Vasculitis

Not your father’s polyarteritis nodosa Abst2099 explores shifting trends in PAN given hx decline of HBV, recog of genetic vasculitides (DADA2, VEXAS). Of n=120 Dx ‘d PAN in Turkish vasculitis database, 70 idiopathic, 28 FMF, 16 DADA2, 4 HBV, 1 VEXAS, 1 MDS @Rheumnow #ACR26

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ACR 2026 Day 3 Report

Jack Cush, MD Nov 10, 2026

Today the ACR began with the Great Debate, an intriguing set of Plenary presentations, a never-ending poster hall and a plethora of stimulation oral presentation sessions. Here are a few of my favorites from today:

Important pearl in the evaluation of NPSLE: Beware of mimickers! - consider PRES esp in the setting of LN - If w/ transverse myelitis and/or optic neuritis, think SLE, NMO and MOG-Ab. Oligoclonal bands can be seen in CSF of SLE but not in NMO and MOG. @RheumNow #ACR26 https://t.co/SjDh47hmtq

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Pugnet et al: Randomized phase 2 data with oral factor B inhibitor iptacopan suggest high remission rates at 24 weeks in active ANCA vasculitis. Could alternative complement inhibition expand our options? @rheumnow #ACR2026 Abstract#LB16

This prospective observational study on NPSLE pts showed that delirium was assoc'd w/ myositis, LN, vasculitis and seizures. Active lupus dse was seen in NPSLE pts w/ delirium vs. those w/o. Delirium correlated w/ higher antidsDNA levels & low C4 @RheumNow #ACR26 Abs2244 https://t.co/6MKWNAuN9g

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Taking a BiTE out of AAV? First 2 pts w/AAV treated with bispecific (CD20xCD3) T cell engager Both had improvement in BVAS (woohoo!) but one had "superinfection" (yikes), the other grade 1 CRS, & neither really had airway improvement Biopsies showed CD19/CD20 B-cell depletion https://t.co/fPxKaAdGO8

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Vasculitis: beyond the guidelines session When is a LoVAS prednisone taper an appropriate candidate? NOT in patient with severe disease like DAH, renal involvement who were excluded from the study A PEXIVAS regimen would be more appropriate in this case @RheumNow #ACR26 https://t.co/vFY4aEgNvf

https://x.com/Dr_Brian_MD/status/2120171628499701891/photo/1

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PMR: Spare The Steroids Please

Daric A. Mueller, PA-C Nov 10, 2026

Steroids remain both the cornerstone and the Achilles' heel of PMR management. We have aspirations of briskly tapering our patients once they have had their honeymoon phase with prednisone. But when Ms. Jones calls you with a reported second PMR symptom relapse at a 6 milligram

#Steroid sparing in #ANCA #vasculitis w #Iptacopan #RCT interim + results Obvious #GC lower does on iptacopan A complement B inhibitor C3bBb Elephant in room 🐘 ?rare side effects of liver and bile duct like #avacopan #LB16 #ACR26 @ACRheum @RheumNow https://t.co/nEoZlgsMZQ

EGPA Treatment: A new Era with the E-MERGE trial? EGPA is the rarest of the ANCA-associated vasculitides. Compared with GPA and MPA, EGPA has a mechanistically distinct pathophysiology involving eosinophil-mediated inflammation. This distinct mechanism has driven the https://t.co/gP5y6rCUJH

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ACR 2026 – Day 2 Report

Jack Cush, MD Nov 09, 2026

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

What happens in #PMR after d/c #secukinumab post 1 yr #Rx? Pts flare #secu 300mg flare 44% Secu 150mg 43% PBO 61.5% Time to flare more prolonged by 2 mo post 300mg secu withdrawal #ACR26 #1893 @ACRheum @RheumNow

Ustekinumab in GCA contradicts other similar small studies of similar design 38pt open label RCT of UST in GCA; pts who recevied UST had higher rate of primary composite (alive, sustained remission, cumulative pred within 10% of plan), 45% vs 12%; p=.028. That's great, but https://t.co/gAvUAan4b3

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Samson et al. RCT (open-label however) Ustekinumab in GCA. 38 patients. Primary endpoint week 52 (alive+sustained remission+<10% deviation from steroid protocol) 45% vs 12% (p=0.028) Relapse rate week 52 50% vs 88% (p=0.013) @RheumNow #ACR26 Abstr#1896 https://t.co/P51ZLklEMA

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To pulse or not to pulse Emulated target trial using retrospective AAV data tx for severe flare Many baseline differences between pulse vs. no pulse so propensity matching used NO difference in composite of death, ESRD, remission, relapse @RheumNow #ACR26 #Abst1154 https://t.co/cu5N5rMnj1

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RWE multicenter cohort: avacopan benefit largely concordant with ADVOCATE study 64 pts w/severe GPA/MPA who received avacopan compared to historical conrols No difference in time to remission (adjusted HR 0.80, 95% CI 0.56-1.15) & no change in renal trajectory, but improved https://t.co/9mzrcCnEET

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1 in 5 pts with EGPA relapse Additional analysis from MAINRITSEG, FVSG RCT of RTX vs AAV for maintenance 19% of pts had relapse w/in 28 mos; rates higher among pts w/prior relapse (obvi, lol) but no difference RTX vs AZA (surprising) As before, I love RTX less in EGPA than I

Half of 260 GCA patients had clonal haematopoiesis (CH). Assoc with higher relapse hazard (aHR 2.55, 95% CI 1.37-4.72), with clone size and mutation type also relevant. Study presents CH as a major determinant of GCA pathogenesis, disease course, & outcomes @Rheumnow #1822 #ACR26

Quinn et al. Tocilizumab vs TNFi in Takayasu arteritis. Clinical response in TNFi vs TCZ - 72.1% vs 60.7%). 94% of treatment failures responded to alternative agent. TNFi appear better in young, tocilizumab in older @RheumNow #ACR26 Abstr#1124 https://t.co/J7JrWh1qpH

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How does five factor score perform for contemporary PAN? 447 pts -> 36 deaths Infection > vasculitis for mortality FFS = 1 trends but NOT significantly associated with mortality FFS 2 or higher very associated Prediction enhanced w/ other factors #Abst1140 @RheumNow #ACR26 https://t.co/O9AJYm4iy8

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Another blow to the physical exam... Pulse exam NOT sufficient for evaluation of TAK lesions - pulse loss correlates with arm/neck lesion - pulse loss inconsistent for leg lesion - MANY silent lesions w/o exam change Serial imaging remains standard #Abst1126 @RheumNow #ACR26 https://t.co/U9a0muql5Q

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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…

GCA with normal CRP? French study of GCA > 50 yrs, dx w/ temp artery Bx 67% or imaging (US, PET) + nl Baseline CRP <10 mg/L. 74 pts (age 73 yrs) 84% filled 2022 Dx criteria. Low CRP pt had less fever, fatigue, wt loss, PMR Sxs & more ischemic Sxs and strokes. They were more https://t.co/olL8Vf93DW

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RITAZAREM: Three Things I Learned about AAV Maintenance

Michael Putman, MD, MSCI Nov 08, 2026

One of the most common questions I receive in my vasculitis clinic is one of the most difficult to answer: “When can we stop rituximab?” While we know everyone needs therapy for at least one year and have reasonably good data for 18 months, whether folks should continue after that remains an

Low-dose naltrexone fails again :( LoDoNaVasc blinded crossover RCT of 60 pts with remission/very low vasculitis activity. No difference in PROMIS physical or mental health Supports results from @TheLancetRheum in fibromyalgia Sadly, this does not seem to work @RheumNow https://t.co/S2XRSyGvIZ