Aime S. de Asis-Fabila, MD & Lorielyn Salvador, MD
WHAT IS NEW?
HOW TO TREAT?
The doors of “Eternal City” were opened wide to welcome the delegates from 120 countries around the world in the 16th Annual European League Against Rheumatism (EULAR) Congress last June 10-13, 2015 held at Rome, Italy. The University of Santo Tomas Hospital, section of Rheumatology and Immunology sent their 2 fellows on training namely Lorielyn Salvador and Aime Fabila to attend the said Congress. It offered both scientific and clinical progress in broad field of the rheumatic and musculoskeletal diseases. The contributions from both People with Arthritis/ Rheumatism in Europe (PARE) and Health Professionals in Rheumatology added further matters of interest to the scientific contents of the Congress. Furthermore, this year features a joint congress of EULAR and the Pediatric Rheumatology European Society (PReS) which held every 3 years with an extended program for pediatric rheumatology.
The program had an impressive growth in quantity and quality of abstracts and sessions ready for some 14,000 physicians, health professionals, scientific researchers, patients and patient group members, and industry representatives who together form a unique platform in the world to discuss and debate rheumatic and musculoskeletal diseases. There were 4,300 abstracts has been submitted, of which 82% were accepted and over 300 were oral presentations. The scientific program provided 160 sessions and 35 symposia which over 350 speakers. The poster area was accessible throughout the day and host more than 2,000 presentations, which constitute the heart of the Congress. There were more than 40 poster tours with 10 selected posters on each tour.
The EULAR recommendation updates focused on the management of comorbidities associated with chronic inflammatory rheumatic diseases. For the first time preliminary recommendations from EULAR in women with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) were discussed by Dr. Laura Andreoli. The recommendation was developed to guide clinicians in the management of women with SLE/APS who desire to give birth to a child by counseling them on prevention of pregnancy-related risk factors for the mother and the baby and maternal disease complications during the postpartum period, as well as possible physical difficulties in parenting. The recommendations also cover the use of contraceptive assisted reproduction techniques, menopause, female tumor prevention and HPV vaccination.
Cardiovascular comorbidity in inflammatory arthritis is one of the most important comorbidities. Dr. Nurmohamed stated that the updated recommendations are expected to yield an international, multicenter collaboration that will ultimately in a decreased cardiovascular burden on patients with inflammatory rheumatic disease. The EULAR recommendations will now advise physicians to assess patients’ risk every 5 years rather than every year. “Rheumatoid arthritis itself is enough for risk multiplication and an RA specific risk models not yet advocated,” Dr Nurmohamed said. “The use of antihypertensives are not recommended anymore, and there is more evidence that antihypertensives and cholesterol- lowering agents are at least as effective as in general population.” Dr. Gossec discussed recommendation updates pertaining to treatment and management of psoriatic arthritis. More specifically she discussed how the results of randomized controlled trials for ustekinumab, secukinumab and apremilast should influenced on how rheumatologists treat patients psoriatic arthritis. Prof. Monica Ostensen discussed the present and future treatment options for rheumatoid arthritis and spondyloarthropathies in pregnancy. Dr. Anja Strangfeld presented the data from German biologics registry RABBIT indicating that biologic therapies around the time of conception does not increase the risk of malformations or other harmful neonatal consequences.
Other highlights of EULAR 2015 were several tools and markers that were developed and discovered. First, was the new Juvenile Dermatomyositis Disease Activity Index (JDMAI). The new Juvenile Dermatomyositis Disease Activity Index (JDMAI) which incorporated physician evaluations of disease activity, reports of well-being from patients and parents, and objective measures of muscle strength and cutaneous disease, is a simple, reliable tool to assess the level of disease activity as discussed by Dr. Alessandro Consolaro. Meanwhile, a new research showed a link between innate immunity, reactive oxygen species, mitochondria and muscle impairment in dermatomyositis. According to Dr. Alain Meyer, skeletal muscles in patients with dematomyositis has mitochondrial dysfunction and high reactive oxygen species production, showing reduction in oxygen consumption and increase hydrogen peroxide production. Muscle samples from patients showed upregulation of Interferon-I. These findings highlighted that focusing on reactive oxygen species and mitochondria may open new avenues for better understanding and management of the disease. On the other hand, a new key receptor known as the retinoic acid receptor-related orphan receptor (ROR) gamma which was thought to be involved I the pathogenesis of SLE has shown promising results among mouse model. TH17 cells and associated interleukin (IL-17A and IL-17F) are key to pathogenesis of SLE. Mice and human patients with worsening lupus have increased TH17 cytokine expression and the RORgt nuclear hormone receptor is the central regulator of TH& cellular differentiation, function and cytokine production. By blocking he retinoic acid receptor-related orphan receptor (ROR) gamma as it is the key control switch of TH17 cytokine production have shown modest efficacy on autoimmune animal models. The results of the study by Dr. Anderson Gaweco highlighted the importance of targeting and blocking TH17 cytokines through small-molecule drug modulation. Lastly, a protein S100A9 alarmin was discovered as a new marker of inflammatory activity. A fluorescent tracer for this protein amplifies inflammation yielding optical images that correlate well with clinical signs, serum tests and histology findings in mice with arthritis. This tracer could provide a new fluorescence imaging method for local diagnosis of inflammatory activity in RA patients. These innovations will definitely revolutionize approach and treatment to autoimmune diseases.
The congress discussed on recommendations on patients with pulmonary hypertension and connective tissue disease as well as the challenges and drug-drug interactions among these patients as discussed by Dr. Matucci-Cerinic.
As the 2015 EULAR congress closed its door, it opened an opportunity to participants to learn and update themselves to rheumatic and musculoskeletal diseases. The participants left the Eternal City with lots of learnings that would be transpired to the patients which constitute the core of the Congress.
Rheumatology Educational Trust Foundation Inc.
Dr. Lanniyati Hamijoyo