Lupus

From mechanism to manifestations: Abstract 1821 3 preclinical clusters of lupus 1: ↑ IFN/inflammation → systemic/hematologic; 53% ⟶ lupus 2: ↓ innate effectors → articular/mucocutaneous 3: Stable immune signals → mainly cutaneous; fastest progression #ACR26 @RheumNow https://t.co/0d977ijf18

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Ab#1821 #ACR26 @RheumNow Preclinical autoimmunity leading to SLE UCTD -> SLE pts have higher IFN/TNF signatures at b/l compared to UCTD non-progressors Does HCQ change proteomic trajectories? Suppresses IFN and skews Th2/Treg-ass chemokines HCQ may alter immunologic pathways https://t.co/wnEk0lTXgM

Data from the GLADEL cohort 2.0 show that a numerically higher number of pts on CYC achieved CRR at 6 & 12 mos vs. MMF users as initial induxn tx Pop: 76 pts only, majority female (86.8%), Mestizo ethnicity (72.4%) No superiority bet MMF or CYC seen. @RheumNow #ACR26 Abs1271 https://t.co/0J9Zaf1S3H

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Progression towards lupus followed three proteomic paths in SMILE: inflammatory/IFN signals rose in some patients, fell in others, and stayed relatively stable in a third group. 129 participants, including 48 progressors. #1821 @Rheumnow #ACR26 https://t.co/vsBAvadBvk

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CAR-T in SLE 2026 -Autologous CART: likely to achieve target faster (shorter time for SLEDAI/DORIS) -CD19-vs dual target (BCMA): no significant difference on SLEDAI -Pt w/ LN at baseline had steeper decline on SLEDAI -SAFETY: 64% of pts had CRS manageable (low grade) 95% of https://t.co/XyMOeoSpPL

SjD management: what is new? -Current therapies with low efficacy and no strong data. -Define target population: Important on treatment response What is new: -Ianalumab: B cell depletion. -Telitacicept: dual target Blyss+APRIL phase 3 showed promising results on both activity and https://t.co/ccJFr8Gb5t

INTONATE RCT by Dr Roccatello et al evaluated intensified B-cell depl tx (IBCDT) vs. SOC (GC+MMF) in LN CRR at 12mos in 16/27 pts on IBCDT vs. 10/27 on SOC, at 30mos, CRR in 70% IBCDT (p0.028) IBCDT arm: lower cumulative pred, greater antidsDNA reduxn @RheumNow #ACR26 Abs1228 https://t.co/FtBjtWBitm

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-Clusters identification SjD may aid in management (High vs low IFN1 signal vs B cell signals) -High systemic disease associated w mortality -Persistent hypergammaglobulinemia: over time: high extraglandular manifestations/organ damage, salivary flow impairment. -Early treatment https://t.co/TBd0zFs85p

The utility of minor salivary gland Bx in suspected SjD: > Diagnosis of sero(-) patients include pan-negative for ANA/RF/SSA/SSB > Discovery of an alternative Dx > Focus score may risk stratify for NHL (+) Bx also leads the way for clinical trial enrollment #ACR26 @RheumNow https://t.co/YI999edc3I

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Unstimulated whole saliva (UWS) flow rate pearls: - UWS ≤ 0.1 mL/min part of ACR/EULAR 2016 SjD criteria - Normal human UWS median 0.48mL/min - UWS follows circadian rhythm, less in the early AM, increases by lunchtime! All you need is urine cup and a scale! #ACR26 @RheumNow https://t.co/l3helNwHaT

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SjD diagnosis: -No test w/ absolute specificity -Sicca does not need to be present for a dx. -Extraglandular manifestations also play role in dx: ILD, purpura, hypergammaglobulinemia, low complements etc -Symtom burden not always correlate with DAI -Sicca can be absent in certain https://t.co/8HG69extNv

Tools for lymphoma risk stratification in SjD: -Salivary gland enlargement -LAD -(+) RF -Raynaud's -Monoclonal Gammopathy -Low C4 -(+) SSA and/or SSB >2 predictive factors enhances lymphoma risk Consider assessing these at baseline! #ACR26 @RheumNow https://t.co/Z2odTVCpF0

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Does aPS-PT IgG predict adverse pregnancy outcomes in SLE? Abstract 1844 looked at 98 pregnancies in prospective LEGACY cohort. • APO risk: aPS-PT IgG > LAC > IgM (HR 8.5 > 5.1 > 1.5) • aPS-PT IgG comparable performance predicting APO vs LAC (AUC 0.77 vs 0.83) #ACR26 @rheumnow

Article

Can We Predict Work Disability in Lupus?

Akhil Sood, MD Nov 09, 2026

Despite our increased understanding of lupus immunology including treatment options, many of our patients with SLE continue to experience significant functional impairment and work disability. Several abstracts from ACR 2026 highlight the burden of work disability, the factors associated with

Article

In Vivo CAR-T in Lupus and Scleroderma: 14 Patients, no Lymphodepletion

Henrique Dalmolin, MD Nov 09, 2026

Three reports at ACR Convergence 2026 describe CD19 CAR-T cells generated inside the patient, with no apheresis and no ex vivo manufacturing step. None of the three used fludarabine and cyclophosphamide conditioning.

Early tocilizumab leads to less hospitalization in #GCA. TriNetX study of 127 GCA Rx (w/in 3 mos Dx) w/ TCZ+GC vs GC alone (127). Early TCZ had 36% less hosp in 12 mos (19.7 vs 30.7%) but no diff in vascular events. Abstract #166 #ACR26 https://t.co/a9WfEMQ8wg https://t.co/ors9EBYb6T

Early Tocilizumab Initiation and 12-Month Hospitalisation in Giant Cell Arterit…

#dcSSc active Early allogenic #CAR-T -initial dosing had #mRSS drop of 16pts (L Chung) Well tolerated in vivo #CAR-T #CD19 N=3 SSc + for #skin & #lung 🫁 from China + in SLE NEJM just published closer to scalable Rx vs autologous! #ACR26 @RheumNow @ACRheum #0223, 0225

Use deep B cell depletion in #diffuse #scleroderma if #rituximab fails? 🤞 Small case series from France showed #obinutuzimab seemed to be well tolerated and reduced #skin #score #mRSS post #RTX which was d/c for loss of effect or infusion rx’n Need RCT @RheumNow #0222 #ACR26 https://t.co/iEv2T4XcYS

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For SLE pts with APS experiencing VMS like hot flashes sec to menopause, HT should be avoided. Instead, non-hormonal options can be given like gabapentin, oxybutynin, SSRIs and neurokini antagonists. @RheumNow #ACR26 https://t.co/T7QdNBoglw

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Gliech at al. CAR-T 2.0 in AAV. PR3-CATCR-T cells selectively eliminate pathogenic PR3-ANCA+ B cells in AAV while sparing normal B cells and therefore avoiding off-target toxicity. Very prelimary but exciting! @RheumNow #ACR26 Abstr#0928 https://t.co/kibFxYL8Vy

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Consider these potential risks in pts with SARDs when starting HT: thrombotic risk, potential exacerbation of dse, incr BRCA & other CAs, CVDs & Rx interxns Estrogen-containing HT should be Avoided in women w/ APS/aPL+ @RheumNow #ACR26 https://t.co/Zaaan8OfE7

#ACR26 @RheumNow Ab#0954 CONQUER Cohort Serial Anti-Scl-70 in SSc assoc w/ pulm decline Early incr in Scl-70 from b/l to 6 mos -> steeper subseq FVC decline 30%+ incr in Scl-70 in 18 pts, 44% had ILD progress, v 14% wo Scl70 30% rise HR 3.67 No assoc w DLCO slope, mRSS, global

Does anxiety predict cognitive performance in lupus? Abs 0924: Anxiety was the strongest potentially modifiable predictor. • Each 10-point increase: 0.12 SD lower cognitive scores • Modest gains over time, consistent with practice effects @RheumNow #ACR26 https://t.co/X1qmvUaCQy

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@RheumNow #ACR2026 Abstract #0129 (Poster) The Lupus Gene Curation Expert Panel (GCEP) evaluated 55 genes implicated in monogenic lupus using ClinGen’s clinical validity framework. 5 genes achieved definitive gene–disease association: C1QA, C1QB, C1QC, DNASE1L3 and PRKCD.

Low PREVENT risk (<3%) misses coronary calcium in SLE Women 40-60, n=83 vs 166 matched controls CAC>0: 25.3% vs 9.6%, OR 4.47 Low-risk subgroup: 21.9% vs 6.7% 14 of 21 CAC+ pts were low risk In SLE with any damage (SDI≥1), get the CAC. @RheumNow #ACR26 Abstr#0922 https://t.co/DxgL5Eye9j