EULAR 2026 Daily Podcast Day 2a Save

You're listening to a RheumNow podcast coming to you from London and EULAAR twenty twenty six. Enjoy. I'm Anthony Chan. I'm reporting here from London at EULAAR twenty twenty six, And there have been a lot of interesting abstracts and presentations today in the field of psoriatic arthritis. And I want to highlight to you an interesting abstract that was just presented.

I've just come out of this session right now. It's oral presentation OP068. Now we've all been here before. We have done psoriatic arthritis clinics. We've examined the joints.

There is nothing swollen. There's nothing that is tender, but the patient still reports having pain. Is there any inflammation there? What can we do if we can't see it? And I think today we had some interesting result from this presentation.

The study comes from India and it's using Gallium sixty eight PET scan. Now, what's interesting about this is understanding the molecular signals behind this presentation where patients are complaining of pain when we can't see it or feel it when we examine the patients. So this is a study where they looked at the use of Gallium sixty eight PET scan to look for inflammation in patients who clinically didn't have any tender or swollen joints. Now we know that in psoriatic arthritis, there is a subclinical inflammation that can happen, where there is inflammation but maybe not visible or not something that we can examine. And what happens is there's synovial angiogenesis, so new blood vessels being formed, which is the early pathogenic event in psoriatic arthritis, and often this precedes the onset of joint symptoms.

We know that there cytokines, VEGF, TNF alpha, IL-seventeen, and also an important integrin, which is alpha V beta-three. Now in this study, the Gallium sixty eight PET scan is able to detect the alpha V beta three integrin. In this study, they had fifteen patients with psoriatic arthritis and in total they examined around ten twenty joints, so a lot of joints. Now what is interesting is that they found that in fifty two percent of these patients, the PET scan lit up, as in the PET scan was positive, but the examination was negative, as in there were no tender or swollen joints. So these were clinically questioned in this group of patients.

There was good correlation in terms of the examination finding and the negative examination finding and the positive PET scan and also the PET scan results correlated with dapsa, with swollen joint count, CRP and also the napsi score, the nail score. Now, I think what we are saying here is that the PET scan is not yet going to be used in our clinics. We certainly would not be using this routinely in our patients. But what is telling us that there is this concept of subclinical inflammation that can be seen using other imaging modalities such as this Gallium sixty eight scan compared to our traditional examination, where we know that in psoriatic arthritis damage can happen as early as six months in early disease and uncontrolled disease. So they also were able to use latent class analysis where they found that there are patients who are very PET positive.

So these are patients who they call PET predominant where the scans were positive but clinically they were found to have no tender or swollen joints. And these were in thirty five percent of patients with positive joints, where they actually had one hundred percent PET positivity but zero percent clinically tender joints. Now what does this all mean to us? I think it helps us to dissect the molecular imaging of angiogenesis bit more and this perhaps one day could serve as a way for us to identify and detect, psoriatic arthritis earlier and perhaps start treatment a bit earlier and also to monitor the response certainly in this early phase of disease. So, in PSA I think what we are saying here is that the clock starts much earlier than we think, as in we can examine the patients but in fact the inflammation and the angioedema might be happening much closer and much earlier than we think.

So I think this adds to our understanding of the importance of this pathological process, namely angiogenesis and how more detailed scanning such as the sixty eight Gallium scan hopefully in the future might be able to help us to detect these conditions much sooner. I'm Anthony Chan reporting for RheumNow here at EULAR twenty twenty six in London.

Hello. I'm Jonathan Kaye reporting for RheumNow from London on the first day of EULAR twenty twenty six. The meeting got off to an excellent start with many interesting presentations. As expected, there are many presentations at this meeting about CAR T cell therapy for a variety of rheumatologic diseases. Georg Schetz Group in Erlangen has published their impressive and dramatic results with CD nineteen CAR T cell treatment for lupus, scleroderma, and idiopathic inflammatory myopathies.

At the plenary session this afternoon, Fredrik Albach of the Department of Rheumatology and Clinical Immunology at Charite in Berlin presented the phase one results of their COMPARE trial, which evaluated mivocabtogene otilucel, a human CD19 CAR T cell treatment, in six patients with ACPA positive treatment refractory active rheumatoid arthritis. Patients received lymphodepletion with cyclophosphamide and fludarabine, followed by infusion of the CAR T cells. The primary endpoint was safety, and secondary endpoints were clinical and biologic efficacy and a reduction in ACPA. All patients were followed for at least thirty six weeks, and two were followed for fifty two weeks. There was robust CAR T cell expansion with depletion of CD19 positive B cells from both peripheral blood, bone marrow, and synovium.

All six patients experienced a rapid decrease in disease activity with a median DAS28 CRP reduction of nearly 50%, and imaging confirmed the reduction in joint inflammation. By thirty six weeks, four of the six had achieved an ACR 70 response. All patients were able to discontinue DMARD therapy with continued control of disease activity. Only one experienced a flare that required a brief period of treatment with corticosteroid. The treatment with CAR T cells was well tolerated.

Cytokine release syndrome was limited to mild to moderate events, and there were no unexpected toxicities or cases of neurologic toxicity. There was a marked reduction in ACPA and rheumatoid factor, but not in antibodies to tetanus, suggesting that there are different mechanisms for the development of autoantibodies and protection from vaccination. These results in rheumatoid arthritis are similar to the early results in lupus and other rheumatologic diseases. However, this phase one study treated only six patients and was open label without a control arm. Phase two is ongoing, in which five patients will be treated with CD19 CAR T cells and five others will be treated with rituximab as a comparator arm.

It is most impressive that CD19 CAR T cell therapy results in deep tissue depletion of B cells and allows for complete discontinuation of DMARD therapy. The prospect of long term drug free disease control may make this treatment attractive to patients with difficult to treat rheumatoid arthritis. However, it requires leukapheresis and generation of the CAR T cells as well as pretreatment lymphodepletion. Availability of off the shelf allogeneic CAR T cells should make this approach to treatment more feasible. I look forward to seeing the results of additional studies of CAR T cell therapy in rheumatoid arthritis and in other diseases.

For more information about this and other studies presented at EULAR twenty twenty six in London, go to rheumnow.com. I'm Jonathan Kaye reporting from London. I look forward to seeing you tomorrow. Thanks.

Hello. This is Nelly Zade reporting from EULAR twenty twenty six in London for RheumNow. I had the pleasure to attend today to be part of a session called This is a Woman's World. So the EULAR Congress dedicated an entire session to women's health and rheumatic diseases. It was one of the most clinically rich sessions at the meeting.

From pregnancy in RA and axSpA to the impact of perimenopause on PSA, this session titled This is a Woman's World made clear that sex and reproductive stage are not just footnotes in rheumatology, they are central to disease management. I will start with the talk of my team, axSpA fertility and pregnancy. So this is OP0245, the ARCHE group study. The ARCHE group included five nineteen patients with AHPRA who had ever attended conception, recruited from 26 centers across 15 Arab countries. So this was a multinational effort.

We found that fertility and pregnancy outcomes were largely preserved, with a live birth rate of eighty seven point nine percent, and rates of miscarriage, preeclampsia, and preterm birth comparable to the general population. The median time to pregnancy was four months and only eleven percent had subfertility. The single most important modifiable determinant of prolonged time to pregnancy was smoking. So women with axSpA reported a higher desired versus achieved number of children compared to men and more frequently cited their rheumatic disease as a limiting factor. This data provides strong real world reassurance and underscore the importance of proactive reproductive counselling and smoking cessation in axSpA.

So let's move to rheumatoid arthritis. Some good news for RA. Two large registry studies painted a broadly reassuring picture of RA during pregnancy. From Norway, Ingoon Sagberg, OP0242, presented data from the RevNetOS registry covering five ninety eight pregnancies and four seventy five women. Most women maintained stable low disease activity during pregnancy, with remission rates climbing from sixty four percent in preconception to seventy five percent in the third trimester.

The catch: postpartum flares were common, with twenty percent of women flaring at the first postpartum visits at six weeks, and remission rates dropped back to fifty nine percent. Seropositive women showed the most pronounced pregnancy related fluctuations and the highest postpartum disease activity. Importantly, temporal trends showed markedly lower disease activity in pregnancy after 2020, parallellying broader uptake of biological DMARDs. Another study from Japan came from Shizuku et al. February, who analyzed data from the NINJA National Registry across nineteen twenty one women of reproductive age.

They found that pregnant and breastfeeding women had lower STI scores and fewer swollen joints than non pregnant counterparts, but were significantly more likely to be on corticosteroids and had near zero methotrexate use, which reflect appropriate but challenging medication adjustment during this period. Now let's move to France. RheumAbosan et al, OP0242, analysed twelve year data of follow-up from the French cohort, six twenty four women with early RA. Among the three thirty nine women at risk at baseline, seventeen percent experienced at least one pregnancy during follow-up. Younger age, absence of NSAID use and absence of teratogenic treatment were independently associated with pregnancy occurrence.

Among eighty nine pregnancy captured, seventy five percent resulted in full term delivery and nineteen percent had adverse outcome. NSAIDs used in the six months preceding pregnancy outcome were associated with a six fold increase risk of adverse outcome, which is a really striking signal and adds to concerns about NSAIDs in the preconceptional period. Now to autoinflammatory disease in pregnancy. So, Isabelle has OP0244 presented data from the German registry on fifty one pregnancies in women with autoinflammatory diseases, FMF, STILL, etc. The overall picture was encouraging.

Life birth, ninety three percent. No cases of preeclampsia or HELP. Neonatal outcome were generally favorable. However, flares occur in thirty eight percent of pregnancies and elevated rates of small for gestational neonates warrants further investigation. One concerning observation from this study was that colchicine and interleukin-one inhibitors were frequently withdrawn during pregnancy despite their established safety profile.

So there's a gap between evidence and clinical practice in counselling. Also, Laura Coates presented the safety data on biselkumab in pregnancy, and it was very reassuring. Eleven eighteen maternal exposure cases from the J and J global safety databases, four hundred pregnancy with known outcome. The majority of exposures were in women with psoriatic disease. While the authors appropriately cautioned their data limitation, prevent definitive conclusions, these findings add to the growing body of evidence supporting the relative safety of interleukin-twenty three during pregnancy.

Now let's move to the other side of the woman's life, to menopause. There are two studies on menopause. First one, Simone Perignola, OP0243, presented data from the Italian Bio Pure Registry, two thousand six hundred and forty five women starting a biological GMAT. They showed that postmenopausal women present with a more severe immunological and radiological phenotype, higher seropositivity, more erosions, higher CRP compared to women of childbearing age, and are significantly less likely to achieve thus twenty eight CRP remission. Notably, however, early remission remained achievable in postmenopausal women who were B DMR naive, had lower inflammatory burden, and did not have comorbid fibromyalgia.

The message here, menopause is a risk modifier, but not a treatment barrier if the disease got early. And the last study also in menopause in psoriatic arthritis, Lihi Edder OP0246 prospectively tracked four seventy seven women over more than twelve years and found that perimenopause was independently associated with a significant rise in dAPSA scores, tender and swollen joint counts, and PASI scores compared to both pre and postmenopausal age. Fatigue partially mediated this effect, accounting for twelve to eighteen percent of the data change, whereas BMI was not a mediator. So they suggest that hormone replacement therapy warrants consideration in perimenopausal women's which is a really thought provoking conclusion that will likely spark further studies. So the bottom line from this is a woman's world session at EULA twenty twenty six in London, that it delivered a clear and urgent message.

Reproductive stage hormonal transitions and sex specific disease phenotypes must be integrated into how we assess and treat inflammatory rheumatic diseases in women. From the postpartum flare and risk in RA to the perimenopause driven disease spike in PSA to the safety of biologic in pregnancy, rheumatologists now have richer data to counsel their patients and stronger reason to act on it. Thank you very much for your attention.

Peter Nash reporting for RheumNow, EULA, London 2026. This is another interesting PSA abstract further to the one I've previously presented, OPO seventy led by Lehi Iida. And she took patients with moderately active PSA, and she gave them and their BMIs were between twenty five and forty. A lot of them are quite heavy, over thirty, thirty four. Stable on treatment, many on a biologic, and they either got a Mediterranean diet or they got a weight loss diet or they got standard of care with some leaflets about diet.

And guess what happened at twenty four weeks? The patients nearly all lost weight. There wasn't any difference between the different diets, but their disease activity improved significantly just by losing weight. And by, week twelve, they've improved MDA, they've improved PASTAS scores, and the amount lost was proportional to the clinical improved outcomes. So the first abstract talked about, that weight reduction and and the BMI predicted, who'd respond.

This abstract talks about weight loss. Then we move to another couple of abstracts that looked at the GLP one agonists. O p o six nine Laura Coates, we've now seen the together study published and reported the IL-seventeen inhibitor execizumab combined with the GLP one agonist, tirzepatide, compared with ICSI alone, and they had significant improvements in outcome, ACR 50 plus PASI 100 in those patients that were on the combination, and the weight loss was significant and made a difference to outcome, particularly pain and function. And then there were two real world studies. One POS, double o, fifty by Venereto, which looked at the same combination, but in a real life study with propensity score matching.

So they took a small number of patients, and they started them on a biologic plus the GLP one agonist and matched them with patients who were just starting the biologic. And, the outcome was significantly improved if you started the weight loss drug, and there was another small study that looked at the same thing. Rheumatologists need to get on board with these drugs, learn how to use them, take them back off the endocrinologists and the weight loss doctors, and act to start the first script and talk all your patients with a BMI over 30 into a short period of time, maybe six months, lose 10 or 15 kilos. If it's unaffordable, then stop and try and fight to keep the weight off. Many people are now microdosing to keep the weight off.