EULAR 2025 - Day 1 Report
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.
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Sometimes you hear:
“PMR dose steroids don’t really matter”
Errrrr…
(You wouldn’t accept this steroid exposure in any other disease. Never)
#EULAR2025 POS0139 @RheumNow https://t.co/o6w2RpaGBj
David Liew @drdavidliew( View Tweet )
#EULAR vs #ACR #RA #recommendations
Do you agree that #ERA pts should receive #glucocorticoids
@RheumNow #EULAR2025
@eular_org
Janet Pope @Janetbirdope( View Tweet )
Management of AAV:
1.High dose GC f/b reduced dose taper ‼️caution in pts w/severe renal dz and RTX induction.
2. RTX effective for induction and maintenance, best for relapses.
3.PLEX: in RPGN pts if accesible ⚠️ risk for infection.
4.Avacopan: for faster GC weaning. No https://t.co/kfZ4gM38KG
Links:
Adela Castro @AdelaCastro222( View Tweet )
Pearls on EGPA:
1. GC are mainstay for mild
dz
2. Organ threatening/relapsing➡️CYP (RTX alternative)
3. W/o organ threatening➡️ anti-IL-5/IL-5R.
4. IL5i are less effective for ENT
5. Consider sx for nasal polyps.
#EULAR2025 @RheumNow https://t.co/zoJEWxafsN
Links:
Adela Castro @AdelaCastro222( View Tweet )
“That is why this task force continues to say: nothing is better than methotrexate and glucocorticoids to start”
- Josef Smolen, on RA treatment
#EULAR2025 @RheumNow https://t.co/AbkgWS8tvH
Links:
David Liew @drdavidliew( View Tweet )
#EULAR new #RA #recommendations
J Smolen presents justification for
#MTX +#glucocorticoids at onset
do you agree?
Diff from #ACR
#EULAR #Recommendations II
#EULAR2025 @RheumNow https://t.co/wqCX5HA87q
Janet Pope @Janetbirdope( View Tweet )
Recommendations for RA management at #EULAR2025
- MTX [or other csDMARDs] and steroids still remain the first line- nothing beats that!
- ofcourse minimize steroids!
- rather than stopping meds at remission, reducing doses may be a better solution.
Not much changed.
@RheumNow https://t.co/NK5ejsgjWV
Bella Mehta @bella_mehta( View Tweet )
#EULAR2025 Abstr#OP0324 Cohort study of #lupus nephritis in Greece showed Earlier GC Discontinuation (D/C) & flare protection post-D/C is associated with renal response, low disease activity & HCQ use at GC D/C. Membranous LN & recent diagnosis were assoc w early GC D/C @RheumNow https://t.co/agFgyG5eaS
Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
What kills in GCA?
Greek national prospective cohort, small numbers and no doubt some channeling bias, but:
Steroids (absence of DMARD use) is more of a factor than CV disease in GCA mortality.
With new options, all GCA pts should be on something
#EULAR2025 POS0960 @RheumNow https://t.co/Wmvf6tEvaF
David Liew @drdavidliew( View Tweet )
Stabilize the pts with HLH with steroids when still trying to figure out the diagnosis of #HLH/ #MAS
Many drugs can be used...but important to balance infection risk with immunosuppression
These are critical pts. Be vigilant..
#EULAR2025 @RheumNow https://t.co/id4ae3SWtj
Links:
Bella Mehta @bella_mehta( View Tweet )
Treatment strategies for steroid free management of #relapsingpolychondritis
56 patients from a single center
#POS0149 #EULAR2025 @RheumNow https://t.co/d4I56opS02
Bella Mehta @bella_mehta( View Tweet )
#MTX in new #PMR?!
RCT of #MTX was negative in early #PMR - no effect on #steroid #tapering
ACR24 #1697
At #EULAR2025
👇
+RCT of #methotrexate in PMR <8wks #steroids #Rx MTX 25 mg/wk v #placebo
N=64
⬆️GC remission ✅80% v 46%
⬇️relapse w MTX
🤔
Abst0064 @RheumNow #EULAR2025
Janet Pope @Janetbirdope( View Tweet )
Single center study of 1538 #SLE pts found 2.2% w/ lupus mesenteric vasculitis (LMV) - 39 LMV episodes in 31 pts - 2/3 had Nausea, vomiting, diarrhea & abdominal pain (~15% peritoneal irritation) & had active Dz (renal, Skin, Heme). LMV responded to steroids & https://t.co/vXCpbiC60P
Dr. John Cush @RheumNow( View Tweet )
Early RA or undiff. arthritis (UA) shows initial hi-dose steroids have significantly better earlier outcomes, but lower doses have fewer early side effects. IMPROVED used high dose GC (60 mg/d tapered to 7.5 mg in 7wks). tREACH used lower dose GC (15 mg/d tapered in 10 wks to https://t.co/TkrGPb6EBZ
Dr. John Cush @RheumNow( View Tweet )
Belimumab in SLE with Mucocutaneous or Vasculitis Findings
A post hoc analysis of a belimumab (BEL) inn systemic lupus erythematosus (SLE) study showed lupus mucocutaneous and vasculitic manifestations improve with BEL and standard care.
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Steroids in Lupus Nephritis: No Free Lunch
https://t.co/yPQuZcnRLH https://t.co/V8GZoslSqV
Dr. John Cush @RheumNow( View Tweet )
2025 ACR Guideline for the Treatment of SLE
The ACR has released its 2025 Systemic Lupus Erythematosus (SLE) treatment guidelines and consensus-based good practice statements, applicable to children and adults with SLE.
Overall, the goals of SLE management are to achieve remission or a low level disease activity, reduce
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Treat to target 🎯 #SLE #recommendations
Considerations are nuanced and Impt
Lowest clinical disease activity is goal
Try for remission
🎯 Get patients off #glucocorticoids
If not ⬇️low dose #prednisone
@RheumNow #LUPUS2025 https://t.co/HlBeh2FLxP
Links:
Janet Pope @Janetbirdope( View Tweet )
controversy re
👇
Monitoring for +Ro pregnant re
#congenital #heart #block
87% Y
echo is possibly too late
No ideas if flourinated #steroids work
But many thing we should do something
Guidelines differ on recommendations
Would fetal home HR be better
#LUPUS2025 @RheumNow https://t.co/MY0oPjLnGs
Janet Pope @Janetbirdope( View Tweet )
‘It’s #Lupus, it’s all in your head!’
➡️ Some patients with #SLE have heard this from others
At #LUPUS2025 in a packed session on #CNS lupus
#Dx is tricky
40% of #neuropsychiatric lupus have NEGATIVE #brain #MRI
👇r/o
infarct/bleed
Infection
Rx #steroids
@RheumNow https://t.co/yU1olg0uZU
Links:
Janet Pope @Janetbirdope( View Tweet )
‘To screen or not’?
For
#CHB #congenital #heart #block
Great debate #LUPUS2025
In #pregnant women with #SLE
In + #Ro #SSA &/or #La #SSB mothers
CHB Rx - #flourinated #steroids
To
⬇️#fetal #mortality ❎no benefit
⬇️#cardiomyopathy ❎
⬇️#pacemaker ❎
@RheumNow
??🤷♀️ https://t.co/xauDzfNBsC
Janet Pope @Janetbirdope( View Tweet )
Shifting the Management Paradigm for SLE and Lupus Nephritis
The paradigm for treating patients with systemic lupus erythematosus (SLE) is rapidly shifting and our patients will surely benefit with improved outcomes.
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Vitiligo affects up to 2% of people globally; more in blacks & hispanics than whites & more common in women > men. The prevalence has increased over time. Oral corticosteroids are most frequently prescribed, followed by other immunosuppressive drugs https://t.co/wNh6z3lKg1 https://t.co/hQo9sNn4kg
Dr. John Cush @RheumNow( View Tweet )
MTX works in pulmonary Sarcoid! NEJM reports Open label RCT of 138 un-Rx pulm. Sarcoid pts w/ either MTX or placebo. After 24 wks MTX was noninferior to PBO w/ mean change in FVC (-6.7 vs -6.1). AE: more Wt gain, insomnia w/ pred & more Nausea fatigue LFTs w/ MTX https://t.co/8XMCM2DitR
Dr. John Cush @RheumNow( View Tweet )
