During the Plenary II session on Monday at ACR Convergence 2026, authors of six of the year’s highest-rated scientific abstracts presented their work. Additional top-rated abstracts were featured in Plenary I on Sunday and will be featured in Plenary III on Tuesday. Recordings of all three plenaries will be available to registered participants of ACR Convergence 2026 for on-demand viewing.
The Association of Gout Flares and Subsequent Cardiovascular Events: Secondary Nested Case-Control Study of the CARES Trial
Chio Yokose, MD, MSc, Rheumatologist and Clinical Researcher at Massachusetts General Hospital, discussed findings from a nested case-control study examining the relationship between acute gout flares and risk of major adverse cardiovascular events (MACE) in people with gout starting urate-lowering therapy (ULT).
In this post-hoc analysis of the CARES trial, there were 655 cases with MACE and 3,237 cases without MACE.
Compared to controls, cases with MACE did not have significantly higher odds of gout flare in any of the exposure windows examined. Researchers also examined gout flares that required additional treatment and gout flares that occurred in the first year of the trial and still found no association between gout flares and subsequent MACE.
“Gout flares that occur in the setting of ULT initiation do not appear to be a trigger for MACE, even in patients with high cardiovascular risk, which is reassuring for us,” Dr. Yokose said.
Because these results differ from previous studies, further replication and clarification of the underlying nature of the association, if present, are needed.
Molecular Heterogeneity in Preclinical Lupus: Distinct Longitudinal Proteomic Trajectories Preceding Disease Progression
Rufei Lu, MD, PhD, Assistant Professor at Oklahoma Medical Research Foundation, discussed results from a study characterizing disease progression in lupus.
The SMILE study examined whether hydroxychloroquine could slow or prevent disease progression in patients with incomplete lupus erythematosus (ILE). However, participants progressed whether they received hydroxychloroquine or a placebo. The trial identified three outcome groups: stable ILE, progressing ILE, and classified systemic lupus erythematosus (SLE).
The subsequent Mechanisms of New-Onset Autoimmunity Longitudinal Immune System Analysis (MONA LISA) trial aimed to determine why participants with incomplete lupus follow a different clinical course, how hydroxychloroquine modifies their molecular trajectories, and what biological patterns distinguish progression type.
“We found that even at baseline, participants who eventually transitioned to disease had increased interferon (IFN) and antigen presentation signatures,” Dr. Lu explained. “And when we looked at the progressors only, we found that at the top of the list is increasing transforming growth factor (TGF)-beta signals, suggesting that even at baseline there might be some sort of regulatory element.”
Rising or persistently elevated IFN signatures accompanied SLE transition in both placebo and the hydroxychloroquine arms of SMILE. Additional results showed that HCQ leaves a distinct molecular footprint, suppressing IFN and skewing Th2/Treg-associated chemokines in non-progressors. Ultimately, these results demonstrate that progression to SLE can occur through immunologically distinct mechanisms, Dr. Lu reported.
Clonal Hematopoiesis Orchestrates Giant Cell Arteritis Disease Trajectory and Immune Landscape: A Multicentric and Multiomics Approach
Nader Yatim, MD, PhD, Clinician-Scientist and Postdoctoral Fellow at the Icahn School of Medicine at Mount Sinai, discussed results from a study examining whether clonal hematopoiesis (CH) influences giant cell arteritis (GCA) outcomes and whether specific driver mutations exert distinct effects.
To address this question, researchers performed a meta-analysis of all genotyped GCA cohorts. Among 260 patients, CH was detected in 50%, including DNMT3A mutations in 24% and TET2 mutations in 14%. Investigators then used a multi-omics approach to determine the effect of these distinct mutations. Based on their results, they propose that DNMT3ACH drives an interleukin-6 (IL-6)-independent SPP1+MMP12+ macrophage axis that increases relapse risk.
“Overall, the conclusion that I would like you to take home with you is that the myeloid compartment is a key driver of tissue aging and late-onset inflammatory disease,” Dr. Yatim said.
Obinutuzumab Induces Histologic Remission and Deep Kidney Parenchymal B-cell Depletion in Patients With Lupus Nephritis: Exploratory Analyses From a Phase III Trial
Richard Furie, MD, MACR, Chief of the Division of Rheumatology and Professor of Medicine at the Zucker School of Medicine at Hofstra/Northwell, discussed results from a sub-study of the phase 3 REGENCY study in lupus nephritis (LN).
The objective of the sub-study was to compare the effects of obinutuzumab versus placebo between baseline and post-week 76 paired biopsies on rates of histologic remission and depletion of B cells and antibody-secreting cells.
Results showed that more patients receiving obinutuzumab achieved histologic remission than placebo, with an adjusted difference of 30.75 percentage points. Further, obinutuzumab almost completely depleted B cells from the kidney parenchyma and reduced the number of intra-renal plasma cells by approximately 50%.These data suggest that obinutuzumab administration resulted in favorable outcomes in LN beyond the traditional clinical trial endpoint of clinical complete renal response.
“The bottom line is that there’s more to know than just the clinical response. We do need a handle on what’s happening as far as inflammatory markers indicate,” Dr. Furie said.
Pharmacogenomic Associations of Methotrexate Metabolite Concentrations in a Cohort of Juvenile Idiopathic Arthritis
Nuria Lara Castillo, PhD, MSc, Translational Researcher at Children’s Mercy Hospital, discussed results of a study aimed at understanding how methotrexate is metabolized to aid in identification of patients who will respond to treatment.
The study included children diagnosed with juvenile idiopathic arthritis (JIA) who were started on methotrexate. The primary outcome was the methotrexate polyglutamates ratio (MTXPG). Previous observations found that an MTXPG ratio greater than 1.86 is associated with an adequate response to methotrexate. The median MTXPG ratio in the study was 2.5, suggesting that patients responded well.
Multivariable analysis and genetic association analyses were performed to identify independent predictors of the MTXPG ratio.
“The dose, route, and phenotype might be influencing the ratio of this metabolite. The next step will be correlating this ratio with the response to methotrexate,” Dr. Castillo said.
Defining an MRI Indicative of Axial Spondyloarthritis in the Sacroiliac Joints of Patients with Axial Spondyloarthritis: A Data-Driven and Consensus-Based Framework of Recommendations by the Spondyloarthritis Research and Treatment Network and the Society of Skeletal Radiology
Walter P. Maksymowych, MD, FRCPC, MRCP, FACP, Professor at the University of Alberta, Edmonton, Canada, discussed work conducted to define an MRI as indicative of axial spondyloarthritis (axSpA) in the sacroiliac joint (SIJ).
An international working group conducted a systematic literature review and analyzed 1,050 cases for MRI lesions typical of axSpA to inform a Delphi consensus voting exercise.
The definition reached incorporates both inflammatory and structural lesions and is based on both qualitative and quantitative considerations. To be defined as an MRI indicative of axSpA there must be ≥3 consecutive slices with bone marrow edema (BME), or at least 2 of 3 lesions (BME, erosion, rat lesion), each lesion being present in ≥3 SIJ quadrants or ≥3 SIJ halves with ankylosis. Importantly, assessment of BME excludes the two most anterior semicoronal slices.
“The quantitative component of this definition consistently attains specificity over 90% in different cohorts and with different standards,” Dr. Maksymowych said.
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.
