Abstract Presenter: Annabelle Small, PhD, Postdoctoral Research Fellow, Synovial Tissue Translational Research Group, Flinders University, Adelaide, Australia
Abstract Title: Synovial Neutrophilic Inflammation Defines a Clinically Distinct Endotype of Early Rheumatoid Arthritis Associated with Poor Early Outcomes
Abstract Session: Abstracts: Rheumatoid Arthritis – Translational Models and Mechanisms (0914-0919), 1–2:30 p.m., Sunday, November 8
What is your abstract about?
Dr. Small: We looked at synovial tissue biopsies from 42 people with early, untreated rheumatoid arthritis (RA). Twelve of these had a prominent presence of neutrophils in the joint. Patients in this group experienced higher levels of pain, were more likely to develop joint erosions, took longer to reach remission, and cycled through more DMARDs in their first year of therapy. Using spatial transcriptomics, we found that neutrophils clustered near lymphoid aggregates and within fibrin-rich areas, where they were forming extracellular traps. Nearby fibroblasts and myeloid cells were the main producers of neutrophil-recruiting chemokines, with increased SPP1-expressing macrophages. These patients seem to form a distinct group that we can identify through tissue analysis at diagnosis.
Why did you decide to investigate this topic?
Dr. Small: Neutrophils are often considered short-lived bystanders in RA, and most previous synovial tissue studies have focused on lymphocytes, macrophages, and fibroblasts. However, after we started to notice a pattern of discrete neutrophilic infiltrates present in some RA tissue biopsies and not others, we wanted to ask whether these had clinical relevance, and why they accumulated in some patients and not others.
What are you working on next related to this research?
Dr. Small: My next steps are to elucidate communication networks between neutrophils and other cell types in the synovial tissue, to identify targetable pathways, and to develop precision treatment approaches for this patient group.
What excites you most about your work?
Dr. Small: We know that a good early response to therapy is associated with better long-term outcomes and preserved physical function in RA. We found that the degree of neutrophil presence in the joint at diagnosis was independently associated with a poor early response to treatment. I’m excited to translate these findings to help identify patients who would benefit from more intensive therapy from their diagnosis, to improve their long-term outcomes.
What are you most looking forward to at ACR Convergence 2026 in Orlando?
Dr. Small: I’m looking forward to sharing my findings and learning about the latest advances from other researchers, clinicians, and global leaders in rheumatology.
THERE’S STILL TIME TO JOIN US
If you haven’t registered for ACR Convergence 2026, you can still register on-site at the Orange County Convention Center in Orlando, Florida, through November 11. All registered participants receive on-demand access to scientific sessions through September 30, 2027.
