Rheumatology

2025 EULAR RA update reinforces MTX-first, treat-to-target, and cautious JAKi positioning

The 2025 EULAR RA recommendations condense management into 5 principles and 9 recommendations covering csDMARDs, bDMARDs, tsDMARDs, and tapering. Initial therapy should be methotrexate, ideally combined with short-term glucocorticoids, within a strict treat-to-target strategy. If response is inadequate after 3–6 months, adding a bDMARD is preferred; JAK inhibitors are considered only after explicit cardiovascular and malignancy risk review. After failure of the first bDMARD or JAKi, switching within or across b/tsDMARD classes is recommended. 1

AxSpA app-based program meaningfully improves BASDAI, function, and QoL on stable therapy

In a 12-week RCT of 200 axSpA patients with stable pharmacotherapy, the Axia app improved outcomes versus standard of care. The intervention group showed significantly greater reductions in BASDAI, BASFI, and disease-specific quality-of-life scores, all exceeding minimal clinically important differences. ASAS20 and ASAS40 responses were much more frequent with Axia than control (51% vs 9% and 23% vs 3%). No concerning safety signals emerged, supporting Axia as a safe nonpharmacologic adjunct for symptom control, exercise guidance, and self-management. 2

axSpA and PsA carry excess mortality; TNF inhibitors associate with lower death risk

In TriNetX data including 32,368 axSpA, 52,402 PsA patients, and 9.7 million controls, both diseases showed elevated all-cause mortality. Mortality risk versus controls was higher in axSpA (HR 1.71) than PsA (HR 1.26). AxSpA patients had 42% greater mortality than PsA patients, and male sex further increased mortality in both conditions. Treatment with b/tsDMARDs, particularly TNF inhibitors, was associated with a 47% mortality reduction in axSpA and 38% in PsA versus untreated patients. 3

JAK inhibitors in RA increase keratinocyte cancer risk compared with TNFi

Among 21,756 Swedish RA patients, JAK inhibitor use was associated with higher incident keratinocyte cancer risk than TNFi (HR 1.39). This risk difference corresponded to approximately one additional keratinocyte cancer per 244 JAKi-treated patients per year. Elevated risks were seen for both basal cell carcinoma (HR 1.41) and squamous cell carcinoma (HR 1.49) versus TNFi. Non-TNFi bDMARDs overall did not increase keratinocyte cancer risk, but abatacept showed higher squamous cell carcinoma risk versus etanercept (HR 1.48). 4