ACR 2026 – Day 2 Report Save

It's a wrap on Day 2 at ACR Convergence 2026. These five abstracts caught my eye.

Gout Flares Do Not Trigger CV Events in CARES: (Abstract 1820) Dr. Chio Yokose (MGH) presented a nested case-control analysis of the CARES trial (allopurinol vs febuxostat in gout patients with established CVD) to test whether acute gout flares precede cardiovascular events. The question is when starting urate lowering therapy, will you induce gout flares that may have downstream CV risks?  The answer is No. From the CARES study, there were 207 cases with a first MI or stroke and 3,065 controls (mean age ~65, ≥89% male), flares in the 0–60 days before a CV event occurred in 12.6% of cases vs 11.7% of controls (aOR 1.08; 95% CI 0.67–1.75), and in the 61–120 days before in 8.2% vs 7.2% (aOR 1.15; 95% CI 0.65–2.03). No flare window showed a significant association. The bottom line: the flare–MI/stroke link seen in claims data may reflect the risky drugs used to treat flares (NSAIDs, steroids) rather than gouty inflammation itself. Link

Clonal Hematopoiesis Drives GCA Relapse: (Abstract 1822) Dr. Nader Yatim (Paris/Mount Sinai) studied 260 GCA patients from four cohorts (median age 73, 70% female) for clonal hematopoiesis of indeterminate potential (CHIP; VAF ≥0.5%). CH was found in 50% (DNMT3A 24%, TET2 14%) and independently predicted relapse (aHR 2.55; 95% CI 1.37–4.72), with a dose-response by clone size (HR 1.51 per VAF doubling); relapse occurred in 68% of those with VAF >4.7% vs 22% without CH. TET2 mutations carried the highest relapse risk (aHR 4.14), patients with both TET2 and DNMT3A had an aHR of 6.12, while DNMT3A was paradoxically associated with less AION/CRAO (aOR 0.31). Single-cell, serum proteomic and temporal artery spatial transcriptomic data showed enhanced myeloid activation and IL-1 signaling in CH-positive patients. Half of GCA patients carry CH, and it may become a prognostic marker for who needs longer or steroid-sparing therapy. Link

REGENCY Biopsies — Obinutuzumab Clears B Cells from the Kidney: (Abstract 1823) Dr. Richard Furie presented paired baseline and week-76 repeat kidney biopsies from the phase 3 REGENCY trial of obinutuzumab plus standard therapy in proliferative lupus nephritis. In 64 biopsies (32 per arm), significantly more obinutuzumab patients achieved histologic or near-histologic remission (NIH activity index 0 or ≤1). Strikingly, among patients who did not reach a complete renal response, 52.6% (10/19) on obinutuzumab had an activity index of 0 vs 8.3% (2/24) on placebo — histology was better than proteinuria suggested. Tissue CD79a+ B cells fell by −28.5 vs −11.9 with placebo (difference −16.6; p<0.0001), nearly to zero in most treated patients. This is the first demonstration of deep kidney-tissue B-cell depletion by any anti-CD20 agent and argues for histologic endpoints in future LN trials. Link

SGLT2 Inhibitors in Non-Diabetic Lupus Nephritis: (Abstract 1867) Dr. Gurjot Singh (TriHealth, Cincinnati) used the TriNetX network (110 US health systems) to ask whether SGLT2 inhibitors, now endorsed by KDIGO 2024 for proteinuric CKD regardless of diabetes, help patients with lupus nephritis who are not diabetic. All patients with any diabetes diagnosis were excluded, and SGLT2i users were propensity-matched 1:1 to non-users on CKD burden and on mycophenolate and HCQ use, yielding 1,154 patients per cohort (all SMD <0.05). Over 3 years, SGLT2i users had consistently lower cumulative rates of ESRD/dialysis, heart failure, AKI and high-grade proteinuria (UPCR ≥2 g/g), with Cox hazard ratios of 0.84–0.99 across all four endpoints. ESRD showed a 37% relative risk reduction but was only borderline on log-rank testing (p=0.051), and acute MI did not differ (HR 1.19; p=0.246). Importantly, there was no excess AKI once immunosuppression was matched. The signal is consistent but not yet statistically robust — a hypothesis-generating result that supports adding an SGLT2 inhibitor to proteinuric LN while we await prospective trials. Link

Outcomes in ANCA Associated Vasculitis - The Mayo Clinic Avacopan Experience (Abstract 1152). Meade and colleagues presented a 3 center Mayo clinic review of their experience with 128 GPA and MPA patients and their use of avacopan. 64 consecutive avacopan users were compared to 64 consecutive patients in the pre-avacopan era. Most patients were treated with rituximab. With at least 12 mos. of follow-up, avacopan was associated with faster complete remission (aHR 1.60), more remissions at week 52 (52% vs 33%) and earlier prednisone discontinuations (aHR 1.59).  Both groups improved their renal function equally and safety outcomes were similar without significant hepatotoxicity.