Personalised treatment innovations in the field of rheumatology are transforming patient care and outcomes, driven by significant advances in understanding the origins of rheumatological diseases. Professor Xenofon Baraliakos, president-elect of EULAR, speaks to Helen Quinn about the biggest challenges and opportunities in the field and where he sees rheumatology advancing to next.
Scientific advancements in rheumatology are shifting treatment from a one-size-fits-all approach towards more patient-centred care. Inflammation can show up differently across individuals, arising from a variety of causes. Targeted therapies now offer more effective and individualised options for patients, marking the beginning of a new era in rheumatologic care.
Within this exciting landscape of research innovation and clinical advancement, Professor Xenofon Baraliakos will take over the European Alliance of Associations for Rheumatology (EULAR) presidency in June 2025, having recently been voted as the Alliance’s president-elect.
Professor Baraliakos is a world-leading expert in rheumatology and is currently seeing out his term as president of the Assessment of Spondyloarthritis International Society alongside his roles as medical director at Rheumazentrum Ruhrgebiet in Herne, Germany, and full professor of internal medicine and rheumatology at Ruhr-University Bochum, Germany.
‘We are at a pretty advanced stage when it comes to now being able to have the right techniques to understand where diseases come from,’ Professor Baraliakos explains. ‘In the last 20 to 25 years, we have seen a huge development with biologics, which was a revolution.’
Indeed, biologics have transformed the treatment of inflammation, offering a safer and more effective options compared to traditional medications such as prednisone and cortisone, which reduce inflammation but can have unwanted side effects.
Personalising care and finding a cure
The rise of personalised therapies means there has been a step away from broad treatment options like TNF blockers, IL-6 blockers and IL-17 blockers, which treat everything rather than specific cytokines. Alongside this, advancements have also been made in tissue and blood analysis, allowing researchers to gain further insights into the causes of inflammation and select treatments based on an individual’s needs.
‘We understand better why one [patient] is getting a response and one is not and what this means. We understand better how diseases occur and how they develop over time. Now that means we also have a big unmet need: to translate that basic science back to clinical outcomes,’ Professor Baraliakos says. ‘Before, we just didn’t know where the disease came from. I think now we are in a very good position in terms of developing the field further – even faster.’
It is hoped that this additional knowledge will lead to fewer treatment failures for patients, as clinicians can identify the most effective treatment for each individual. In addition, Professor Baraliakos explains that by borrowing treatments from fields such as oncology and haematology and developing them further for their own needs in rheumatology, certain treatments may even be able to give the hope of a cure.
‘We are now also in the position to speak about possibilities to cure rheumatological diseases,’ he says. ‘This of course may take time, but curing is now, I believe, in reach, as compared to not being an option 10 years ago.’
Imaging and technology innovations
Professor Baraliakos has contributed extensively to imaging research in rheumatology, and he says the first 10 years of this century saw the MRI and ultrasound becoming standard tools for diagnosing rheumatic diseases. But the biggest changes have come through recent improvements in image quality, with clinicians now able to get much greater detail of information from the images, allowing them to read and understand the progression of the disease more accurately.
‘We’ve learned how to interpret the images better in the clinical context. Something showing as ‘positive’ on imaging does not always mean the presence of a disease. We’ve learned to make that differentiation: that signal of inflammation may not be rheumatological, the inflammation may be something else. [It’s a] distinction between pathology and a coincidental finding,’ he explains.
In addition to advancements in imaging and the understanding of pathology, Professor Baraliakos emphasises the critical role of artificial intelligence (AI) in driving the future of rheumatology. Screening for diseases using AI is enabling early and accurate diagnosis, reducing the risk of misdiagnosis and unnecessary treatment while also ensuring patients are directed to the right clinician without losing time.
‘AI will change everything,’ he says. ‘It will make us aware of things we’re not really seeing that much. AI will be much more sensitive to [pathological] change, so the sensitivity of image interpretation will be improved beyond the human eye and human understanding.’
Coupled with AI’s ability to identify images with greater speed and accuracy, Professor Baraliakos believes these advancements will play an essential role in enhancing patient-centred treatment models. ‘I would see AI as a tool and not as a threat,’ he says.
Leading EULAR, supporting rheumatology
Professor Baraliakos hopes to use his platform as the future president of EULAR to expand the Alliance’s global outreach and education initiatives, leveraging recent scientific advancements and enhancing interdisciplinary collaboration to ensure optimal treatment for all patients no matter where they live.
‘I think EULAR is on a very good track,’ he says. ‘We are already the number one global rheumatology organisation worldwide. But of course, we need to develop and go with the science of the times. We need to invest in improving the patients’ situation because there are big differences between countries and continents.’
To this end, Professor Baraliakos hopes to extend the EULAR’s reach ‘to provide research, but also educational activities that are for everyone,’ whether they are based in Europe or further afield.
One of his first tasks as president will be to oversee the Alliance’s annual Congress and he is keen to make it ‘the place to be’ in the rheumatology calendar and ‘where you really see the most recent rheumatological status, what is moving the field, and where the field will be moving towards’.
While the focuses of next year’s Congress remain safely under wraps for the time being, Professor Baraliakos is resolute that it will cover the most recent research and innovations in the field at a time of such exciting progress. He believes that being flexible in the structure and forward-looking in the content is the key to achieving this goal.
‘We are trying new formats to attract people and implement their ideas where possible. Content wise, we’re concentrating on what’s hot and what’s important. I think that makes it attractive for everyone, and also really exciting, but suited to the times we’re living in,’ he says.
Reflecting on his work and plans for the future, Professor Baraliakos says that at the heart of his ambitions is a strong desire to understand rheumatological diseases even better and to champion translational research and bring it back to the patient.
‘The most rewarding part of my work is to really see ideas coming into life,’ he says. ‘I feel the responsibility, but I’m also looking forward to really applying my plans to reach the goal, to improve patients’ lives and improve outreach overall.’
