A look at the most compelling ACR25 research through a patient’s lens
Rheumatoid arthritis (RA) is often described as a disease of the joints—but anyone living with it knows that’s only part of the story. RA is a systemic autoimmune condition that can affect nearly every part of the body, from energy levels and sleep to mood, heart, and lung health. The 2025 American College of Rheumatology (ACR) meeting once again reminded me just how complex and multidimensional RA truly is. The science presented this year explored not just inflammation, but the lived realities that shape daily life: resilience and frailty, fatigue and function, pain that goes beyond the joints, and the deep interplay between mental health and physical disease.
As someone living with RA and now attending my seventh ACR as a patient partner in research, I’ve had the privilege of watching the field evolve—slowly but meaningfully—toward a more holistic understanding of what it means to live with this disease.
This year, I’m sharing 26 abstracts that caught my eye—studies that go beyond statistics to reflect our real-world experiences. They reveal patterns that patients have long recognized: that fatigue can persist even in remission, that mental health and trauma influence pain, and that resilience and social support can protect our health as much as medication. These findings deepen understanding, spark better communication, and remind both patients and clinicians that progress in rheumatology is not only about new drugs—it’s about treating the whole person.
Each study featured here was presented at the 2025 American College of Rheumatology Convergence. Abstracts are publicly available at acrabstracts.org.
Pain is not only physical; it’s also neurological. In “Neuropathic-Like Pain Characteristics Predict Worse Pain Outcomes in Early RA”, people who described burning or tingling pain—signs of nerve involvement—had poorer pain outcomes over time, suggesting that the nervous system may amplify pain signals independent of inflammation.
That idea was expanded in “Multimodal Analysis of Difficult-to-Treat RA”, which found changes in brain connectivity and neuro-immune signaling in patients whose RA didn’t respond to multiple medications. In short, chronic inflammation can reshape how the brain processes pain. Future treatments may need to target both the immune and nervous systems to bring full relief.
This year’s mental-health research emphasized that RA isn’t just a physical condition—it’s deeply intertwined with stress, sleep, and emotion.
“Association of Disease Activity with Insomnia, Depression, and Fatigue” found that over 80 % of RA patients reported insomnia and fatigue, and 13 % screened positive for depression, all strongly linked with higher disease activity. Another study showed that anxiety was tied to higher pain sensitivity—patients with more anxiety tended to report more tender joints than swollen ones.
Childhood and adult trauma also surfaced as critical factors. In patients with lupus and systemic sclerosis, a large share reported adverse childhood experiences (ACEs), which were connected to higher rates of depression and lower coping ability later in life. In “Impact of Stress, Anxiety, and Depression on Fatigue”, depression was the strongest driver of fatigue, reinforcing the need for integrated psychological care.
The thread running through all these studies is clear: treating inflammation alone isn’t enough. Addressing sleep, mood, and trauma can directly improve how patients feel and function.
RA rarely exists in isolation. Research at ACR25 highlighted how nutrition, mental health, and co-occurring conditions shape outcomes.
The “Healthy Dietary Patterns” meta-analysis showed that people who followed anti-inflammatory eating patterns like the Mediterranean or DASH diet were less likely to develop RA. Another study linked good nutrition to better physical function among patients already living with RA, emphasizing that food is part of therapy, not separate from it.
Comorbidities—especially anxiety, depression, and fibromyalgia—were found in 30–50 % of routine rheumatology patients, according to a study using the MDHAQ tool. Recognizing these overlaps helps clinicians treat the whole person, not just the disease.
Meanwhile, “Osteoarthritis and Other Degenerative Disorders in Difficult-to-Treat RA” found that persistent pain in RA often stems not just from inflammation but from structural joint damage or mechanical issues—reminding patients that physical therapy and pain management remain essential even with biologic therapy.
Several studies underscored a crucial point: remission on paper doesn’t always mean feeling well.
In “Physical Function Across Age in Rheumatoid Arthritis”, patients with RA had weaker grip strength and poorer hand function than peers without RA, but the gap didn’t widen with age—implying that much of the functional loss happens early in the disease. Early, aggressive treatment is key to preserving strength and independence.
Fatigue emerged as another major theme. The MDHAQ/RAPID3 study showed that many people with RA experience exhaustion even when inflammation is well-controlled. Traditional lab tests can miss this, but patient-reported tools reveal it clearly—reminding clinicians that fatigue deserves attention as its own outcome.
A separate multicenter study found that roughly one in four patients in clinical remission still reported significant fatigue, particularly women, smokers, and those with depression. The message: fatigue isn’t just a side effect—it’s a core symptom that needs dedicated management.
Finally, “Beyond the Joints” explored non-articular pain—pain outside the joints. More than half of newly diagnosed patients had regional or widespread pain linked to worse function, sleep, and mood. It’s a reminder that rheumatology must look beyond swollen joints to truly measure well-being.
Frailty is a medical term for decreased physical strength, stamina, and resilience that makes a person more vulnerable to stress, illness, or injury. It’s often seen in older adults, but people with chronic diseases like RA are also at risk. A study called “A Balancing Act: The Interplay Between Resilience and Frailty in Rheumatoid Arthritis” found that patients who scored higher on resilience—meaning their ability to adapt, persevere, and draw on support—were significantly less likely to be frail. Every 10 % increase in resilience reduced the odds of frailty by about 40 %.
In other words, emotional and social strength can be just as protective as physical strength. Building resilience—through community, mental-health support, or self-efficacy training—could help people with RA stay stronger longer.
Not all RA behaves the same way. In “Comparative Outcomes in Seropositive and Seronegative Rheumatoid Arthritis”, researchers followed more than 100,000 patients and found that those with antibody-positive (“seropositive”) RA had higher risks of death, lung and heart disease, and more severe joint damage compared with those who were antibody-negative. Knowing your antibody status helps guide treatment intensity and preventive care.
Meanwhile, “Decade-Based Trends in First Remission” showed that people diagnosed in the 2000s and 2010s reached remission faster than those in the 1990s—but they also tended to flare sooner afterward. Modern care works, but long-term stability remains a challenge.
And although deaths from RA have dropped by more than 50 % in the United States since 1999, “Rheumatoid Arthritis Mortality in the U.S.” revealed that progress hasn’t been equal. Women, American Indian/Alaska Native people, and rural residents still face higher mortality rates. RA care is improving—but equity hasn’t caught up.
