Professor Graeme Jones

Hundreds of rheumatologists converged in Hobart this week for their first chance to network and share knowledge as a community in three years.

The ARA’s Annual Scientific Meeting, held at Hotel Grand Chancellor Hobart, attracted 722 registrants in what marked the return of a face-to-face meeting.

Co-convenors Associate Professor Anne Powell and Associate Professor Alberta Hoi welcomed delegates ahead of the first plenary session on Saturday, and also acknowledged the five international guest speakers featured in the program.

“At the time that we asked our international speakers it was two years ago in times of extreme uncertainty. We’re really grateful they were prepared to commit to come to Australia when things were so uncertain,” Associate Professor Powell told delegates.

She said the meeting’s first session – a year in review covering four topics: clinical practice with Professor Graeme Jones, basic science with Professor Fabienne Mackay, allied health with Associate Professor Joanne Kemp and paediatrics with Professor AV Ramanan – had been brought back “by very popular demand”.

Here are some highlights from the clinical year in review below.

RA

Professor Jones, from the University of Tasmania and a rheumatologist in private practice at Noosa Hospital, said there had been some more light shed on how to approach “the big problem” of fatigue in the inflammatory arthritis population.

He cited a paper in Lancet Rheumatology [link here] showing both cognitive behavioural approaches and personalised activity recommendations improved fatigue in stable inflammatory disease, concluding that “once you’ve got the disease controlled, you can make a difference to the remaining fatigue by these other approaches”.

As for the “controversial” role of methotrexate in melanoma, Professor Jones pointed to data published this year that raised doubts about the three times higher risk suggested in previous Australian data. He said the JAMA Dermatology [link here] study showed low-dose methotrexate had a 15% increased risk of melanoma, a risk that was considered “trivial… and not worth communicating to patients”.

Professor Jones’ ‘most impressive paper’ award went to observational data published in Arthritis Care & Research journal [link here], which showed RA is a lifestyle disease. Modifiable lifestyle factors such as BMI, alcohol intake, exercise, smoking and diet explained about 34% of the risk of incident RA in the female population.

Other important findings included that tocilizumab had a three times higher risk of diverticular disease and perforation compared to rituximab or abatacept [link here], which Professor Jones said was worth communicating, and direct IL-6 inhibition with olokizumab was found to be effective in RA patients who are MTX incomplete responders [link here] and was non inferior to adalimumab in combination with MTX [link here].

OA

Professor Jones prefaced this part of his talk by saying: “So I’m an osteoarthritis researcher and one of the things I’ve learned from osteoarthritis research, is you’ve got a good clinical idea and when you do the clinical trial, it often bites the dust.

“And this is another year of another one bites the dust for OA.”

The list of options were in fact getting smaller every year, he joked, with colchicine out for hand OA [link here] as was prehabilitation before total knee replacement for knee osteoarthritis to improve functional outcomes [link here].

Even exercise plus education was no better than placebo for knee OA, according to one study [link here] and yoga lost its effect on function within six months and had no effect on knee pain [link here].

“I was a big fan of IV bisphosphonates for knee BMLs (bone marrow lesions), so we did a meta analysis [link here] of all the trials published that showed they were non effective. So there’s another one gone,” Professor Jones said.

“And tramadol had no effect in a meta-analysis [link here] and was toxic, so we shouldn’t be using it.”

However, in some good news, there were some treatments shown to be successful, including methotrexate for hand OA and genicular nerve block for knee OA, which was “something to consider, as a very safe procedure”, Professor Jones said [link here].

Meanwhile, having weight loss surgery decreased the need for total knee replacement by 30% and those who did have a total knee replacement had less complications [link here], he noted.

SLE

In systemic lupus erythematosus, Professor Jones said anifrolumab seemed to work well regardless of interferon signature [link here] and subcutaneous litifilimab may improve swollen joint count but had no effect on other measures [link here].

And while “JAK Inhibition is controversial  for SLE with two papers in the Lancet one suggesting it’s positive and one suggesting it isn’t, so we really don’t know what’s happening there, but TYK2 inhibition may be effective” [link here].

Tribute

To conclude his presentation, Professor Jones also made special mention of colleague Associate Professor Phil Robinson, who died in January at age 43.

“Phil’s made a number of similar contributions; ankylosing spondylitis, gout, and COVID and rheumatology,” Professor Jones said.

“In the words of Gandalf, ‘so do I,’ said Gandalf. “And so do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us.

“I’m sure Phil used his time very, very effectively, based on what he achieved in a life cut tragically short.”

There will be a tribute to Professor Robinson at the ARA Annual Conference Dinner on Monday.