ACR open rheumatology最新文献

{"title":"Beyond Glucocorticoids: The Current Landscape and Prospects for Treating Immune Checkpoint Inhibitor-Induced Autoimmunity.","authors":"Xizi Hu, Ji Eun Ryoo, Brian S Henick, Adam Mor","doi":"10.1002/acr2.90092","DOIUrl":"10.1002/acr2.90092","url":null,"abstract":"<p><p>The rapid integration of immune checkpoint inhibitors (ICIs) into standard oncology protocols has birthed a new frontier in clinical rheumatology: immune-related adverse events (irAEs). By disrupting the programmed cell death-1 (PD-1)/PD-L1 and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) axes to restore antitumor T cell activity, these therapies inadvertently breach peripheral tolerance. This results in a spectrum of de novo autoimmune and inflammatory syndromes that frequently mimic established rheumatic diseases, including inflammatory arthritis and myositis. Although ICIs have revolutionized survival outcomes, the resultant irAEs pose a significant clinical challenge, affecting nearly 50% of patients and often necessitating the expertise of rheumatologists for management. This manuscript explores the unique rheumatologic phenotype of ICI-induced toxicities, emphasizing the urgent need for a shift from broad-spectrum glucocorticoid use toward targeted, mechanism-driven therapies that do not compromise the abscopal antitumor effect. We review the current landscape of clinical trials investigating the repurposing of traditional disease-modifying antirheumatic drugs and advanced biologics. Specifically, we discuss the efficacy and safety of tumor necrosis factor-alpha inhibitors, interleukin-6 receptor antagonists, and JAK inhibitors in the context of steroid-refractory irAEs. We further analyze the molecular commonalities between idiopathic autoimmune diseases and ICI-induced inflammation. As the patient population receiving ICIs grows, the rheumatologist's role as a co-manager is increasingly essential. This review highlights the need for standardized grading and treatment algorithms for rheumatologic irAEs and advocates collaborative research to separate immunotherapy toxicities from its oncological benefits.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 8","pages":"e90092"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13438176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674769","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":"Detecting Borrelia burgdorferi-Triggered Seronegative Rheumatoid Arthritis Using [⁶⁸Ga]Ga-DOTA-Siglec-9-Positron Emission Tomography/Computed Tomography.","authors":"Prince Dadson, Heli Ylä-Outinen, Simona Malaspina, Mikko Koivumäki, Sirpa Jalkanen, Laura Pirilä, Anne Roivainen","doi":"10.1002/acr2.90116","DOIUrl":"10.1002/acr2.90116","url":null,"abstract":"","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 8","pages":"e90116"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649936","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 Care Complexity in Inflammatory Arthritis: A Population-Based Approach Using Classification and Regression Tree Analysis to Examine Health Care Utilization.","authors":"Melissa Sipley, Camila Aquino, Trafford Crump, Cheryl Barnabe, Glen Hazlewood, Claire E H Barber, Jessalyn K Holodinsky","doi":"10.1002/acr2.90134","DOIUrl":"10.1002/acr2.90134","url":null,"abstract":"<p><strong>Objective: </strong>We identified which care complexity characteristics contribute to high health care utilization (physician visits and emergency department [ED] visits) among individuals with inflammatory arthritis in Alberta.</p><p><strong>Methods: </strong>We identified individuals diagnosed rheumatoid arthritis (RA), psoriatic arthritis (PsA), or axial spondyloarthritis (axSpA) between 2010 and 2015 using a validated case definition. Sociodemographic and disease characteristics contributing to care complexity were described for each population. Classification and regression tree models were developed to identify which combination of care complexity characteristics were predictive of high health care use (physician visits and ED visits) within the first five years after diagnosis. Care complexity predictors included age, sex, place of residence, socioeconomic status (SES), inflammatory arthritis disease type, comorbidities, medication use, and opioid and glucocorticoid dispensations.</p><p><strong>Results: </strong>Care complexity characteristics varied across cohorts (n = 13,170 individuals): older age, rural residence, multimorbidity, and glucocorticoid use were most prevalent in RA; low SES was most prevalent in PsA; and opioid use was most prevalent in axSpA. High physician visit utilization was associated with polypharmacy, the presence of anxiety, older age, living in an urban area, and having PsA (sensitivity of 78%). High ED visit utilization was associated with polypharmacy, rural place of residence, and having RA or axSpA (sensitivity of 68%).</p><p><strong>Conclusion: </strong>Our models identified key predictors of high health care utilization in inflammatory arthritis, with modest predictive performance. These findings provide insight into factors contributing to care complexity and may support health care providers to better understand patient needs and inform resource planning.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 8","pages":"e90134"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809585","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":"Transition to Adulthood Through Coaching and Empowerment in Rheumatology (TRACER): Results of a Feasibility Randomized-Control Trial.","authors":"Madison Lackie, Megan Clarke, Julie Herrington, Pamela Jarvis, Roberta Berard, Karen Beattie, Michelle Batthish","doi":"10.1002/acr2.90125","DOIUrl":"10.1002/acr2.90125","url":null,"abstract":"<p><strong>Objective: </strong>Health care transitions are a time of high needs for youth with chronic rheumatic conditions. Our study aimed to evaluate the feasibility of a multicenter randomized-controlled trial implementing a virtual transition coach intervention (TCI) for youth transitioning from pediatric to adult rheumatology care.</p><p><strong>Methods: </strong>Youth aged 17 to 18 years with pediatric-onset rheumatic diseases were recruited from McMaster Children's Hospital in Hamilton, and Children's Hospital, London Health Sciences Centre in London, Canada. Participants were randomized to receive a youth transition roadmap (YTR) (standard of care), or YTR plus TCI-eight virtual monthly coaching sessions covering topics from the YTR. Primary outcomes included feasibility criteria, whereas secondary outcomes focused on measures of readiness for transition (Transition-Q), global functioning (PedsQL 4.0), and self-efficacy (PROMIS self-efficacy for managing chronic conditions) at baseline, 8 months, and 11 months. A satisfaction survey was provided to TCI participants upon study completion.</p><p><strong>Results: </strong>Of 65 patients approached, 31 (48%) consented. Over 95% of TCI sessions were attended, 80% of patients completed 8-month follow-up questionnaires, and missing data were 13%. TCI participants demonstrated slightly larger mean changes across each time point for each instrument compared to controls. TCI participants overwhelmingly endorsed the intervention, with 78% satisfied with the intervention and 89% willing to recommend the intervention to a friend.</p><p><strong>Conclusion: </strong>Transition coaching is a feasible intervention to support youth transitioning from pediatric to adult rheumatology care. Results from this trial will inform a multicenter trial, investigating the efficacy of a TCI on transition readiness and self-efficacy for managing chronic conditions.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 8","pages":"e90125"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765366","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":"Biosimilar Rituximab in ANCA-Associated Vasculitis Compared to the Originator: A Multicenter Cohort Study.","authors":"Arielle Mendel, Lillian Barra, Hassan Behlouli, Sasha Bernatsky, Alison H Clifford, Jan Willem Cohen Tervaert, Natasha Dehghan, Aurore Fifi-Mah, Jean-Paul Makhzoum, Rosalie-Sélène Meunier, Nataliya Milman, Medha Soowamber, Elaine Yacyshyn, Nader Khalidi, Christian Pagnoux","doi":"10.1002/acr2.90119","DOIUrl":"10.1002/acr2.90119","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the six-month effectiveness and safety of rituximab biosimilars compared to the originator in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), and outcomes following originator to biosimilar switching.</p><p><strong>Methods: </strong>We recruited adults with GPA or MPA treated with the rituximab originator or a biosimilar for induction or maintenance, or who switched from originator to biosimilar maintenance (2018-2023). Participants either started the treatment within the preceding six months or were recruited from vasculitis research cohorts. Outcomes included six-month remission (Birmingham Vasculitis Activity Score [BVAS] version 3 of 0), relapse (BVAS rise after achieving remission requiring treatment), vasculitis damage, and serious adverse events (SAEs).</p><p><strong>Results: </strong>We studied 207 participants from 9 centers: 132 starting induction (58 originator and 74 biosimilar), 59 starting maintenance (23 originator and 36 biosimilar), and 16 in the \"switch\" group. Mean age was 56.7 years (SD 17.5), 52% were female, 80% were White, and 70% had GPA. At six months from induction, 51 of 53 (96%) originator and 66 of 73 (90%) biosimilar recipients achieved remission (difference 6%, 95% confidence interval [CI] -4% to 15%), whereas at three months (exploratory) 48 of 51 (94%) and 57 of 72 (79%) recipients, respectively, had achieved remission (difference 15%, 95% CI 2% to 26%). All individuals in the maintenance and \"switch\" subgroups were in remission at six months. One minor relapse occurred in each of the induction groups and in the originator maintenance group. Change in vasculitis damage and SAEs were not significantly different between groups.</p><p><strong>Conclusion: </strong>This study found no significant differences in six-month outcomes between the rituximab originator and biosimilars for induction of GPA and MPA, with no concerning early signals in those initiating maintenance or switching from the originator to a biosimilar.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 8","pages":"e90119"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633025","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":"Outcomes of Immune Check Point Inhibitor Use in US Veterans With Pre-Existing Idiopathic Inflammatory Myopathies: Case Series and Literature Review.","authors":"Denis Krutko, Selene Rubino, Gary A Kunkel, Jessica A Walsh, Jorge Rojas, Brian C Sauer, Shardool Patel, Grant W Cannon, Tawnie J Braaten","doi":"10.1002/acr2.90127","DOIUrl":"10.1002/acr2.90127","url":null,"abstract":"<p><strong>Objective: </strong>Our objective was to identify and describe the clinical characteristics and outcomes in patients with pre-existing idiopathic inflammatory myopathies (IIMs) in the Veterans Health Administration (VHA) treated with immune checkpoint inhibitors (ICIs).</p><p><strong>Methods: </strong>All veterans receiving ICI infusions were identified. Patients with at least two International Classification of Disease codes for IIM before first ICI infusion underwent chart review to identify patients with confirmed IIM by American College of Rheumatology/EULAR criteria. The demographics, cancer diagnoses, laboratory findings, clinical course, and mortality rates were reported. IIM cases were also reviewed to determine if patients developed IIM flare following ICI treatment.</p><p><strong>Results: </strong>We identified 29,539 veterans who received at least one ICI infusion in the VHA between June 6, 2011, and February 14, 2023. The eight patients with confirmed IIM before ICI treatment were mostly White men with an average age of 71.7 years at first ICI infusion. The IIM diagnoses were dermatomyositis in three patients, polymyositis in two, antisynthetase syndrome in two, and one rheumatoid arthritis (RA)/myositis overlap. Cancer diagnoses were lung (two), melanoma (two), head and neck (two), kidney/other urinary (one), and mesothelioma (one). Diagnosis of IIM was made on average 3.1 years before ICI treatment. One patient had an IIM flare after ICI. No IIM flares were identified in other patients.</p><p><strong>Conclusion: </strong>Our findings show that an IIM flare after ICI therapy can occur, but most patients did not develop a flare. These observations suggest ICIs can be considered as an option in patients with cancer with IIM with shared decision-making and close monitoring.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 8","pages":"e90127"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13454731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702871","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 Treatment Patterns in Rheumatoid Arthritis-Associated Interstitial Lung Disease.","authors":"Justin T Dunn, Scott M Matson, Michael D George, Yangyuna Yang, Punyasha Roul, Jean D'Amour Kwizerimana, Jorge Rojas, Grant W Cannon, Brian Sauer, Jeffrey R Curtis, Joshua F Baker, Ted R Mikuls, Bryant R England","doi":"10.1002/acr2.90135","DOIUrl":"10.1002/acr2.90135","url":null,"abstract":"<p><strong>Objective: </strong>We evaluated real-world treatment patterns in rheumatoid arthritis-associated interstitial lung disease (RA-ILD) within the Veterans Health Administration (VA).</p><p><strong>Methods: </strong>We performed a cohort study of RA-ILD treatment patterns in the VA between 2006 and 2021. Patients with RA-ILD were identified using validated administrative algorithms. Pharmacy databases were queried for medication dispensing before and after ILD diagnosis. The primary comparison was the proportion of patients prescribed each medication before and after ILD diagnosis. Multivariable Cox regression was used to evaluate predictors of initiating an American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) guideline recommended medication after ILD diagnosis among patients not using these therapies at baseline.</p><p><strong>Results: </strong>Among 4,108 patients with RA-ILD, mean age was 68.6 years and 93.4% were male. Prednisone was commonly prescribed before (64.6%) and after (76.7%) ILD diagnosis. Use of conditionally recommended first-line therapies in the ACR/CHEST guideline (mycophenolate, azathioprine, rituximab, and cyclophosphamide) increased after ILD diagnosis, but the overall frequency was low (range 1.2% to 12.0%). Methotrexate use decreased (47.1% to 30.4%), whereas leflunomide, tumor necrosis factor inhibitors, and abatacept use increased after ILD diagnosis. Reduced forced vital capacity, anti-cyclic citrullinated peptide/rheumatoid factor seropositivity, ILD diagnosis between 2012 and 2021 (vs 2006 and 2011), and higher pulmonary visit frequency were associated with guideline recommended medication initiation while older age at RA-ILD diagnosis, and higher comorbidity burden were associated with less frequent initiation.</p><p><strong>Conclusion: </strong>Most ACR/CHEST first-line recommended therapies for RA-ILD treatment were infrequently used among VA patients with RA-ILD between 2006 and 2021. These findings illustrate real-world use of RA-ILD therapies and suggest that treatment decisions in RA-ILD are guided by many factors in addition to ILD severity.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 8","pages":"e90135"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802920","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":"B-Cell Depletion Relative to Tumor Necrosis Factor Inhibition Extends the Duration of Viral Shedding in COVID-19 Among Autoimmune Disease Patients: A Matched Prospective Cohort Study.","authors":"Liya Sisay Getachew, Xiaosong Wang, Naomi J Patel, Zachary S Wallace, Lauren A O'Keeffe, Madison Negron, Jiaqi Wang, Grace Qian, Alene A Saavedra, Kevin T Mueller, Natalie Davis, Yijia Li, Brooke M Leeman, Manish C Choudhary, Sebastien Haneuse, Luke Benz, Julie Boucau, Gregory E Edelstein, Owen T Glover, Yumeko Kawano, Rinki Deo, Zahra Reynolds, Karry Su, Chase B Mandell, Zoie Smith-Sparks, Eliza Passell, Mamadou Oury Barry, Dessie Tien, Sarah P Hammond, Gaurav D Gaiha, Jacob E Lemieux, Amy K Barczak, Jonathan Z Li, Mark J Siedner, Jeffrey A Sparks","doi":"10.1002/acr2.90120","DOIUrl":"10.1002/acr2.90120","url":null,"abstract":"<p><strong>Objective: </strong>To investigate SARS-CoV-2 viral shedding duration in autoimmune patients using B cell depleting (BCD) therapy or tumor necrosis factor inhibitors (TNFi) and immunocompetent comparators.</p><p><strong>Methods: </strong>We conducted a matched cohort analysis among participants in POSITIVES, a prospective study enrolling outpatients with acute COVID-19 within five days of diagnosis. Anterior nasal swabs were self-collected thrice weekly over two weeks and then weekly until two negative polymerase chain reaction (PCR) results. We compared autoimmune cases on BCD or TNFi at baseline with immunocompetent comparators, matched using a propensity score based on age, sex, race and ethnicity, number of COVID-19 vaccinations, calendar time, and antiviral use. Survival methods with Cox proportional hazards modeling was used to compare the time to undetectable PCR.</p><p><strong>Results: </strong>We enrolled 16 BCD users and 30 TNFi users, each matched to 33 and 53 immunocompetent comparators, respectively. The most common autoimmune disease was rheumatoid arthritis (31% among BCD and 53% among TNFi). About 60% used an antiviral, and the mean number of COVID-19 vaccinations was 4.3. At the time of infection, BCD users had significantly longer viral shedding duration than comparators (median 15 vs 7 days; hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.22-0.86; P = 0.017). The median time to undetectable viral load was similar between TNFi users and comparators (10 vs 8 days; HR 0.77, 95% CI 0.48-1.23; P = 0.27).</p><p><strong>Conclusion: </strong>BCD users had eight days longer viral shedding duration than immunocompetent comparators; TNFi users and comparators had similar viral shedding duration. These findings inform clinical and public health strategies for autoimmune patients with COVID-19.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 8","pages":"e90120"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714924","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":"Vitamin B3 (Nicotinamide) Supplementation in Primary and Scleroderma-Related Raynaud Phenomenon.","authors":"Mogeshni Govender, Natalie Tomson, Johnny Fang, Mohamed Bakry, Raymond Liu, Kathleen Morrisroe, Ross Penglase, Kokum Dissanayake, Ted Tsai","doi":"10.1002/acr2.90106","DOIUrl":"10.1002/acr2.90106","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to explore if vitamin B3 (nicotinamide) supplementation is a safe and effective adjunctive therapy for patients with primary Raynaud phenomenon (RP) and scleroderma-related RP. The effect of nicotinamide supplementation in human patients with RP has not been studied before.</p><p><strong>Methods: </strong>Primary endpoints were to assess adherence to vitamin B3, vitamin B3-related adverse events, and changes in the following: (1) RP frequency and severity (via the Raynaud Condition Score diary), (2) RP-related quality of life (via the Short-Form Assessment of Systemic Sclerosis-Associated Raynaud's Phenomenon questionnaire), and (3) nailfold videocapillaroscopy (NVC) patterns and parameters. NVC incorporated artificial intelligence using Capillary.io software based on the validated CAPI-Detect algorithm. We conducted a six-week prospective longitudinal, within-participant crossover intervention study using a three-phase study design: A1 (baseline), B (vitamin B3 500 mg twice daily orally), and A2 (vitamin B3 washout); each phase was two weeks long. A total of 38 participants completed the study (20 with primary RP and 18 with scleroderma-related RP).</p><p><strong>Results: </strong>Vitamin B3 showed excellent adherence (98.7%) with few mild adverse events. NVC patterns improved in 45% postsupplementation (P < 0.001; total cohort), with increased normal and reduced abnormal capillaries. RP-related quality of life and severity improvements were significant only in primary RP, persisting after washout.</p><p><strong>Conclusion: </strong>Vitamin B3 was well tolerated and improved NVC patterns and parameters in both groups, with benefits persisting postwashout. Participants with primary RP had significant improvements in patient-related outcome measures, which were not found in the scleroderma-related RP group. Scleroderma microvasculature may be more resistant to vasodilation, possibly due to structural remodeling. Improvements during the washout phase suggest that vitamin B3 may induce functional microvascular effects beyond its pharmacological half-life.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 8","pages":"e90106"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686867","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: A decade of retinal thinning: progressive hydroxychloroquine macular toxicity in Sjögren's disease.","authors":"Nicolas T Yoshino, Danielle T DuPuis, Rajesh C Rao","doi":"10.1002/acr2.90132","DOIUrl":"10.1002/acr2.90132","url":null,"abstract":"","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 8","pages":"e90132"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802869","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}