EULAR (European Union of Rheumatology Associations) recognizes the role of diverse real-world data to complement knowledge from randomized controlled trials. Data presented at the 2026 Annual Meeting in London provides new real-world evidence for patients with rheumatic musculoskeletal diseases (RMD), improving understanding of everything from risk factors to treatment strategies.
You can perform large-scale analysis using real-world or observational data from registries, claims datasets, or electronic health records. These findings complement insights gained from randomized trials and help improve patient care and outcomes. As an important example, EULAR recommends a treat-to-target (T2T) strategy in the management of rheumatoid arthritis and other RMDs, which aims for clinical remission or low disease activity through frequent monitoring and rapid treatment adjustment. However, the actual implementation in daily work is still not sufficiently investigated.
The Italian group evaluated T2T adherence in 1,494 outpatient clinic visits with rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis. This study was a retrospective study aimed at identifying the main barriers to implementation. Findings showed that overall T2T adherence was suboptimal and significantly lower in patients with spondyloarthritis, at only 40% compared with more than 70% in patients with rheumatoid arthritis and psoriatic arthritis. The main barrier to consistent implementation of T2T strategies is the lack of disease activity recorded using validated indicators in patient records, and this gap was identified as the reason for nonadherence in approximately 90% of cases.
In a smaller proportion, treatment non-compliance was due to failure to adapt treatment to consequences of disease activity. The authors also examined whether certain clinical characteristics were associated with T2T adherence. Across all diagnoses, treatment with ts/bDMARDs was strongly associated with improved strategy adherence. Interestingly, younger age was associated with T2T adherence in rheumatoid arthritis and spondyloarthritis, but not in psoriatic arthritis. There was no statistical association between disease duration and number of comorbidities.
These findings highlight potential pitfalls of T2T in clinical practice and perhaps ways to improve implementation and adherence. ”
Giorgia Trignani, University of Milan
Another major recommendation for RMD patients is to maintain a healthy weight. This will help improve disease activity, function, and patient-reported outcomes in RMD. Glucagon-like peptide-1 receptor agonists (GLP-1RA), such as semaglutide and tirzepatide, have been approved for type 2 diabetes and obesity, and it is important to understand their usage patterns and effects in RMD. Data on more than 60,000 RMD patients using GLP-1RA were collected from the American College of Rheumatology’s (ACR) Rheumatology Information System for Effectiveness (RISE) registry by Nick McCormick and colleagues and presented at the conference by Jeffrey Curtis, senior author of the abstract. The mean baseline BMI was 36.3, and two-thirds had diabetes. Across all RMD cohorts, patients with psoriatic arthritis had the highest rates of GLP-RA use for weight loss, followed by ankylosing spondylitis and rheumatoid arthritis. In an intention-to-treat analysis, at 12 months, nondiabetic tirzepatide users lost 8% of their starting body weight, while semaglutide users lost 6%. Weight loss in patients with diabetes was slightly less, but showed a similar pattern, with tirzepatide consistently outperforming semaglutide. Weight loss plateaus after 12 months. Ongoing studies are evaluating the impact of GLP-1RAs on patient-reported outcomes in disease activity, function, and RMD, and understanding the magnitude of weight loss associated with GLP-1 dose and adherence.
Patients with rheumatoid arthritis are at risk of developing interstitial lung disease (RA-ILD), which is associated with high mortality rates. ANCHOR-RA is a large international cross-sectional prospective study that allows the development of multivariate models to help detect RA-ILD. Researchers enrolled 1,169 participants with rheumatoid arthritis and at least two ILD risk factors but no known ILD. Results presented at the 2026 EULAR conference showed that 9.1% had undiagnosed ILD. In a preliminary analysis, factors associated with RA-ILD were older age, male gender, heavy smoking, and higher rheumatoid arthritis disease activity. Pulmonary-based factors include decreased oxygen saturation and pulmonary diffusion results, crackles on auscultation, and portability. MUC5B Promoter variants – genetic risk factors.
Jeffrey Sparks, from the Massachusetts General Brigham/Brigham and Women’s Hospital at Harvard Medical School, who published the study, said: “This is an ILD screening study aimed at people with rheumatoid arthritis and risk factors for ILD across multiple institutions and countries. “These preliminary analyzes reveal that approximately one in 10 people have undiagnosed ILD and summarize several known risk factors and characteristics. Our next step will be to validate our approach to risk.” To stratify ILD and investigate whether early intervention can change the natural history of RA-ILD. ”
As mentioned above, smoking is associated with RA-ILD. It is also known to be a major environmental risk factor for rheumatoid arthritis and a major contributor to cardiopulmonary complications. Smoking rates have been falling in Europe over the past decade, with a sharp decline in smoking rates among young people as reported by the European Commission in 2026, but the Swiss group wanted to know whether their country’s downward trend in smoking rates was also reflected in rheumatoid arthritis patients, or whether the overall estimates could be masking widening gender inequalities.
To do this, Eve Caroline Berthouzoz and colleagues conducted repeated cross-sectional analyzes using visit-level data from patients in the Swiss Clinical Quality Management (SCQM) registry. Overall, 5,523 visits from 3,983 patients with smoking status recorded were included. The results showed that the current smoking prevalence among rheumatoid arthritis patients in Switzerland parallels the national decline, dropping from 18.5% in 2012 to 15.1% in 2022, compared to 28.2% and 23.9% in the general Swiss population, respectively.
However, smoking prevalence among men with rheumatoid arthritis increased from 2012 to 2022 (from 64.9% to 68.8%), whereas it decreased among the general population (from 57.0% to 51.4%). However, among women with rheumatoid arthritis, the proportion of women with a history of smoking remained consistently lower than in the general population. Analyzes adjusted for age and education confirmed increased lifetime smoking exposure, particularly among men with rheumatoid arthritis compared with the general population. This widening gap is consistent with smoking being a risk factor for rheumatoid arthritis and suggests that population-level primary prevention efforts in Switzerland have had little effect on men who subsequently develop rheumatoid arthritis.
These four summaries highlight the value of real-world data in RMD. These sources of evidence are increasingly used to inform and guide clinical decision-making.
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European Federation of Rheumatology Societies
