Latest news with #EULAR
Medscape
an hour ago
- Health
- Medscape
Fast Five Quiz: Sjögren Disease Management
Learn more about ocular dryness in Sjögren disease. B cells have been shown to significantly impact the pathogenesis of primary Sjögren disease. However, B-cell targeted therapies are generally considered in severe, refractory cases, or in patients with systemic involvement. Specially, the EULAR recommends considering B-Cell targeted therapies only in severe, refractory systemic disease. This is consistent with recommendations from the Sjögren's Foundation, wherein most biologic therapies are recommended for refractory cases or those with systemic involvement. Additionally, the Sjögren's Foundation specifically recommends against the use of tumor necrosis factor inhibitors to treat sicca symptoms in patients with Sjögren disease. Learn more about B-cell therapies for Sjögren disease. Pulmonary manifestations of Sjögren disease, which include interstitial lung disease, are a potentially serious complication of the disease. For patients with symptomatic cystic vocal cord lesions (bamboo nodules), the Sjögren's Foundation recommends voice therapy, inhaled corticosteroids, or intralesional corticosteroid injections. A recent review has further confirmed these approaches are most appropriate in this setting. Nebulized saline is usually recommended for patients with Sjögren disease and ' clinically relevant bronchiectasis.' Systemic corticosteroids are not usually recommended as an initial treatment in this setting; they are typically used for other pulmonary manifestations, such as interstitial lung disease and certain small airway diseases. Surgical resection is typically considered when these approaches fail and after a consultation with a laryngologist. Learn more about pulmonary manifestations in Sjögren disease. For patients with Sjögren disease and acute musculoskeletal pain, EULAR recommends limiting NSAID use to no more than 10 days at full dosage, citing evidence that one third of patients will have a rapid clinical response to short-term analgesics. For inflammatory musculoskeletal pain, the Sjögren's Foundation guidelines recommend hydroxychloroquine and/or methotrexate, progressing to corticosteroids, then leflunomide, sulfasalazine, azathioprine, and cyclosporine. EULAR also suggests hydroxychloroquine for this indication due its effectiveness in other systemic autoimmune diseases but note a pivotal RCT did not show significant benefit. As such, they emphasize nonpharmacologic management of chronic pain and note that treatment should follow general chronic pain guidance. Learn more about pain in Sjögren disease. Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication. Lead image: Peakstock/Science Source
Yahoo
17-07-2025
- Business
- Yahoo
Fate Therapeutics, Inc. (FATE) Reaffirmed at Neutral After EULAR Data
Fate Therapeutics, Inc. (NASDAQ:FATE) is among the . Analysts at H.C. Wainwright have reaffirmed their Neutral rating on Fate Therapeutics, Inc. (NASDAQ:FATE), while maintaining their price target of $5.00, implying an upside potential of around 358%. This was after the company presented its T819 data on lupus at the European Alliance of Associations for Rheumatology (EULAR) 2025 Congress in Barcelona, Spain. This study, conducted in five patients, revealed that three patients with active lupus nephritis and a history of B-cell-targeted therapy were successful in achieving a primary renal response. The data's SLEDAI-2K scores showed significant improvement within the one-, six-and-a-half-, and twelve-month periods, indicating a positive performance. A laboratory scientist testing a small molecule modulator as a potential immune-oncology therapy. The research firm expressed its eagerness in DORIS remissions to consider FT819 a viable commercial threat. While the early signal of activity has led Fate Therapeutics, Inc. (NASDAQ:FATE) to continue its efforts to accelerate the study, particularly by enrolling at higher doses, the company finds itself on the bleeding edge of engineered cell therapy in autoimmune disease, a market that's anticipated to reach high levels. Fate Therapeutics, Inc. (NASDAQ:FATE) is a California-based clinical-stage biopharmaceutical company that focuses on the development of programmed cellular immunotherapies for people living with cancer and immune disorders. Incorporated in 2007, the company is committed to improving the lives of many. While we acknowledge the potential of FATE as an investment, we believe certain AI stocks offer greater upside potential and carry less downside risk. If you're looking for an extremely undervalued AI stock that also stands to benefit significantly from Trump-era tariffs and the onshoring trend, see our free report on the . While we acknowledge the potential of FATE to grow, our conviction lies in the belief that some AI stocks hold greater promise for delivering higher returns and have limited downside risk. If you are looking for an AI stock that is more promising than FATE and that has 100x upside potential, check out our report about this cheapest AI stock. READ NEXT: The Best and Worst Dow Stocks for the Next 12 Months and 10 Unstoppable Stocks That Could Double Your Money. Disclosure: None.
Medscape
03-07-2025
- Health
- Medscape
Fast Five Quiz: Management of GPA
Granulomatosis with polyangiitis (GPA) is a variant of anti-neutrophil cytoplasmic antibody ( ANCA)-associated vasculitis that most commonly presents with proteinase 3 (PR3) serology and distinct clinical features that necessitates swift identification and therapeutic intervention. Prompt treatment plays a crucial role in minimizing permanent organ damage, particularly in the renal and pulmonary systems. What do you know about the management of GPA? Check your knowledge with this quick quiz. The latest guidelines from the Kidney Disease Improving Global Outcomes (KDIGO) and European Alliance of Associations for Rheumatology (EULAR) both recommend initiating immunosuppressive therapy in patients with suspected PR3 positive ANCA vasculitis, which is indicative of GPA, even if clinicians are still awaiting biopsy results. Further, EULAR specifically acknowledges that collecting biopsies might not be feasible for each patient with ANCA vasculitis and treatment should 'not be delayed while awaiting histological information.' Learn more about biopsy for GPA. KDIGO recommends maintaining therapeutic intervention for 18 months to 4 years following successful remission, which is similar to the EULAR guidelines recommending maintenance therapy for 24-48 months in patients with GPA. They also state, 'longer duration of therapy should be considered in relapsing patients or those with an increased risk of relapse, but should be balanced against patient preferences and risks of continuing immunosuppression.' Learn more about remission maintenance in GPA. Infection is a significant concern in ANCA vasculitis, especially regarding immunosuppressive therapies including glucocorticoids that are used to manage the clinical manifestations of the disease. Recent research has shown that chronic nasal carriage of S aureus is significantly higher in patients with the GPA subtype; it has also been shown to be associated with increased endonasal activity and risk for relapse. Although M catarrhalis, H influenzae, and S pneumoniae do not appear to have a specific association with GPA, data have shown that infection is among the most common causes of death in GPA. Learn more about infection in GPA. Data indicate that the GPA subtype is an independent risk factor for disease recurrence. Additionally, KDIGO also considers lower serum creatinine, more extensive disease, PR3 histology (which is associated with higher relapse rates than MPO-positive disease commonly seen in MPA) and ear, nose, and throat involvement as 'baseline factors' for disease recurrence. Factors after diagnosis include history of relapse, ANCA positivity at the end of induction, and rise in ANCA. Treatment-related relapse factors include lower cyclophosphamide exposure, immunosuppressive withdrawal, and glucocorticoid withdrawal. Learn more about prognosis in GPA. To ensure disease does not recur into the transplanted tissue, KDIGO specifically recommends delaying kidney transplantation until patients have achieved complete clinical remission for at least 6 months. Further, ANCA positivity or negativity should not factor into this decision, with KDIGO stating, 'the persistence of ANCA should not delay transplantation.' Although a serum creatinine of > 4 mg/dL is a significant predictor of relapse, guidelines recommend considering combination of a monoclonal antibody and an alkylating agent for this indication. Similarly, induction and maintenance of dialysis should also be done under various separate conditions. Learn more about kidney transplantation for GPA. Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.
Medscape
03-07-2025
- Health
- Medscape
Methotrexate Boosts Steroid-Free Remission in Early PMR
BARCELONA, Spain — Compared with placebo, adding methotrexate (MTX) to treatment for newly diagnosed polymyalgia rheumatica (PMR) nearly doubled glucocorticoid (GC)-free remission rates at 1 year, according to research presented at European Alliance of Associations for Rheumatology (EULAR) 2025 Annual Meeting. Patients in the MTX group also achieved GC-free remission sooner than those in the placebo group, but researchers did not find that adding MTX significantly reduced the cumulative GC dose. Previous studies evaluating MTX as a GC-sparing agent in PMR have had variable results, said Aatke van der Maas, MD, PhD, a rheumatologist at Sint Maartenskliniek, Nijmegen, the Netherlands, who presented the findings at the meeting. However, these earlier trials used lower doses than those typically used for other rheumatic diseases. 'We wanted to look at whether MTX at 25 mg weekly would be effective in achieving GC-free remission in recently diagnosed PMR patients,' she said. Van der Maas previously presented results from this trial at the American College of Rheumatology 2024 Annual Meeting in Washington, DC. At that time, the analysis suggested that MTX did not increase GC-free remission rates; however, due to a coding error that resulted in some patients being placed in the wrong allocation group, those older results were considered erroneous. These updated results followed an audit and re-analysis of the source data. Targeting Early Disease The interleukin-6 receptor antagonist sarilumab is already approved for PMR in patients who have had an inadequate response to corticosteroids or could not tolerate a corticosteroid taper. But this trial targeted a different patient population, said Sara K. Tedeschi, MD, MPH, of Brigham and Women's Hospital, Boston. 'It's a very different scenario, and one that I think is very attractive about the study,' she told Medscape Medical News . Tedeschi was not involved in the research. 'For many patients with PMR, it would be great to discuss starting a steroid-sparing agent at the time of diagnosis, rather than needing to wait many months to see how they respond to a steroid taper before deciding to add a steroid-sparing agent.' To see whether a higher MTX dose resulted in higher steroid-free remission rates, researchers recruited 64 patients who had been diagnosed with PMR within the past 12 weeks. All patients met the 2012 EULAR/ACR classification criteria for PMR and had been taking GCs for < 8 weeks. Patients with other rheumatic inflammatory conditions, contraindications to MTX, or those receiving other immunomodulatory therapies were excluded. Patients were randomly assigned in a 1:1 ratio to receive a weekly dose of 25 mg oral MTX or placebo. An accelerated GC taper accompanied both treatment groups, beginning at 15 mg and tapering to 0 mg over 24 weeks. The primary outcome was GC-free remission, defined as a PMR activity score of < 10 and no systemic GC use, at week 52. Patients assigned to placebo had a higher median age than the MTX group (68 years vs 63 years) and a higher BMI (28 vs 25). The proportion of men and women enrolled in the study was approximately equal. Higher GC-Remission Rates in Less Time A total of 80% of patients in the MTX group achieved GC-free remission at 1 year compared with 46% of individuals in the placebo group ( P = .004). The median time to remission was shorter in the MTX group than in the placebo group (28 weeks vs 39 weeks; P = .013). The MTX group experienced fewer relapses through week 52 (31 vs 45). Relapse was determined by clinical judgement. From week 0 to 52, the median cumulative GC dose was 2050 mg (interquartile range, 1770-2583 mg) in the MTX group and 2288 (interquartile range, 1880-2878 mg) in the placebo group; this difference was not statistically significant ( P = .17). Adverse events were comparable between the two groups. 'We conclude that there is a significant effect of methotrexate 25 mg in recently diagnosed patients on GC-free remission, median time to remission, and the number of relapses, but we could not demonstrate a significant GC-sparing effect or an effect on percent of relapsing patients,' van der Maas said. Larger and Longer Study Needed Researchers are still following these patients, which will provide more insight on long-term GC use and prolonged remission, van der Maas said. The difference in GC-free remission rates between the two groups is 'pretty striking,' Tedeschi said, and the similarities in relapse rates and cumulative GC doses raise interesting questions that should be explored further. 'Based on these data, I do think it would be worthwhile to do a larger study.'
Medscape
03-07-2025
- Health
- Medscape
Rheumatoid Nodules: Rare, Recurrent, and Still a Challenge
Despite the rising incidence of rheumatoid arthritis (RA), extra-articular manifestations have become rare in the era of modern treat-to-target therapy. However, they still present clinical challenges — particularly in the case of rheumatoid nodules. In addition to the need to rule out serious differential diagnoses and address potential complications, especially those involving the lungs, these recurrent inflammatory granulomas can affect daily life not only cosmetically but also functionally. Christopher Edwards, MD, professor of rheumatology at University Hospital Southampton in Southampton, England, discussed the clinical relevance and management of rheumatoid nodules during the 2025 Annual Meeting of the European Alliance of Associations for Rheumatology. When Edwards began his career in rheumatology, the presence of rheumatoid nodules was considered a key diagnostic criterion for RA. If not found on the hands, clinicians often examined the elbows and Achilles tendons, which are also common sites. Histologically, rheumatoid nodules are granulomatous inflammatory lesions that evolve through multiple stages. While often subcutaneous, they can also be found on the sclera, larynx, heart valves, and — most significantly — in the lungs. Biopsy When Malignancy Is Suspected Pulmonary nodules can present diagnostic difficulties. 'I've seen patients who were initially told they had lung metastases,' Edwards recalled. Waiting for further imaging and biopsy can be highly distressing for patients. Granulomatosis with polyangiitis can also resemble rheumatoid nodules, further complicating the diagnosis. It is especially important to distinguish these nodules from infections such as tuberculosis. Patients with RA are at increased risk for infection due to both the underlying disease and immunosuppressive treatment. Like tuberculomas, pulmonary rheumatoid nodules can undergo central necrosis when exposed to tumor necrosis factor-alpha inhibitors, leading to cavitation or even pneumothorax. 'Any cavity in the lung can become infected,' Edwards cautioned. Diagnosing Peripheral Nodules Diagnosing peripheral rheumatoid nodules is usually straightforward. These nodules typically feel rubbery on palpation and are movable relative to the underlying tissue. Important differential diagnoses include gouty tophi, lipomas, epidermoid cysts, infectious granulomas, sarcoidosis, and neoplastic lesions. Imaging tools such as ultrasound or fine-needle aspiration can help clarify the diagnosis, particularly when gout is suspected. 'Biopsy is rarely required — only if there's concern about a neoplastic or malignant process,' Edwards explained. Better Disease Control, Fewer Nodules 'In my practice, I see very few nodules these days,' said Edwards. Epidemiological data support this trend: The 10-year cumulative incidence of subcutaneous nodules in RA patients decreased from 30.9% between 1985 and 1999 to 15.8% between 2000 and 2014. Multiple factors likely contributed to this decline, including the earlier initiation of more effective therapies and a reduction in smoking rates. Smoking remains a major risk factor for nodule development, along with long-standing, severe RA, male sex, and seropositivity for rheumatoid factor or anti-cyclic citrullinated peptide antibodies. 'Patients with nodules are almost always seropositive,' Edwards noted. These findings suggest that maintaining tight control of disease activity is more critical for preventing nodules than concerns about drug-induced nodulosis. Little Reason to Discontinue Methotrexate 'There was a time when we worried that methotrexate might be causing nodules,' Edwards said, referring to anecdotal reports of increased nodulosis after initiating methotrexate (MTX). 'But now we're using more MTX and seeing fewer nodules.' He emphasized that the presence of nodules alone should not prompt discontinuation of MTX. 'It wasn't a reason to stop methotrexate back then, and it's not a reason now — though in some cases, it may justify a more aggressive treatment approach.' Other medications — particularly tumor necrosis factor inhibitors like etanercept — have also been linked to nodule development, though Edwards suggested this may reflect reporting bias. 'It might not be causal,' he said. Often, treatment isn't necessary. 'Sometimes it's just a matter of observation,' Edwards noted. Painful or functionally limiting nodules may be managed with local glucocorticoid injections to reduce discomfort and soften the nodules. However, he admitted he had never personally injected a rheumatoid nodule. He also cautioned against injections over the elbow. 'There's something about the skin and the olecranon bursa that makes infections more likely in that area. I saw one patient who needed plastic surgery after an infection left a significant wound.' Rheumatoid nodules also have a tendency to recur. When to Consider Surgery 'Surgery can benefit some patients,' Edwards said. Surgical removal may be warranted for nodules that ulcerate, become infected, or impair function — such as large nodules on the thumb or fingertip that interfere with gripping. 'Patients are usually happy to regain function, even if the nodule comes back a couple of years later.' Nodules that are consistently irritated by shoes or clothing straps may also merit removal. Pulmonary rheumatoid nodules — unlike subcutaneous ones — often contain B cells and typically respond well to rituximab or abatacept. 'These lung nodules tend to shrink or stabilize with rituximab, and certainly, no new ones seem to develop,' Edwards noted. Case reports and small series have also documented improvement with Janus kinase inhibitors.
