Research Highlights from the British Society for Rheumatology

In April, we were present at the BSR Annual Conference and attended a wide range of sessions across the three days. We’ve selected a few of our favourite highlights that we think you’ll find particularly interesting.

Stratify Lupus Trial: Advancing Personalised Treatment for SLE
Professor Michael Ehrenstein, University College London 

Professor Michael Ehrenstein introduced the Stratify Lupus clinical trial — a significant new study aimed at improving personalised treatment strategies for Systemic Lupus Erythematosus (SLE), an autoimmune condition in which arthritis is one of the most common and debilitating manifestations.

Despite advances in treatment, many people with lupus remain reliant on broad-spectrum therapies that fail to address the disease’s complex and varied presentation. Access to targeted biologics remains limited due to cost and availability.

The new trial builds on findings from the BEAT-Lupus trial (2015–2021), funded by Versus Arthritis, which demonstrated that combining rituximab with belimumab effectively controlled disease activity and reduced severe flares in some patients. However, this benefit was not seen across the board.

To understand this variability, researchers analysed patient data and identified a potential biomarker – IgA2 anti-dsDNA antibodies – present in around 50% of patients who were resistant to conventional therapies. This biomarker’s relevance was further validated using external datasets from a trial conducted in the U.S.

The Stratify Lupus trial aims to evaluate whether this biomarker can reliably guide clinical decision-making. Patients who test positive for IgA2 anti-dsDNA will be randomly assigned to receive either belimumab following rituximab, or placebo following rituximab, to assess the biomarker’s predictive value.

The trial drugs are being provided by GlaxoSmithKline, and the outcomes could mark a significant step forward in tailoring effective, biologic-based treatment pathways for people with SLE.

Practical Techniques for Supporting Patients to Manage Their Weight
Dr Helen Ashby - Dudley Group Hospitals NHS Foundation Trust

Weight loss remains a significant challenge, often because diets alone are ineffective. Biologically, the brain is wired to retain weight as a survival mechanism, which makes sustained weight loss complex. Many patients experience deep psychological distress when they struggle to lose weight and may feel a personal sense of failure. Despite this, patients often do not seek support from healthcare professionals (HCPs). Reasons include past experiences of unhelpful advice, lack of sensitivity, and a strong desire for more personalised, practical, and reliable support.

A major barrier to effective care is the presence of unconscious weight stigma, including assumptions and stereotypes about individuals living with obesity. This stigma can have serious consequences — increased rates of depression, body image distress, overeating, and avoidance of physical activity. Notably, patients who feel judged by their HCPs are significantly less likely to achieve meaningful weight loss. Studies also show that patients with obesity are often given shorter appointments and are perceived as less likely to adhere to medication.

Dr Ashby emphasises the importance of recognising that obesity is a chronic condition. The focus of management should be on improving long-term health and wellbeing rather than simply reducing numbers on a scale. Interventions should be timely, addressing root causes and individual barriers to progress. Success will look different for each person, and a patient’s healthiest weight may not always be what is considered a traditional “ideal” weight.

To support patients effectively, Dr Ashby recommends a holistic and compassionate approach. The ‘5 As’ framework offers a practical model for HCPs:

• Ask – Always seek permission to talk about weight. Respectful questions such as “Would you be open to discussing your weight?” help build trust.
• Assess – Evaluate contributing factors, including physical, emotional, social, and financial barriers. Assess the patient’s health risks, complications, and readiness to change.
• Advise – Share evidence-based information about health risks and the significant benefits of even modest weight loss (5–10%). Address lifestyle factors such as sleep and stress.
• Agree – Collaboratively set realistic, achievable goals tailored to the individual’s circumstances and priorities.
• Assist – Help the patient overcome obstacles by offering education, signposting resources, making referrals where appropriate, and ensuring consistent follow-up.

Ultimately, supporting weight management requires clinicians to reflect on their own attitudes, commit to empathy, and adopt an individualised, non-judgmental approach. By doing so, HCPs can play a vital role in helping patients make meaningful, sustainable improvements to their health.

Writing Rheumatology Outpatient Letters to Patients: Preferences, Perspectives and Practice Change
Dr Charlotte Sharp – University of Manchester

Current national guidance recommends that outpatient clinic letters should be addressed directly to patients. Despite this, the practice has not been widely adopted in rheumatology, and little research has explored healthcare professionals’ (HCPs) views on this shift.

Dr Charlotte Sharp presented findings from a mixed-methods study aimed at understanding patient preferences, HCP perspectives, barriers to change, and the support needed to adopt this practice. The study involved surveys, interviews, and co-production of practical resources to assist clinicians in writing directly to patients.

Key findings included:

• Letter-writing practices vary widely: Only 20% of HCPs currently write directly to patients; 67% address letters to the GP and copy in the patient; 12% write solely to the GP; and 2% write separate letters to both.
• Patient preferences are clear: 64% of patients preferred letters addressed to them, while 36% preferred letters to be addressed to their GP. Only one patient did not want to receive a letter at all.
• Differences exist between clinic and results letters: Half of respondents reported differing practices, with 88% more likely to write results letters to patients and clinic letters to GPs.
• Barriers to change included concerns about how information would be communicated and coordinated within primary care.
• Facilitators (levers) included alignment with national policy and encouragement from peers already using the approach.

Overall, the study highlights that current practice does not align with national guidance or patient preferences. There is strong evidence that patients want to be addressed directly and that doing so can enhance the consultation experience. Importantly, clinicians who already write directly to patients report that it does not increase consultation time and has a positive impact on communication and engagement.

Resources are now being developed to support clinicians in adopting this patient-centred communication approach.