Exploring new data in real-world populations
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EULAR – The European Alliance of Associations for Rheumatology – acknowledges the role of diverse real-world data to complement knowledge from randomised controlled trials. Data presented at the 2026 annual Congress in London showcase new real-world evidence for patients with rheumatic and musculoskeletal diseases (RMD) – building our understanding, from risk factors to treatment strategies.

Real-world or observational data from registries, claims datasets, or electronic health records can enable us to perform large-scale analyses. These findings complement the insights gained from randomised trials, and can help to improve patient care and outcomes.¹ As a key example, EULAR recommends a treat-to-target (T2T) strategy in the management of rheumatoid arthritis and other RMD,^2,3 aiming for clinical remission or low disease activity guided by frequent monitoring and prompt therapy adjustments. But real-world implementation in daily practice remains poorly investigated.

Now, a group in Italy have assessed adherence to T2T in 1,494 outpatient visits for people with rheumatoid arthritis, psoriatic arthritis, or spondyloarthritis – with a retrospective study designed to identify the main barriers to implementation. Findings showed that overall adherence to T2T was suboptimal and significantly lower in people with spondyloarthritis – just 40% compared with rates of over 70% for people with rheumatoid arthritis or psoriatic arthritis. The main obstacle to consistent implementation of a T2T strategy was the lack of recorded disease activity using validated indices in patient records – with this gap identified as the reason for non-adherence in around 90% of cases. In a smaller proportion, non-adherence was due to failure to adapt therapy to disease activity results. The authors also looked to see whether any particular clinical characteristics were linked with rates of T2T adherence. Across all diagnoses, treatment with ts/bDMARDs was strongly associated with better adherence to the strategy. Interestingly, younger age was associated with T2T adherence in rheumatoid arthritis and spondyloarthritis, but not in psoriatic arthritis. Disease duration and number of comorbidities did not show a statistical association.

In conclusion, Giorgia Trignani from the University of Milan in Italy said “These findings highlight potential pitfalls for T2T in clinical practice – and possibly ways to improve implementation and adherence.”

Another core recommendation for people with RMD is to maintain a healthy weight⁴ – which can help to improve disease activity, function, and patient-reported outcomes in RMD. Glucagon-like peptide-1 receptor agonists (GLP-1RA) such as semaglutide and tirzepatide are approved for type 2 diabetes and obesity, and understanding their use patterns and effects in RMD is crucial. Data from over 60,000 RMD patients using a GLP-1RA were collected from the American College of Rheumatology’s (ACR) Rheumatology Informatics System for Effectiveness (RISE) registry by Nick McCormick and colleagues, and presented at the Congress by the abstract’s senior author, Jeffrey Curtis. The mean baseline BMI was 36.3 and two-thirds had diabetes. Across all RMD cohorts, the highest proportion of GLP-RA use for weight loss was in people with psoriatic arthritis, followed by ankylosing spondylitis, and rheumatoid arthritis. At 12 months in an intent-to-treat analysis, non-diabetic tirzepatide users lost 8% of their starting body weight, compared to 6% with semaglutide. Diabetic users lost somewhat less weight – but showed a similar pattern, with tirzepatide consistently outperforming semaglutide. Weight loss plateaued after 12 months. Ongoing work is evaluating the impact of GLP-1RA on disease activity, function, and patient-reported outcomes in RMD, as well as to understand the magnitude of weight loss in relation to GLP-1 dose and adherence.

People with rheumatoid arthritis are at risk of developing interstitial lung disease (RA-ILD), which is associated with high mortality. ANCHOR-RA is a large, international cross-sectional prospective study that will enable the development of a multivariable model to help detect RA-ILD.⁵ Investigators enrolled 1,169 participants with rheumatoid arthritis and at least two ILD risk factors, but without known ILD. Results presented at the 2026 EULAR Congress showed that 9.1% had undiagnosed ILD. In preliminary analyses, factors associated with RA-ILD were older age, male sex, greater tobacco exposure, and higher rheumatoid arthritis disease activity. Lung-based factors included lower oxygen saturation and lung diffusion results, crackles on auscultation, and carrying the MUC5B promoter variant – a genetic risk factor.

Presenting the work, Jeffrey Sparks from the Mass General Brigham / Brigham and Women’s Hospital, Harvard Medical School, United States, said “This is the largest prospective study implementing a screening strategy for ILD among people with RA and ILD risk factors across multiple centres and countries. These preliminary analyses reveal that about 1 out of every 10 have undiagnosed ILD, and recapitulate some known risk factors and features. Our next steps will be to validate approaches to risk stratify for ILD and investigate whether early intervention may alter the natural history of RA-ILD.”

As noted above, smoking is linked to RA-ILD. It is also known to be a key environmental risk factor for rheumatoid arthritis and a major driver of cardiopulmonary comorbidity. Smoking prevalence has fallen in Europe in the past decade, with a sharper decline among young people – as reported in 2026 by the European Commission⁶ – but a group in Switzerland wanted to know whether their own national declining smoking trends are mirrored in people with rheumatoid arthritis, or whether overall estimates might mask widening sex-specific inequalities. To do this, Eve Caroline Berthouzoz and colleagues conducted repeated cross-sectional analyses using visit-level data from patients in the Swiss Clinical Quality Management (SCQM) registry; overall, 5,523 visits from 3,983 patients with documented smoking status were included. The results show that current smoking prevalence among Swiss patients with rheumatoid arthritis parallels the national decline: falling from 18.5% in 2012 to 15.1% in 2022, compared with 28.2% and 23.9% in the Swiss general population, respectively. However, among men with rheumatoid arthritis, ever smoking prevalence increased from 2012 to 2022 (64.9% to 68.8%), but it declined in the general population (57.0% to 51.4%). Yet among women with rheumatoid arthritis, rates of those who had ever smoked remained consistently lower than in the general population. Age- and education-adjusted analyses confirmed an increasing excess of lifetime smoking exposure – specifically 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 been less effective in men who subsequently develop RA.

These four abstracts highlight the value of real-world data in RMD. These evidence sources are increasingly used to inform and guide clinical decision-making.¹

Source
Arese M, et al. Treat-to-target in inflammatory arthritis: a recommended strategy, an incomplete practice. Presented at EULAR 2026; OP0351. Ann Rheum Dis 2026; DOI: 10.1136/annrheumdis-2026-eular.B.4502.

McCormick N, GLP-1 Receptor Agonists to Facilitate Weight Loss and Improve Disease Activity, Pain and Function in Patients with Rheumatic and Muskuloskeletal Disease: Real-World Evidence From the Rheumatology Informatics System for Effectiveness (RISE) Registry. Presented at EULAR 2026; OP0112. Ann Rheum Dis 2026; DOI: 10.1136/annrheumdis-2026-eular.A.1843.

Sparks JA, et al. Risk factors for interstitial lung disease in patients with rheumatoid arthritis: results from the international ANCHOR-RA study. Presented at EULAR 2026; OP084. Ann Rheum Dis 2026; DOI: 10.1136/annrheumdis-2026-eular.B.1963.

Berthouzoz EC, et al. Increasing lifetime smoking exposure among male rheumatoid arthritis patients despite declining current use in Switzerland. Presented at EULAR 2026; OP0109. Ann Rheum Dis 2026; DOI: 10.1136/annrheumdis-2026-eular.B.992.

References

1. Jani M, et al. Navigating real-world data sources in rheumatology: opportunities, pitfalls, and practical guidance. Ann Rheum Dis 2025:S0003-4967(25)04550-9. DOI: 10.1016/j.ard.2025.1018.
2. Smolen JS, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biologic disease-modifying antirheumatic drugs: 2025 update. Ann Rheum Dis 2026. DOI: 10.1016/j.ard.2026.01.023.
3. Gossec L, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Ann Rheum Dis 2024;83(6):706–19. DOI: 10.1136/ard-2024-225531.
4. Gwinnutt JM, et al. 2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases. Ann Rheum Dis 2023;82(1):48–56. DOI: 10.1136/annrheumdis-2021-222020.
5. Sparks JA, et al. Design of ANCHOR-RA: a multi-national cross-sectional study on screening for interstitial lung disease in patients with rheumatoid arthritis. BMC Rheumatol 2024;21(8):19. DOI: 10.1186/s41927-024-00389-4.
6. European Commission. Commission evaluation of the EU tobacco control framework highlights progress and emerging public health challenges. April 2, 202 https://ec.europa.eu/commission/presscorner/detail/en/ip_26_771
   

About EULAR
EULAR is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with rheumatic and musculoskeletal diseases (RMDs). EULAR aims to reduce the impact of RMDs on individuals and society, as well as improve RMD treatments, prevention, and rehabilitation. To this end, EULAR fosters excellence in rheumatology education and research, promotes the translation of research advances into daily care, and advocates for the recognition of the needs of those living with RMDs by EU institutions.

Contact
EULAR Communications.