Rheumatology Month in Review: May 2025

In May, the rheumatology landscape was marked by key clinical trial readouts, expanded efficacy data for approved therapies, and new insights into disease burden and management strategies. Notably, Merck KGaA reported positive phase 2 results for enpatoran in patients with cutaneous and systemic lupus erythematosus, with the agent showing promising skin-specific efficacy and a favorable safety profile. Separately, a meta-analysis confirmed belimumab’s effectiveness in systemic lupus using BICLA criteria, supporting its continued use across diverse patient subgroups.

New real-world data on chronic refractory gout revealed persistent urate elevation and high healthcare resource use despite ongoing treatment, underscoring the unmet need for more effective therapeutic approaches. Meanwhile, in fibromyalgia research, an exploratory study showed immersive virtual reality-based exercise significantly reduced perceived pain, offering a potential nonpharmacologic tool to address chronic pain, though its impact on pain sensitivity was limited.

New Research on Pain Modulation in Fibromyalgia

Aquatic Exercise, Resistance Training Most Beneficial for Reducing Fibromyalgia Pain

A network meta-analysis of 51 randomized clinical trials found that aquatic exercise is most effective short-term, while resistance training provides the greatest long-term pain relief in women with fibromyalgia. These findings challenge aerobic exercise as the gold standard and support tailoring therapeutic exercise approaches to patient preferences and characteristics.

VR Biofeedback Experience Shows Potential for Fibromyalgia Pain

A pilot randomized controlled trial found that immersive virtual reality with multisensor biofeedback (IVR-BF) significantly reduced pain and improved quality of life in women with fibromyalgia after just five sessions. Participants also showed physiologic improvements and high satisfaction with the therapy, with 81% indicating they would recommend it. Although pain relief diminished by day 15, quality-of-life benefits were partially sustained, supporting further investigation in larger trials.

VR-Based Exercise Reduces Perceived Pain Intensity, Mechanical Pain Sensitivity Persists in Fibromyalgia

Most participants in a small, exploratory study evaluating immersive virtual reality-based exercise (iVRE) program experienced meaningful pain relief, especially those at medium risk of poor outcomes, but had no changes in pressure pain thresholds, indicating limited impact on pain sensitivity mechanisms.

Data Readouts for Lupus

Enpatoran Meaningfully Improves Active Lupus Rash

In the Phase 2 WILLOW study, enpatoran, a novel oral TLR7/8 inhibitor, demonstrated clinically meaningful improvements in cutaneous disease activity in patients with CLE and SLE with active lupus rash. Mtst patients achieved a ≥50% improvement in CLASI-A scores by week 24, and the treatment was well tolerated with no new safety signals. Although systemic efficacy was less clear, these results support the initiation of Phase 3 trials.

Belimumab Superior to Placebo in Yielding Systemic Lupus Erythematosus Responses

A meta-analysis of five Phase 3 trials has confirmed the efficacy of belimumab in systemic lupus erythematosus (SLE) using the BICLA responder index. The pooled analysis of over 3000 patients showed significantly higher BICLA response rates with belimumab versus placebo, particularly in those with high disease activity or serologic markers. The therapy was also more effective when combined with antimalarials, reinforcing its clinical utility in SLE management.

Highlighting the Disease Burden of Gout

Chronic Refractory Gout Needs Better Management in US

In a retrospective real-world study, most patients with chronic refractory gout in the US maintained elevated serum urate levels despite urate-lowering therapies, including allopurinol. Around half of surveyed patients failed to reach target urate levels, while high healthcare resource utilization and widespread use of pain management medications highlight the substantial burden of CRG.

Global Rates of Gout Rising in Young Adults

A new global analysis of data from the Global Burden of Disease 2021 study reveals a steady rise in adolescent gout incidence since 1990, driven largely by high BMI and socioeconomic factors. The study highlights a pressing need for early preventive strategies to mitigate long-term disability in youth. Projections indicate continued growth in disease burden, particularly in high-SDI countries such as Taiwan.