The 52nd Congress of the Spanish Rheumatology Society (SER) in Bilbao, Spain, highlighted a shift toward precision medicine in rheumatology, with experts pointing to multiomics, biomarkers, and targeted therapies as key tools expected to shape more personalized treatment strategies and future clinical practice. 

Natividad Oreiro Villar, MD, PhD, from the Rheumatology Department at the University Hospital Complex of A Coruña, A Coruña, Spain, said, “We need to bring rheumatology closer to personalized medicine. In fact, many specialties are already moving in that direction; this approach is essential because, moreover, the foundations for it already exist — though they still need to be developed — since they will be what enables us in the future to treat patients with rheumatic diseases more effectively, with better outcomes, and in a more precise manner.”

Speaking during the keynote lecture “The Best of the Year in Basic Research,” Oreiro Villar reviewed recent advances in the molecular and genetic understanding of rheumatic diseases commonly encountered in clinical practice. Her presentation covered DNA and RNA analysis, disease-associated polymorphisms, and microbiome research in systemic lupus erythematosus (SLE), systemic sclerosis, Sjögren syndrome, rheumatoid arthritis (RA), psoriatic arthritis (PsA), and osteoarthritis.

She also highlighted advances in biomarker research, emphasizing that rheumatology requires the integration of multiple biologic systems. Multiomics is an integrative approach that combines multiple layers of molecular information to holistically study biological systems. “We need to address all of this now because it will be what allows us to better tackle all the challenges in our specialty in the future,” she said.

Basic Research

According to Oreiro, the most significant advances in basic research over the past year are “not the discovery of definitive cures,” but rather “the emergence of new avenues of treatment for certain rheumatic diseases;” we see this reflected in our clinical research; “we sense that something is brewing when new attempts to test molecules on patients begin to emerge,” she said.

She stressed the importance of identifying patient subgroups within each rheumatic disease in order to tailor therapies, improve outcomes, and reduce adverse effects. The goal, she explained, is not only greater efficacy but also an improved quality of care.

Oreiro Villar also highlighted advances in multiomic techniques. “Multiomics is clearly what will allow us to accurately assess each of our patients, and based on the results, we will be able to offer them the most appropriate personalized treatment,” she said.

Another major focus involves fibroblast research. Oreiro Villar said, “This year, many studies have been presented that focus on better analyzing fibroblasts and their overall population because these cells will not only be used in rheumatology; ultimately, fibroblasts will be one of the future therapeutic targets in medicine. In chronic kidney disease, researchers are trying to make rapid progress in this area.”

Undifferentiated Arthritis

Oreiro Villar noted that rheumatologists often diagnose patients with undifferentiated arthritis, a condition whose long-term course may only become clear over time. “There are cases, and we have published studies, showing that this type of arthritis progresses toward rheumatoid arthritis, psoriatic arthritis, and cutaneous psoriasis,” she said.

However, she noted that undifferentiated arthritis appeared to have distinct epigenetic profiles from the outset. “In other words, if we had that data, we could classify that group of patients differently; right now, we can’t. But a lot of work is underway behind the scenes that could help us classify them better; we’re still only seeing the tip of the iceberg.”

Oreiro Villar concluded by emphasizing the need to advance toward personalized medicine tailored to each patient’s needs, adding, “Genetic testing and biomarkers are key to determining the appropriate treatment. That is the path we must follow in our specialty.”

Clinical Research

Rubén Queiro Silva, MD, PhD, rheumatologist and professor from the Hospital Universitario Central de Asturias in Oviedo, Spain, delivered the keynote lecture “The Best of the Year in Clinical Research.”

He reviewed recent developments in multiple rheumatological conditions. In RA, he highlighted updated recommendations from the European Alliance of Associations for Rheumatology (EULAR). “The new recommendations represent a small revolution, not a major one. They emphasize a goal-oriented treatment strategy, with frequent patient follow-ups, while escalating therapies depending on whether the goal is achieved or not,” he said.

Queiro also discussed a trial evaluating vagus nerve neuromodulation in RA. The intervention used a surgically implanted device placed on the left side of the neck to stimulate the vagus nerve and trigger anti-inflammatory effects without medication. “It is a very promising field for the treatment of arthritis,” he said.

In the field of spondyloarthritis, he referred to two trials involving two different approaches. One of them involves starting treatment with highly advanced therapy at the onset of the disease. “To see if using a biologic drug would be better than conventional therapy. For now, the results tell us that it isn’t — that the outcomes would be the same,” he emphasized.

The other study that stood out was the TOGETHER-PsA trial (NCT06588296), which demonstrated for the first time that when patients with active PsA who also have obesity are given both an arthritis medication such as ixekizumab and an obesity medication such as tirzepatide, better results were achieved than when only an arthritis medication was administered.

Systemic Diseases

In the field of systemic autoimmune diseases, Queiro highlighted the updated EULAR recommendations for managing lupus nephritis and interstitial lung disease associated with connective tissue disorders.

In osteoporosis, he noted increasing use of targeted treatment strategies. “It’s not just about preventing or reducing the risk of fractures associated with osteoporosis but also about determining the patient’s baseline bone mineral density in order to select the best medication for them,” he said.

He also reviewed new recommendations for managing VEXAS syndrome released by an international expert panel convened under the auspices of the American College of Rheumatology.

Queiro highlighted studies examining SARS-CoV-2 infection and vaccination and said, “Current evidence suggests that exposure to SARS-CoV-2 triples the risk for developing systemic autoimmune diseases, whereas vaccination does not increase that risk. This is something we can convey to our patients, reassuring them because some have concerns about whether the COVID vaccine might have caused them any rheumatic disease. According to the studies, it appears that there is no link whatsoever between the COVID vaccine and rheumatic diseases, but there is a link between the viral infection itself and the risk of rheumatic diseases.”

Treatment Advances

He outlined the advances made over the past year, including new therapies for dermatomyositis, a complex and serious systemic autoimmune disease. Progress has extended beyond the development of new drugs, he noted, highlighting new treatment strategies for SLE. “There is a shift in how we use the drugs we already know; what we call strategy trials are demonstrating that it is not only important to choose the specific drug, but also how we implement it in highly innovative management strategies in our field.”

Echoing Oreiro Villar’s view, he advocated increasingly personalized treatment approaches: “In addition to the search for biomarkers to guide personalized treatment responses, researchers are exploring innovative ways to use the treatments we already have. It’s not just about administering a drug but about tailoring the timing of its administration to achieve better responses.”

Despite progress over the past year, major challenges persist. “We must bear in mind that, unfortunately, for most systemic autoimmune diseases, a high percentage of patients do not achieve remission or even low disease activity. And that has led us to make significant strides in developing new treatment approaches.”

Oreiro Villar also highlighted CAR T-cell therapies, which are attracting growing interest in systemic autoimmune diseases. She presented results from the CASTLE basket trial, which showed that CAR T-cell therapy enabled virtually all patients with lupus to achieve sustained remission. “We are also seeing that these CAR T therapies can be extended to other diseases such as systemic sclerosis or idiopathic inflammatory heart disease. Therefore, we are getting closer to making a leap toward personalized treatments, although there is still a long way to go,” she concluded.

Oreiro Villar and Queiro reported having no relevant conflicts of interest related to the topics discussed during the keynote lectures at the SER. 

This article was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.