm looking forward to looking at some of the data, really. Looking at the influence of GLP ones and and the combination therapy with those on weight loss and whether that's going to create a difference in the outcomes of patients with rheumatoid arthritis. That's one thing. Although some of the TriNetX data

are not really as robust as we would like them to be, they're showing that we might have

an answer there. Some of the other things that are really quite exciting are about the preclinical phases of RA and how you can predict people who will progress. And there's quite a lot of biomarkers that are being validated at this meeting, and we've seen a few of them today. We'll see a few over the next few days. Although the really exciting thing for me is something really simple.

How frequently do you monitor methotrexate?

Yes.

There's actually three papers about this, and it shows that we shouldn't be monitoring it as much as we should, as we do now and if we take it up to six months we'll actually reduce the number of interventions and office visits which I think is a very good message to go. And the last bit in rheumatoid which in that we saw is, again, steroids. We're using far too much of them, and we're underestimating how much steroids we're being we're giving out to our patients. And we keep on doing this, and every single year we hear the same story. But does practice change?

Not sure if it does.

So if we can pick up on maybe a couple of those points. So just looking at the GLP one data. So I too was looking at the the try the TriNet data as well. And I think all of the abstracts here, unfortunately, are well, fortunately or unfortunately, are coming from the same database. How do you think that area of research is gonna evolve as we move forward?

I think it's it's a good dataset for things that are really rare.

Yeah.

So looking at looking at small events, very rare events Yeah. China text data would be fantastic. But I think just looking at associations, you if you test enough times, you'll find an association. So an ingrowing toenail being linked with a flare and rheumatoid is not science. But you can actually prove that using China text data.

Yeah.

And that's not really what it's for. What it's for is for really rare events to have collect really large data and get some meaningful information to maybe inform clinical trials. But now what we're seeing is lots of hypothesis generating. And let's put it this way, you test a 100 things, you'll find five of them in significance Five. Yeah.

Report on it.

We need some real world data, really, but that's gonna take time, obviously, to come through. And then going to the methotrexate monitoring, there's also some really good abstracts on the final day, I think, on microbiome and using that to sort of detect who's gonna respond to methotrexate or not, which would be a good thing to do perhaps. So do you have any comments on that?

That's a really interesting because what they're giving, they're actually giving my fiber.

Yeah.

And they're also giving methotrexate at the same time. And the idea is that your, you know, your mucosal surface is where it is. I mean, there's another one about the mucosal surface which includes sputum CCP levels.

Yes. Just just

being read on again. And, again, they're very, very interesting in that we now understand that a lot of our immune systems all have a link with mucosal surfaces lining up your lung, lining up your gut. Yes. So I think we'll be lying more in bed with the gastroenterologist Yeah. Microbiomes a hell of a lot going forward.

Yes. And then just I think the final topic, if we look at pre RA. So obviously, has been a really hot topic for the past couple of congresses, what with all of the stuff coming out of London with Epipra, now Alto, and then the IS. And then we've got the stop RA data of last year as well. So what are you most looking forward to specifically in the pre RA field?

I think the the pre RA field, I think the important thing is to look at using AI to actually help you to see who's going to progress and use a combination of approaches to look at it. I'm sure you haven't seen Arthur or Diana at this meeting in the asthmatic ultrasound system. That might just give you something. We're not sure, but it's disappeared. It was a flashing van.

It's disappeared. You had, you know, biomarkers like fourteen three three f and the vector chip. They they wax and wane

Yes.

Over time. So we're just we're not sure that we've got the right biomarker. It tells you who who's going to progress from clinically suspect arthralgia Yeah. Into developing rheumatoid. And that's really the important thing that we need to know.

But lots of hypotheses, but still some answers to be had in our area.

Perfect. Right. Well, thank you very much for sharing your insights. We have done a whistle stop tour on what you can look out for in the rheumatoid arthritis world here the congress. So we hope that you managed to catch some of those sessions.

If you'd like to know more about what's going on here at ACR twenty twenty five, do keep watching the RoomNow coverage, and I'll see you again on the next video. Thank you.

Thank you.

I'm Jonathan Kaye reporting from ACR Convergence twenty twenty five in Chicago. Large language models have been used in studies of rheumatological diseases such as rheumatoid arthritis and are increasingly being incorporated into electronic health record systems to abstract data from medical records and patient notes, to do studies from real world populations. Abstract 02/1960 from the Mayo Clinic used a large language model trained on medical records from 2,800 patients with rheumatoid arthritis and patients without rheumatoid arthritis, looking at 6,600,000 notes from patients without rheumatoid arthritis, 1,200,000 notes from patients with rheumatoid arthritis, not just from rheumatologists, but also nursing notes and other notes. And they were able to find evidence of rheumatoid arthritis antedating the diagnosis of rheumatoid arthritis. They were able to find various aspects in the notes with a precision of 0.8, one year before the diagnosis of rheumatoid arthritis, that predicted the onset of rheumatoid arthritis, and with lower precision, as far back as ten years antedating the diagnosis of rheumatoid arthritis.

This use of large language models to abstract data from electronic health records not only can help with epidemiological and clinical research, but also might be used as a biomarker to predict who is at risk for developing rheumatoid arthritis without the requirement for a serum sample or a digital biomarker measuring physical function, for example. Going forward, it will be very interesting to see what happens with the use of large language models to abstract medical records, to teach us more about rheumatoid arthritis and other diseases. For this and more from ACR Convergence twenty twenty five, go to roomnow.com. I'm Jonathan Kaye. I'm Jonathan Kaye reporting from ACR Convergence twenty twenty five in Chicago.

Today, there were two presentations in different sessions. One in a session, an oral abstract session about lung disease and rheumatoid arthritis, and the other a poster about rheumatoid arthritis and depressive symptoms. But both of these were tied together, interestingly, by GDF 15. GDF 15 is a called growth differentiation factor 15. It's a member of the TGF beta superfamily.

It's induced both by tissue injury and inflammation, and it's widely expressed, in lung, heart, liver, pancreas, and has diverse roles. It can increase cardiovascular risk. It can be tumorigenic. It is renal protective, and it suppresses appetite, especially in cancer. There's even been a therapeutic trial, published which suppressed, GDF 15 levels to improve cancer cachexia.

So in the Veterans Administration early rheumatoid arthritis cohort, Bryant England and colleagues identified GDF fifteen as being associated both with incident and prevalent rheumatoid arthritis interstitial lung disease. Now this is an interesting finding. It was statistically significant, and is a correlate of interstitial lung disease and rheumatoid arthritis. Now in another presentation, a poster, a group looked at about forty patients with rheumatoid arthritis and scored depressive symptoms using the PHQ-nine score, and they found that GDF-fifteen levels were higher among those who were less depressed and lower in those who were depressed. So there was an inverse correlation of GDF 15 levels with depressive symptoms.

So it's interesting that this member of the TGF beta superfamily, which is induced both by tissue injury and inflammation, is both inversely correlated with depressive symptoms and associated with the development of interstitial lung disease in rheumatoid arthritis. This brings GDF 15 to the fore in rheumatoid arthritis and should be the subject of future studies looking at other aspects of rheumatoid arthritis. For this and other aspects of rheumatoid arthritis and other diseases at ACR Convergence 2025. Go to roomnow.com. I'm Jonathan Kaye.