Articles By Richard Conway, MBBChBAO, PhD
Are we putting the CAR-T before the horse?
CAR T-cells have been a revolutionary development in rheumatology. We have seen a population of patients with severe refractory autoimmune conditions almost overnight presented with the prospect of not just improvement, but of a cure.
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Should we be using JAKi more in female SpA patients?
In recent years, data has emerged suggesting that female patients with spondyloarthritis, both psoriatic arthritis and axial spondyloarthritis, may have worse outcomes than male patients. A number of post-hoc analyses of randomised controlled trials of both TNF inhibitors and IL-17 inhibitors suggest that this phenomenon is also manifested in the responses to these agents; female patients do less well than male patients. The mechanisms behind this remain to be fully elucidated.
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Combined Therapy in Rheumatoid Arthritis Interstitial Lung Disease
Rheumatoid arthritis interstitial lung disease (RA-ILD) represents a major therapeutic evidence void in our current treatment paradigm. RA-ILD is common, with clinically significant disease seen in 8% of patients. In the past RA-ILD was frequently under-diagnosed, leading to identification of a disproportionate volume of severe cases and subsequently inflating the mortality statistics. However, RA-ILD, particularly in the progressive pulmonary fibrosis phenotype, retains a poor prognosis. I would propose a new framework for RA-ILD treatment.
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ICYMI: EGPA in 2025
Formerly classified as an ANCA-associated vasculitis, EGPA is both most commonly ANCA negative and clinically different to the other two ANCA-associated vasculitis conditions, GPA and MPA. The management of EGPA has frequently fallen into the trap of being copied from its more common and well-known cousins. Now, however, we are seeing a discordance and following GPA/MPA management will potentially lead to both over-treatment and suboptimal treatment for EGPA. In this context, the Sunday morning session at RNL 2025 on “EGPA management in 2025 and beyond” by Dr. Michael Wechsler was both timely and clinically relevant.
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EGPA in 2025
Formerly classified as an ANCA-associated vasculitis, EGPA is both most commonly ANCA negative and clinically different to the other two ANCA-associated vasculitis conditions, GPA and MPA. The management of EGPA has frequently fallen into the trap of being copied from its more common and well-known cousins. Now, however, we are seeing a discordance and following GPA/MPA management will potentially lead to both over-treatment and suboptimal treatment for EGPA. In this context, the Sunday morning session at RNL 2025 on “EGPA management in 2025 and beyond” by Dr. Michael Wechsler was both timely and clinically relevant.
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“Preventing” Arthritis in Psoriasis
The always compelling Dr. Alexis Ogdie explored whether aggressive treatment of psoriasis can prevent psoriatic arthritis in an excellent Saturday morning session at RheumNow Live 2025.
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Best of 2024: Vasculitis Pearls
Once again RheumNow Live 2024 really delivered with high impact learning packed into short sessions. As someone with an interest in vasculitis it was fantastic to see four of my favorite speakers in the Vasculitis Mavens and STEP talks. They gave us what we really want from these talks – personal opinions and approaches that go beyond the guidelines. They really dropped a selection of pearls on us and I wanted to share a few of these with you.
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Methotrexate to Prevent RA, Clear as Mud
Intervention in individuals predisposed to develop RA, with a holy grail of prevention of RA, has long been a hot topic. The 4-year results of the TREAT EARLIER study, presented at Tuesday’s oral abstract session, show that methotrexate appears to prevent the development of RA in high risk ACPA- patients.
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Up-front Secukinumab in PsA?
We now have an absolute plethora of agents available for use in psoriatic arthritis (PsA). In contrast we have an almost complete lack of understanding of how best to optimise use of these agents – what is the right agent at the right time for the right patient. A study presented this week has given us some further information on the topic.
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JAKs and Other Drugs in PMR
This has been an interesting ACR meeting in terms of PMR updates. I would argue that we are still far too wedded to glucocorticoids only in the management of PMR. Yes, some patients will do fine with just glucocorticoids but we persist far too long with a glucocorticoid only strategy in others who clearly need an alternative as glucocorticoid adverse events multiply.
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