Dr Paul Marchetta

Next week the limbic will be reporting on news from the world’s largest rheumatology conference – the American College of Rheumatology’s 2019 Annual Scientific Meeting (ASM) in Atlanta.

And this year it will  feature sessions on rheumatology and reproduction and rheumatology in childhood, its organisers say.

ACR president Dr Paula Marchetta says the conference will cover a wide range of topics from basic science to clinical practice, but her personal passion is for the sessions on rheumatology and women’s health.

“I am excited about the sessions dedicated to reproductive health at this year’s meeting, especially since our guideline on reproductive health for patients with rheumatic disease is scheduled for publication early next year,” says Dr Marchetta, a rheumatologist who practices in New York.

“There is a real need for reliable guidance, as rheumatic diseases so frequently affect women in their childbearing years.”

According to Dr Marchetta, ACR 2019 will also break new ground by featuring novel short format discussions instead of the usual speaker presentations to an audience.

“We are piloting some new ways of presenting our educational content by changing the format of some talks from traditional didactic lectures to some more conversational-style learning sessions — no more than 18 minutes — that focus on what the speaker is most passionate about so that the learner will be so inspired that they are motivated to delve more deeply into the subject.”

“They are designed to help us more actively engage and think about the educational content rather than just passively absorb it.”

Chair of the ACR 2019 organising committee, Dr Anne Stevens, says the program will include a focus on paediatric rheumatology to reflect the fact that general rheumatologists treat children and young adults who transition into their care.

Dr Anne Stevens

Dr Stevens, of the University of Washington, Seattle, says two particular topics of interest for rheumatologists treating children will be covered  at ACR 2019: genetic testing and sclerodoma.

“Now that clinical genetic testing is so much more available, we have the big challenge of making decisions about when and how to use genetic testing. When do we do whole exome sequencing? What do we do with the data? How can it be used to help patients and to direct therapy?”

“Our patients’ families really want genetic testing. They want to have a genetic diagnosis. They want to know what caused their child’s disease,” she says.

“When diagnosed properly through genetics, physicians have a clear path for management. There’s no doubt about the course to take. There’s no trial and error with medicines.”

Another major challenge in paediatric rheumatology to be addressed at ACR 2019 is scleroderma, she says.

“We see localised scleroderma much more often in paediatrics. This can be very serious, leading to permanent deformities and extracutaneous manifestations like seizures and uveitis.

“The problem is, the treatments for localised scleroderma are immunosuppressants that have serious side effects. So we want to use these medicines only as long as necessary. However, we’re often unsure about when to stop. How do we know if the disease is active or not? And once we stop therapy, how do we know when the disease is coming back? It’s really hard to assess these patients. We can’t do biopsies every time they come into the clinic.”

Sessions at ACR 2019 will also address the timely topic in paediatric rheumatology of interstitial lung disease associated with systemic juvenile idiopathic arthritis (JIA).

“This is somewhat perplexing. It’s a fibrotic disease that occurs in patients with a completely different disease than scleroderma,” says Dr Stevens.

“These juvenile arthritis patients have this smouldering lung disease that previously went unrecognised much of the time. Now, researchers have some data for us to help us know when to test for interstitial lung disease in patients with systemic JIA and what may be contributing. There are some theories that the way we treat these patients may be contributing to the lung disease.”

ACR 2019 will feature presentations and posters from many Australian rheumatology clinicians and researchers, which will be featured in next week’s issue of the limbic newsletter.