ACR open rheumatology最新文献

{"title":"IgG4-to-IgG Ratio and Orbital Involvement Predict Clinical Response to B Cell Depletion in IgG4-Related Disease.","authors":"Young Min Cho, Alejandro Quinteros, Pallavi Khattar, Morris Clive Edelman, Lara El Khoury, Galina Marder","doi":"10.1002/acr2.90148","DOIUrl":"10.1002/acr2.90148","url":null,"abstract":"<p><strong>Objective: </strong>IgG4-related disease (RD) demonstrates ethnic variations in phenotype, but data from diverse US populations are limited. We characterized ethnic differences in organ involvement and evaluated predictors of treatment response in a multiethnic cohort.</p><p><strong>Methods: </strong>We conducted a retrospective study of 58 patients meeting 2019 American College of Rheumatology/EULAR criteria at Northwell Health (2011-2023). Data on demographics, organ involvement, histopathology, treatment, and serology (IgG4-to-IgG ratios) were analyzed. Response was assessed using Carruthers' Index.</p><p><strong>Results: </strong>The cohort included 43.1% White, 24.1% Asian, 19.0% Hispanic, and 13.8% Black patients. Organ involvement patterns were consistent across races, with lymph nodes (22.4%), orbital/lacrimal (20.7%), and retroperitoneum (20.7%) being most affected. Higher disease burden was observed in Asian patients (1.93 vs 1.44-1.64 organs, P = 0.058). A striking disparity in rituximab use was observed (0% in Black patients vs 57%-76% in others, P = 0.002), whereas disease phenotype distribution was otherwise similar across groups. Favorable response rates were high and comparable across all racial and ethnic groups (78.6%-100%, P = 0.462). In patients treated with rituximab (n = 35), a reduction in IgG4-to-IgG ratio predicted response (area under the curve = 0.806), outperforming baseline ratios. Orbital/lacrimal involvement was strongly associated with treatment failure (75% of nonresponders vs 13.3% of responders; odds ratio 6.6, 95% confidence interval 1.4-31.9, P = 0.03).</p><p><strong>Conclusion: </strong>In a diverse IgG4-RD cohort, disease phenotypes were consistent across races, though treatment access disparities existed. Dynamic changes in IgG4-to-IgG ratios and the presence of orbital disease are key predictors of response to rituximab, informing personalized treatment strategies.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 10","pages":"e90148"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13603072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Images: Rapidly progressive granulocyte colony-stimulating factor-associated arteritis: initial normal imaging as a diagnostic pitfall.","authors":"Chika Kayabe Kuroda, Takashi Nawata, Toru Ariyoshi, Mayu Nakamoto, Noriko Maeda, Hidenori Takahashi, Hiroshi Nakamura, Motoaki Sano","doi":"10.1002/acr2.90161","DOIUrl":"10.1002/acr2.90161","url":null,"abstract":"","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 10","pages":"e90161"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Usefulness of White Blood Cell Inflammatory Parameters in Children With Systemic Lupus Erythematosus.","authors":"Butsabong Lerkvaleekul, Nongnuch Sirachainan, Duantida Songdej, Karan Paisooksantivatana, Pawadee Chinudomwong, Soamarat Vilaiyuk","doi":"10.1002/acr2.90152","DOIUrl":"10.1002/acr2.90152","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the utility of novel parameters related to immune cell activation, known as white blood cell parameters of inflammation (WBC-IP), as biomarkers of disease activity in childhood-onset systemic lupus erythematosus (cSLE) and compare their performance with conventional markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin (PCT).</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis, including patients with cSLE with active disease (n = 43), remission (n = 31), and healthy controls (n = 112). In a separate longitudinal cohort, patients with active cSLE at baseline were reassessed after four to six weeks and when achieving inactive disease. WBC-IP was measured in dipotassium EDTA-anticoagulated tubes using the Sysmex XN-Series analyzer. Associations with SLEDAI-2K, clinical SLEDAI-2K, and physician global assessment (PGA) scores were assessed using Spearman's rank correlation. Diagnostic performance for distinguishing active disease from remission was evaluated by the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Significant alterations in neutrophil- and lymphocyte-related parameters were observed across disease states. The proportion of immature granulocytes (IG%) correlated most strongly with the SLEDAI-2K (r_s = 0.51), clinical SLEDAI-2K (r_s = 0.50), and PGA (r_s = 0.57; all P < 0.0001) and showed comparable associations with ESR, CRP, and PCT. Longitudinal changes in IG%, neutrophil reactivity intensity, and lymphocyte complexity indices paralleled improvements in disease activity. IG% best discriminated active cSLE among WBC-IP (AUC 0.90, 95% confidence interval [CI] 0.83-0.98; cutoff >0.35, sensitivity 81.4%, specificity 87.1%), whereas ESR demonstrated the highest AUC among conventional markers (AUC 0.92, 95% CI 0.85-0.99).</p><p><strong>Conclusion: </strong>Among the WBC-IP evaluated, IG% showed the strongest association with disease activity and demonstrated diagnostic performance comparable to that of ESR, suggesting it may represent a potential biomarker of disease activity. Further validation in independent cohorts is warranted.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 10","pages":"e90152"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Use of Avacopan in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Early and Long-Term Clinical, Renal, and Patient-Reported Outcomes in an Italian Rheumatology-Nephrology Network.","authors":"Luca Quartuccio, Elena Treppo, Miriam Isola, Maria De Martino, Chiara Marvisi, Luca Iorio, Alessandra Milanesi, Luca Moroni, Edoardo Conticini, Stefania Affatato, Maria Letizia Urban, Enrico Tombetti, Fabio Barone, Pasquale Esposito, Florenzo Iannone, Valentina Binda, Giuseppe Castellano, Corrado Murtas, Lida Tartaglione, Francesco Delle Monache, Amelia Rigon, Maria Chiara Panini, Marco Allinovi, Augusto Vaglio, Bruno Frediani, Paolo Delvino, Sara Monti, Roberto Padoan, Carlomaurizio Montecucco, Lorenzo Dagna, Giacomo Emmi, Federico Alberici, Carlo Salvarani","doi":"10.1002/acr2.90126","DOIUrl":"10.1002/acr2.90126","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Complement activation, particularly through the C5a-C5a receptor axis, plays a pivotal role in the pathogenesis of antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and may represent an important therapeutic target. Avacopan, an oral C5a receptor antagonist, was the first therapy targeting this pathway to enter in clinical practice. Prospective real-world data on its long-term effectiveness, safety, and impact on quality of life (QoL) remain limited. In the context of an evolving therapeutic and regulatory landscape, such data provide valuable evidence on the clinical effects of C5a receptor inhibition and may inform the development and evaluation of future complement-targeted therapies. The objective of this study was to evaluate the real-world effectiveness, safety, kidney outcomes, and patient-reported outcomes of avacopan in an Italian cohort of patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective, multicenter, observational study included patients with newly diagnosed or relapsing GPA or MPA who were started on avacopan therapy across 18 Italian centers. Avacopan was administered in combination with standard immunosuppressive therapy, with or without glucocorticoids (GCs). Clinical remission (Birmingham Vasculitis Activity Score = 0), GC-free remission, kidney parameters, laboratory outcomes, adverse events, and patient-reported outcomes assessed by the AAV Patient-Reported Outcome questionnaire were evaluated up to 52 weeks and beyond. Estimated glomerular filtration rate (eGFR) was calculated using the European Kidney Function Consortium equation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty-six patients were included (63% women; mean age of 59 years); 61% had relapsing disease, and 70% had kidney involvement at baseline. Clinical remission was achieved by 78%, 88%, and 97% of patients at weeks 12, 26, and 52, respectively. GC-free remission occurred in 20% at week 12 and 55% at week 52. Mean GC dose decreased from 23 mg/day at baseline to 5 mg/day by week 12 (P &lt; 0.001). Kidney function improved over time, with median eGFR increasing from 30.5 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; at baseline to 53.5 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; at week 52 (P = 0.002). Significant improvements in QoL were observed as early as week 12 and were sustained until week 52, particularly in the physical function domain. Adverse events were mild to moderate; infections were the most frequent events (40%). Disease relapses were uncommon and occurred exclusively in patients treated for relapsing disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this real-world Italian cohort, patients treated with avacopan achieved high remission rates, substantial GC reduction, improvement in kidney function, and sustained QoL benefits. These findings provide prospective real-world evidence on the clinical outcomes associated with C5a receptor inhibition in routine clinical pract","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 10","pages":"e90126"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Images: Collapsing auricles and airways in relapsing polychondritis with myelodysplastic syndrome.","authors":"Yuqing Dan, Liling Zhao, Qiong Fu","doi":"10.1002/acr2.90166","DOIUrl":"10.1002/acr2.90166","url":null,"abstract":"","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 10","pages":"e90166"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Dual Targeted Therapy as a Treatment Strategy for Refractory Psoriatic Arthritis: Real-World Effectiveness and Safety From a Prospective Cohort\".","authors":"","doi":"10.1002/acr2.90165","DOIUrl":"https://doi.org/10.1002/acr2.90165","url":null,"abstract":"","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 10","pages":"e90165"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Diagnostic Accuracy of Focused Frontal-Branch Ultrasonography in Giant Cell Arteritis.","authors":"Giuseppe Germanò, Carlo Salvarani, Gianluigi Bajocchi, Luigi Boiardi, Maria Grazia Orlando, Alberto Cavazza, Pierluigi Macchioni","doi":"10.1002/acr2.90144","DOIUrl":"10.1002/acr2.90144","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic accuracy, reproducibility, and acquisition time of focused bilateral frontal-branch ultrasonography based on intima-media thickness (IMT) in suspected giant cell arteritis (GCA).</p><p><strong>Methods: </strong>In this prospective single-center study, 171 patients underwent color Doppler ultrasonography of the temporal and large arteries and ultrasonography-guided temporal artery biopsy. Bilateral mean frontal-branch IMT was evaluated against the expert diagnosis established at six months. Diagnostic performance was assessed using ROC analysis and multivariable logistic regression. Reproducibility was assessed in 100 randomly selected images.</p><p><strong>Results: </strong>GCA was diagnosed in 107 patients, including 96 biopsy-positive cases. Mean frontal-branch IMT had the highest observed area under the curve among the temporal artery segments (0.87). At the 0.28-mm cutoff, sensitivity was 71%, specificity 94%, LR+ 11.4, and LR- 0.31. Frontal IMT ≥ 0.28 mm was the strongest independent predictor of GCA (odds ratio 43.0). At a cutoff of ≥3, the exploratory PAMELA (Performance Analysis of a Monosegmental Ultrasonographic Evaluation of the Frontal-Branch of the Superficial Temporal Artery in Giant Cell Arteritis) score had a sensitivity of 74.8% and specificity of 93.7%. Focused bilateral frontal-branch assessment required 1.07 ± 0.24 minutes versus 7.62 ± 1.11 minutes for the complete temporal artery protocol. Intraobserver and interobserver intraclass correlation coefficients were 0.96 and 0.93.</p><p><strong>Conclusion: </strong>Focused bilateral frontal-branch ultrasonography provides a highly specific, reproducible, and time-efficient initial cranial assessment in suspected GCA. However, the 0.28-mm cutoff and PAMELA score require external validation, and the remaining temporal and large-vessel territories should be examined when frontal findings are negative or equivocal.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 10","pages":"e90144"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Efficacy of Cytokine-Directed Therapies in the Management of VEXAS Syndrome.","authors":"Daniel Montes, Hannah E Langenfeld, Andrew C Hanson, Cynthia S Crowson, Mrinal M Patnaik, Ronald S Go, Kambiz Kalantari, Yael Kusne, Terra Lasho, Abhishek A Mangaonkar, Horatiu Olteanu, Kaaren K Reichard, Megan M Sullivan, David S Viswanatha, Kenneth J Warrington, Matthew J Koster","doi":"10.1002/acr2.90153","DOIUrl":"10.1002/acr2.90153","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of cytokine-directed therapies in VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory somatic) syndrome using previously proposed treatment response criteria.</p><p><strong>Methods: </strong>All patients with genetically confirmed VEXAS syndrome who received targeted therapies with JAK inhibitors (JAKi), tumor necrosis factor α inhibitors (TNFαi), or interleukin-1 (IL-1) or IL-6 inhibitors were identified. Clinical and biochemical data were recorded for patients at time of targeted therapy initiation, and at 3-, 6-, and 12-month follow-up time points. Treatment response was labeled as complete response (CR; normalization of C-reactive protein [CRP], prednisone <10 mg/day, and resolution of disease activity), partial response (PR; >50% improvement in CRP, >50% prednisone dose reduction, improvement or resolution of disease features), treatment failure (TF; worsening CRP, increasing prednisone, worsening of disease features), or no response (not meeting criteria for CR, PR, or TF).</p><p><strong>Results: </strong>Overall, 52 patients received an IL-1i, IL-6i, or JAKi therapy. At six-month follow-up, 3 of 19 IL-6i patients experienced CR, 4 of 19 experienced PR, and 7 of 19 experienced TF. 2 of 17 patients receiving JAKi experienced CR, 3 of 17 experienced PR, and 6 of 17 experienced TF. No patients receiving IL-1i or TNFαi experienced CR, and only 1 of 5 IL-1i patients experienced PR. Among those still receiving biologic therapy at 12 months, only 1 of 11 receiving IL-6i and 0 of 7 receiving JAKi experienced CR.</p><p><strong>Conclusion: </strong>IL-6i and JAKi therapies demonstrated limited, unsustained efficacy for management of VEXAS syndrome. IL-1i and TNFαi therapies were not efficacious. Useful application of previously reported treatment response criteria was demonstrated, but future incorporation of hematologic parameters may be beneficial.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 10","pages":"e90153"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13603073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction of CXCR3+CCR6+ CD4+ T Cells and IL-17+ RORγt+ CD4+ T Cells During Secukinumab Treatment Identifies Patients With Axial Spondyloarthritis Responsive to Subsequent Biologic Therapy.","authors":"Addison Pacheco, Patricia Remalante-Rayco, Nigil Haroon, Denis Poddubnyy, Robert D Inman","doi":"10.1002/acr2.90093","DOIUrl":"10.1002/acr2.90093","url":null,"abstract":"<p><strong>Objective: </strong>We recently reported an immune profile that stratifies patients with axial spondyloarthritis based on clinical response to secukinumab. We now undertake an exploratory study on the secukinumab nonresponder patients to determine if immunologic changes occur during their initial secukinumab treatment that could determine their next biologic response.</p><p><strong>Methods: </strong>At the clinician's discretion, 18 patients who did not respond to secukinumab were either switched to a tumor necrosis factor inhibitor (TNFi; n = 8) or underwent secukinumab dose escalation to 300 mg monthly or 150 mg biweekly (n = 10). Flow cytometry-derived immune cell subset frequencies and NanoString gene expression profiling of CD45RO+CD45RA-CD4+ T cells obtained during initial secukinumab treatment were stratified and reanalyzed according to subsequent treatment response based on the Bath Ankylosing Spondylitis Disease Activity Index at week 24.</p><p><strong>Results: </strong>Most patients were either subsequent secukinumab responders (sSecu-Rs; n = 5/10, 50%) or subsequent TNFi responders (sTNFi-Rs; n = 6/8, 75%). During the initial secukinumab treatment, there was a significant decrease in the frequency of TH17.1 cells (P < 0.05) and interleukin-17 positive (IL17+) RORγt+ CD4+ T cells (P < 0.05) in sSecu-Rs and sTNFi-Rs, but not in patients who failed all three biologics (subsequent non responder [sNR]). Multidimensional scaling of NanoString data revealed that subsequent nonresponders (sNRs; before and after secukinumab) clustered distinctly from other groups. Following the initial secukinumab therapy, but not before it, sSecu-Rs and sTNFi-Rs showed lower expression of IL12A, IL12RB1, IFNGR1, and JAK1 compared with sNRs.</p><p><strong>Conclusion: </strong>Secukinumab treatment induces immunologic changes associated with reduced inflammation, even in patients who demonstrate an inadequate clinical response. Notably, patients who display these immunologic profiles are more likely to respond to subsequent biologic therapy.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 9","pages":"e90093"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Humanoid Colleagues and the Rheumatology Workforce: Preparing for a New Era.","authors":"Adam Kilian, Laura Upton, Joshua Samec, Shivang Chaudhary, Adam Friedman, Eva Waineo, Terry Moore","doi":"10.1002/acr2.90128","DOIUrl":"10.1002/acr2.90128","url":null,"abstract":"<p><p>Rheumatology faces sustained workforce strain, widening access gaps, and escalating administrative burden. Fellowship expansion and integration of advanced practice clinicians remain essential, but existing strategies alone are unlikely to meet projected demand. Meanwhile, artificial intelligence (AI) is increasingly embedded in clinical medicine, and physically embodied, general-purpose humanoid robots have begun entering the industrial workforce. This review presents a profession-centered framework for how such humanoid systems could be trained and governed within rheumatology should they eventually enter clinical care. It is an exercise in anticipatory governance: designing oversight before deployment pressure arrives. We conceptualize humanoid systems as supervised trainee analogs within existing fellowship structures rather than as autonomous replacements for clinicians, advancing through four stages: observation and simulation, competency-based assessment, supervised patient contact, and parallel evaluation alongside fellows. Because clinically capable humanoid systems do not yet exist, each stage is paired with technology-readiness and regulatory trigger milestones, verified before activation. Oversight runs on two tracks: US Food and Drug Administration regulation governs the device, whereas fellowship-anchored training and privileging govern its local use. Proposed educational benefits, such as sharper clinical reasoning from teaching a nonhuman trainee, are framed as testable hypotheses rather than established effects. A central boundary is fixed: these systems never graduate to independent practice, and final diagnostic and therapeutic authority remains with the supervising rheumatologist. Without deliberate engagement, AI integration into rheumatology may be shaped by commercial and regulatory forces alone. Proactive stewardship, including honest acknowledgment of uncertainty, can help ensure technological change strengthens patient trust, professional standards, and workforce sustainability.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 9","pages":"e90128"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}