Rheumatology breakthroughs at ACR 2025: Advances in lupus, osteoarthritis, and osteoporosis

The latest American College of Rheumatology (ACR) meeting highlighted significant advances in research and clinical practice, reflecting the rapid evolution of treatments and technologies in rheumatology.

In this interview, Dr Nancy Lane (UC Davis, Sacramento, CA, USA) highlights the progress in new treatments that preserve renal function in lupus, the emerging role of GLP-1 agonists in managing pain and comorbidities in rheumatic diseases, and cutting-edge imaging tools for assessing fracture risk in osteoporosis. Dr Lane also shares how updated clinical guidelines and new therapies are transforming rheumatology care, giving physicians more options than ever to improve patient outcomes.

touchIMMUNOLOGY coverage of ACR 2025: 

What were your key highlights from this year’s ACR meeting?

The ACR meeting was very exciting this year. We have made a lot of progress in treating lupus and the renal disease, lupus nephritis. We now have very good medications to treat the disease and preserve renal function, which is very exciting for rheumatologists.

I also think that the data on CAR T cell therapies is coming along, and we’ll hopefully know soon where they will fit in the treatment of rheumatic diseases. Then there were very good presentations about comorbid diseases that patients with rheumatic disease have and the use of the GLP-1 agonists. It was a very good meeting with many good presentations.

How do you see GLP-1 agonists shaping the future of rheumatic disease and osteoarthritis management?

The GLP-1 agonists are surprising us with new areas in which they seem to improve health. They improve cardiovascular disease, renal disease, and they appear now to improve pain and comorbidities in rheumatic disease populations. When it comes to patients with rheumatoid arthritis or systemic lupus erythematosus who have problems with renal disease, high blood pressure or heart disease, using these medications is going to be very helpful for their health.

They are looking to be very helpful in osteoarthritis, an area where we don’t have any good medications that either slow the disease course or reduce pain. We know that they reduce adipose tissue, which release molecules that probably increase joint pain in these patients. We don’t really know yet where the GLP-1 agonists will fit in the treatment of osteoarthritis, but I think that we have raised awareness that this is being investigated.

What recent advances in imaging or diagnostics are most promising for improving osteoporosis care?

Osteoporosis is a disease where the bone mass can be low, causing bone fractures at very low stress. Usually, we measure the amount of bone with a DEXA scan, which are very helpful, but there are other advances that can provide more detail about a patient’s risk of having an osteoporotic fracture.

There is the trabecular bone score, which is a way to measure trabecular bone in the spine, which can be helpful in patients that are on glucocorticoids, and that can be part of the software obtained from the DEXA scan. We also have a measurement that can be obtained right off the DEXA scan, the vertebral fracture assessment, which measures whether patients have fractures by looking at the lateral spine.

Those are two of the areas where I think we need to take more into practice to better assess our patient’s risk of fracturing. There are also new ultrasound measure devices that are coming out, they are not ready for applying to the clinic, but the research is coming along.

How can updated clinical guidelines help rheumatologists manage osteoporosis in complex or special patient populations?

We made the glucocorticoid guidelines a few years ago and these guidelines are very helpful, especially for steroid-induced or glucocorticoid-induced bone loss. When starting patients on glucocorticoids, the guidelines get physicians to think about fracture risk, bone mineral density, medical history, and, if necessary, using prophylactic medications to prevent fractures. They are also a reminder that patients who have osteoporosis are at a greater danger when starting steroids. Guidelines really raise our awareness, and we need to use them more than we do.

How can rheumatologists apply the latest ACR updates to clinical practice?

I think that guidelines make us aware of all the effective medications that we have today. They provide guidance as to the type of medications that we should be using and there are many biologic agents available now, so the guidelines standardize how we treat patients and raise awareness of the wonderful medications available to treat our rheumatology patients. I never dreamed we would have so much to offer our patients.