Latest news with #EULAR
Medscape
3 days ago
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- Medscape
First Scan for Suspected AxSpA: X-rays, MRI, or CT?
BARCELONA, Spain — Data from a prospective imaging study question the use of x-ray radiography first in the diagnostic workup of patients with suspected axial spondyloarthritis (axSpA), a practice that is currently a part of recommendations by the European Alliance of Associations for Rheumatology (EULAR). The study, which evaluated three different imaging pathways based on whether x-ray radiography, MRI, or CT of the sacroiliac joint (SIJ) was used first, found that the two latter approaches yielded a higher diagnostic efficacy than the radiograph-first approach. While just 13% of 30 people who were in the radiograph-first arm of the study were confirmed as having axSpA after the initial scan, 22% of 91 patients in the MRI-first and 30% of 84 people in the CT-first arms were given an axSpA diagnosis. X-ray, MRI, or CT first? Dominik Deppe, MD 'To x-ray or not to x-ray? What may sound somewhat philosophical, is a relevant question,' said study investigator Dominik Deppe, MD, who presented the findings at European Alliance of Associations for Rheumatology (EULAR) 2025 Annual Meeting. Deppe, a doctoral student in the Department of Radiology at Charité – Universitätsmedizin Berlin, Berlin, Germany, explained that although radiographs could show certain structural lesions, such as erosions, sclerosis, or ankylosis, and used relatively low levels of radiation, interpretation could be problematic. 'Even among experts, inter-reader reliability remains low,' Deppe said. MRIs are often performed if the results on radiography are negative or inconclusive. Such scans provide additional insights, he added, and can show both structural and inflammatory lesions, such as bone marrow edema. However, the high cost and low availability of MRI relative to radiography, however, were issues, he acknowledged. This is where CT could perhaps prove most useful. Although it's not part of the standard imaging pathway as yet, it is 'a gold standard for structural lesions,' Deppe said. He added: 'Historically, CT is considered to have high radiation exposure, but nowadays, we can perform CT with ultra-low dose techniques that allow us to reduce radiation exposure to a level that is comparable, or even less, compared to conventional x-rays.' Strategies Compared and Results The study included 205 people with suspected axSpA, who were randomly allocated into one of three arms: 30 to a radiograph-first or 'standard' arm, 91 to an MRI-first arm, and 84 to a CT-first arm. Scans were designated positive or negative by the consensus of two specialized musculoskeletal radiologists who were blinded to the clinical data. A positive result was defined as clear signs of structural or inflammation suggestive of axSpA and no further imaging was done. Those with negative scans underwent a subsequent scan with another method; those in the radiograph-first arm had an MRI scan and then a CT scan, those in the MRI-first arm had a CT scan, and those in the CT-first arm had an MRI scan. The results are preliminary because the study is ongoing and results from the final diagnosis by a rheumatologist are not yet available, Deppe said. He reported that in the radiograph-first arm, 26 (87%) people had a negative scan and then had an MRI scan. This was positive in three (11%) and negative in 23 (88%) of people. None of the people with a negative MRI scan had a positive CT scan. In the MRI-first arm, scans were positive in 20 (22%) and negative in 71 (78%) of people. Again, CT added no further cases among the people who were also MRI-negative. Finally, in the CT-first arm, there were 25 (30%) positive and 59 (70%) negative scans. MRI performed in the CT-negative patients detected two (3%) additional cases of confirmed axSpA. Deppe said: 'Our standard approach, [which] we're using right now, has the lowest diagnostic efficacy, compared to the MRI-first and CT-first approach.' Patient Characteristics Information about patient demographics were not presented, however, which prompted Uta Kiltz, MD, a senior rheumatologist at Rheumazentrum Ruhrgebiet, Herne, Germany, to ask for clarification and about the study design. 'Can you give some information about the population you included in the study?' she asked. 'I think we need to have some more context about the decision-making process to really understand the results.' Deppe responded that the patients had been referred with the suspicion and not confirmed diagnosis of axSpA and had been randomized through a third party into the three different imaging arms. Topline patient demographics had been given in the abstract, which stated that the mean age of the population studied was 38 years (SD, 10.58 years) and just over half (58%) were women. Around half (53%) of the study population was HLA-B27 positive. The mean C-reactive protein level was 3.66 mg/L, and the mean BMI was 25.57. The mean duration of back pain was around 8 years, and 70.6% of people had signs of inflammatory back pain. Questions Raised Several discussants raised concerns about the study design and the interpretation of these early findings. Eric Ruderman, MD, of Northwestern University Feinberg School of Medicine, Chicago, questioned why all patients did not receive all three imaging modalities: 'Ultimately, you don't know the diagnostic specificity of the [ultra] low-dose CT. Why didn't you do all three images in each patient, so that you can actually make a comparison once you have the confirmed diagnosis?' Deppe replied that the team wanted to be pragmatic: 'We wanted to evaluate the clinical settings where the patient does not undergo every imaging, but if we found positive results, as in the clinical practice, we don't need further imaging, and this is something we want to demonstrate in the study.' Xenofon Baraliakos, MD, head of rheumatology at the Rheumazentrum Ruhrgebiet, and the new president of EULAR, raised concerns about potential false positives: 'What happens if the x-ray is it was falsely positive? Have you been able to check for that?' Deppe acknowledged the limitation: 'I think this is something we have to do when we have the final diagnosis by the rheumatologist, to see whether we missed or misinterpreted some of the images.' This study was independently supported. Deppe had no conflicts of interest. The commentators were not involved in the study.
Medscape
3 days ago
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- Medscape
EULAR Updates Recommendations for Managing RA
BARCELONA, Spain — Patients with rheumatoid arthritis (RA) who have not responded to first-line methotrexate therapy should be started on a biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD), according to new recommendations by the European Alliance of Associations for Rheumatology (EULAR). These updated recommendations contain five overarching principles and nine recommendations — two fewer than those in the 2022 iteration. Several of the recommendations remain unchanged, and a few were merged or modified to provide greater clarity. 'The availability of an increasing number of good drugs and increasing evidence due to wonderful clinical trials made the task force in charge of these recommendations produce increasingly leaner recommendations,' said Josef S. Smolen, MD, of the Medical University of Vienna, Vienna, Austria, who presented them at the EULAR 2025 Annual Meeting. 'It's nice because it makes life simpler.' Josef S. Smolen, MD EULAR continues to recommend methotrexate and short-term glucocorticoids as the first treatment strategy for RA. (In the case of contraindications, leflunomide or sulfasalazine should be considered.) 'We have yet to find something that beats methotrexate plus glucocorticoids [as a first therapy strategy],' Smolen said. However, if the treatment target is not reached with this first conventional synthetic (cs)DMARD approach, then the patient should be started on a b/tsDMARD. Second-Line Therapy With b/tsDMARDs This update eliminates treatment based on stratification according to poor prognostic factors, such as the presence of autoantibodies or high disease activity. In the 2022 recommendations, patients without these factors could start another csDMARD, whereas those with these poor prognostic factors could start a b/tsDMARD. 'The task force felt that the stratification was not necessary because if you fail methotrexate plus glucocorticoids, you already have a bad prognostic sign,' Smolen explained. Alexandre Sepriano, MD, PhD, an assistant professor of rheumatology at NOVA University Lisbon, Lisbon, Portugal, thought this change was the 'most important modification' to these RA treatment guidelines and would have 'significant implications for clinical practice.' He co-moderated the session where these updated recommendations were presented. Alexandre Sepriano, MD, PhD 'In some countries (eg, the United Kingdom), patients previously had to fail two csDMARDs before being eligible for a biologic or JAK inhibitor,' added Kim Lauper, MD, PhD, of Geneva University Hospitals, Geneva, Switzerland, the other moderator of the session. 'This new recommendation could help support policy changes that allow for earlier escalation, potentially helping more patients reach remission faster.' EULAR still recommends that b/tsDMARDs be combined with a csDMARD. In patients who cannot use a csDMARD as a co-medication, interleukin 6 inhibitors and JAK inhibitors 'may have some advantages compared with other bDMARDs,' the recommendations state. More Research Needed on JAK Inhibitors EULAR advises that clinicians should evaluate cardiovascular and malignancy risk factors before prescribing a JAK inhibitor. While the ORAL Surveillance trial found that the risk for major cardiovascular events and cancer was more common with tofacitinib than with TNF inhibitors, patient registries have not shown these same patterns, Smolen said. More randomized controlled trials are therefore needed to understand what could be driving the risk, he added. Kim Lauper, MD, PhD 'We're awaiting more data, and we would love to see and understand the mechanisms that led to a higher incidence of malignancies and cardiovascular events [in the ORAL Surveillance trial],' he said. Once a patient achieves sustained remission, they can taper to a lower DMARD dose; however, the new guidelines emphasize the importance of remaining on DMARDs and not stopping them entirely, Smolen said. 'Now, we more clearly state that this task force, based on newer data, felt that continuation of DMARDs — whether traditional [synthetic], biologic, or targeted synthetic DMARDs — is recommended, but dose reduction may be considered,' he continued.
Business Wire
5 days ago
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- Business Wire
Scipher Medicine Unveils New Tool to Predict Rheumatoid Arthritis Treatment Success at EULAR 2025
WALTHAM, Mass.--(BUSINESS WIRE)--At the European Congress of Rheumatology (EULAR) 2025, Scipher Medicine, the company behind the groundbreaking PrismRA ® test, unveiled a new, AI-driven approach to help doctors better evaluate if a rheumatoid arthritis (RA) treatment is truly working — a challenge that has long frustrated both patients and physicians. This new 'RA Response Calculator,' developed using real-world patient data and machine learning, offers a more accurate way to determine whether someone is actually improving on their current therapy — cutting through the noise of subjective measures like patient self-reports and physician assessments. 'Anyone living with RA knows that figuring out whether a medication is working can take months — and even then, it's often unclear,' said Reg Seeto, CEO of Scipher Medicine. 'We created this tool to make that process faster, clearer, and more personalized. It brings science and objectivity to a space that's long relied on educated guesswork.' The study analyzed data from nearly 1,500 RA patients receiving commonly prescribed treatments — TNF inhibitors, T-cell inhibitors, and IL-6 inhibitors. By applying a machine learning algorithm to joint tenderness, swelling, and inflammation data collected over 24 weeks, Scipher's team identified a combination of two standard clinical measures that best predicts therapy success: Tender Joint Count (TJC) and Swollen Joint Count (SJC). The result: a simple formula that predicts whether a treatment is helping — or if it's time to try something else. 'Doctors already use TJC and SJC in the clinic. What's new is how we've mathematically combined them using real-world data and AI to create a consistent, data-backed benchmark for treatment response,' said Seeto. 'This is about giving providers and patients a clearer, faster answer — and a better shot at remission.' The new tool also showed improved accuracy over standard response metrics like CDAI and ACR scores, which are commonly used in trials but often fall short in real-world care. About Scipher Medicine Scipher Medicine is transforming how autoimmune diseases like RA are treated by using AI and network biology to match patients with therapies that actually work. Through its SPECTRA Rx and Dx platforms, Scipher combines the largest clinico-genomic dataset in rheumatology with real-world medical records, creating powerful tools to personalize care and improve drug development. Learn more at PrismRA is a first-of-its-kind blood test that helps doctors identify which RA patients are unlikely to respond to TNF inhibitor therapy — the most commonly prescribed (and most expensive) class of RA drugs. With just a routine blood draw, PrismRA analyzes a patient's molecular signature to guide more effective and personalized treatment plans. Visit to learn more.
Medscape
5 days ago
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- Medscape
Leflunomide, HCQ Combo Effects Validated in Sjögren Disease
BARCELONA, Spain — In the treatment of primary Sjögren disease, the use of leflunomide (LEF) and hydroxychloroquine (HCQ) in combination was associated with a greater reduction in disease activity than placebo, according to new trial results reported at the European Alliance of Associations for Rheumatology (EULAR) 2025 Annual Meeting. In the randomized controlled RepurpSS-II trial, the LEF-HCQ combination produced a mean decrease in EULAR Sjögren syndrome disease activity index (ESSDAI) score of 4.13 points ( P = .001) relative to placebo after 24 weeks of treatment. There were also greater reductions in serum immunoglobulin G, rheumatoid factor, and complement component 4 with the combination than with placebo. However, there were no differences between the groups in terms of patients' symptoms as measured by the EULAR Sjögren syndrome patient reported index (ESSPRI) or its separate components. There were also no differences between the groups in improving dryness as measured using the Schirmer and unstimulated saliva tests. Confirmatory Trial Wing-Yi Wong, MD 'The major challenge in this disease is the lack of standard treatments, despite the need,' said Wing-Yi Wong, MD, a PhD student at University Medical Center Utrecht, Utrecht, the Netherlands, who presented the findings as a late-breaking abstract. 'Many trials in the past 40 years have failed to show clinical efficacy,' Wong added. One of the few trials that had proven promising previously, however, was the RepurpSS-I trial, which had tested a combination of LEF at a dose of 20 mg/d and HCQ at a dose of 400 mg/d given for 24 weeks vs placebo. RepurpSS-II was set up to confirm the findings of RepurpSS-I. Published in The Lancet Rheumatology in 2020, RepurpSS-I had shown that LEF-HCQ reduced ESSDAI a mean of 4.29 points more than that with placebo. Trial Designs and RepurpSS-II Population RepurpSS-I was a phase 2a trial, and RepurpSS-II was a phase b2 trial. Entry criteria were similar for both trials: Primary Sjögren disease diagnosis, an ESSDAI ≥ 5, and no significant comorbidities. Women of a child-bearing age also had to be taking reliable contraception. Both RepurpSS trials included 24-week double-blind treatment phases, with RepurpSS-II adding a single-arm crossover extension for a further 24 weeks. A total of 37 people with primary Sjögren disease had been screened for inclusion in RepurpSS-I, 29 were included, 21 of whom were treated with the LEF-HCQ combination and eight with placebo. For RepurpSS-II, 85 of 233 people who were considered for inclusion were screened, and 46 were included in the trial. Of these, 21 were treated with LEF-HCQ and 25 with placebo. Among the reasons for not screening or including more people in RepurpSS-II were comorbidities; current or recent treatment with LEF, HCQ, or other disease-modifying antirheumatic drugs; and not meeting other entry criteria. Participants in the LEF-HCQ and placebo groups of RepurpSS-II were demographically similar: The mean age was 55 years; 90.5% and 96.0%, respectively, were women; and the mean disease durations were 6.5 years and 10.0 years, respectively. Mean ESSDAI scores at baseline were 9.52 in the LEF-HCQ group and 9.88 in the placebo group, and mean ESSPRI scores were 7.00 and 6.83, respectively. Other Findings Exploratory analyses using the Sjögren's Tool for Assessing Response (STAR) and the Composite of Relevant Endpoints for Sjögren Syndrome (CRESS) also favored LEF-HCQ. 'STAR and CRESS scores are two novel composite endpoints that includes patient-reported outcomes together with objective measures of dryness alongside the clinical ESSDAI,' Wong said. She reported that there was a 'significantly higher percentage of responders' in the LEF-HCQ group using both measures vs placebo. Adverse event rates were similar between groups: A total of 58 events occurred in the LEF-HCQ group and 57 in the placebo group. Most of these events were considered as mild (77.6% for LEF-HCQ and 66.7% for placebo), with gastrointestinal discomfort and respiratory infections among the most commonly reported. Two severe adverse events occurred, one in each group, and were deemed unrelated to the study treatment. The one in the LEF-HCQ group was a non-ST elevation myocardial infarction, and the one in the placebo group was an allergic reaction to antibiotic treatment. A total of 14 patients in the LEF-HCQ group completed the double-blind phase, and nine chose to enter the 24-week, open-label extension. Although completed, results of this phase are pending. 'Overall, the combination treatment was well tolerated, and leflunomide-hydroxychloroquine is realistic treatment option, which is affordable, accessible, and widely available,' Wong concluded. This study was funded by the Dutch independent government body ZonMw . Wong and fellow investigators for the RepurpSS-II study had no relevant conflicts of interest.
Medscape
14-06-2025
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- Medscape
EULAR, ERS Issue First Guideline for Managing CTD-ILD
BARCELONA, Spain — All patients with systemic sclerosis (SSc) and mixed connective tissue disease (MCTD) should be screened for interstitial lung disease (ILD), according to new guidelines presented at the European Alliance of Associations for Rheumatology (EULAR) 2025 Annual Meeting. The guidelines are a collaboration between EULAR and the European Respiratory Society (ERS) to provide comprehensive, disease-specific recommendations for the screening, diagnosis, and management of ILD in patients with connective tissue diseases (CTDs), including SSc, MCTD, rheumatoid arthritis (RA), idiopathic inflammatory myopathies (IIM), and Sjögren's disease (SjD). "These are the first recommendations [for ILD] that have been developed by rheumatologists and pulmonologists together in Europe," said Bernhard Hellmich, MD, of the University of Tübingen, Germany. He was not involved with the work but moderated the session during which the recommendations were presented. The ERS has published guidelines solely focusing on therapies for ILD, but "the meaningful impact [of these new guidelines] is that it is interdisciplinary work," he said. Screening for ILD The guidelines strongly recommend systematic screening for ILD with high-resolution computed tomography (HRCT) in all patients with SSc and MCTD, regardless of risk factors. This recommendation also applies to patients with IIM, except those with inclusion body myositis. Patients with RA, SjD, and other CTDs should first be assessed for disease-specific risk factors. Patients with identified risk factors should be screened with HRCT. Although some previous recommendations supported screening in SSc, "now the big news is that we should also screen patients with RA who have risk factors," Hellmich said. "We have not done this before, so this will certainly identify more patients who are eligible for therapy and may improve [outcomes] down the line." The guidelines do not include any recommendations on screening frequency because of a lack of evidence, explained Anna-Maria Hoffmann-Vold, MD, PhD, of Oslo University Hospital, Norway, who presented the guidelines. She advised that providers use the same approach as that used at the timepoint of diagnosis and assess for any new risk factors for ILD progression. Any patient with additional red flags such as sustained joint disease in RA should be re-screened, she said. "Of course, in any case of suspicion, re-screen the patient," she continued. The guidelines strongly recommend against replacing HRCT with pulmonary function tests or lung ultrasound for screening for ILD; however, forced vital capacity and diffusing capacity of the lungs for carbon monoxide can be included in case of symptoms or CT abnormalities. Monitoring After Diagnosis The guidelines do have time recommendations for monitoring ILD progression after diagnosis. The recommendations are disease-specific and stratified by risk of ILD progression. Clinicians can assess risk for ILD progression in the following year by looking at prior lung function tests, HRCT results, the 6-minute walking test, and risk factors for poor outcomes in ILD, which include disease-specific circulating markers, higher disease activity, and HRCT pattern and extent. Based on these factors, clinicians can categorize patients as higher or lower risk, Hoffmann-Vold said. "Next, you look at the disease duration of the patient — whether you have a shorter disease duration or longer disease duration in the high-risk group and the low-risk group," she explained during her presentation. "Based on this, you apply the monitoring tools we have identified." Although some time recommendations vary by disease, for high-risk patients with any CTD, lung function tests should be performed every 3-6 months in the first years of disease and every 6-12 months thereafter. For lower-risk patients, perform lung tests every 6-12 months in the first years of disease and annually thereafter. Treatment Recommendations The new treatment recommendations "not only list which treatment options are available for every disease but also give hints [about] which patient might be the right one for a certain medication," Hoffmann-Vold said. The group strongly recommends that patients with SSc-ILD with early diffuse SSc and signs of inflammation should be treated with tocilizumab and that patients with any IIM-ILD should be treated with immunosuppressive treatment, which can include glucocorticoids, calcineurin inhibitors, rituximab, mycophenolate, or azathioprine. Other recommendations are conditional, largely because of limited patient populations and a small number of randomized controlled trials. SSc-ILD, RA-ILD, and IIM-ILD all have individual treatment algorithms. This comprehensive guideline will "certainly help to get patients earlier into treatment," Hellmich added. "Some of these therapies [currently] are more or less off-label," he said. But if they are included in EULAR guidelines, "people are more likely to use them in clinical practice and to improve prognosis." The full guidelines will be published next month in Annals of the Rheumatic Diseases and European Respiratory Journal .
