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      Day 4 was a half day closeout to the EULAR 2023 Congress. For me the big presentations were the late breaking abstracts, although there were other review and abstract sessions for those remaining.  Many people missed the last day (June 3rd) of the meeting as a pending Milan airport strike on June 4th dictated last-minute changes to travel and learning. Here are a few of my favorite abstracts from the Late Breaker Session.
      Some subjects in rheumatology seem to create contention the more they get explored, and one of those areas is a traditional crowd favourite for discussion at EULAR - clinically suspect arthralgias. At EULAR 2023 in Milan, the perfect platform was provided for an airing of grievances, in a debate entitled ‘Clinically suspect arthralgias: fact or myth’.
      T cells are known to play a key role in RA pathogenesis and the diversity of the T cell repertoire is known to be reduced in RA. 
      There is a clear unmet need for new and effective therapies in primary Sjogren’s Syndrome (pSS) patients, as there are no current licensed therapies.  
      Day 3 was a sunny warm day in Milan at the 2023 EULAR Congress meeting. Here are a few of my favorite abstracts from today.
      A nationwide population-based study, by Beydon et al. (OP0044), has performed a more recent (2010-2020) analysis of cancer incidence in people living with RA within the French national claim database, compared to general population, measured in the French Network of Population-Based Cancer Registries.
      The use of artificial intelligence to analyse large data sets using its subset component machine learning has taken centre stage recently in the management of rheumatic conditions, including rheumatoid arthritis. The use of AI is now starting to cross the various stages in patient care from detection, diagnosis, treatment and the prediction of long-term outcome.
      Risk of poor pregnancy outcomes in lupus patients continues to remain high, especially in the setting of high disease activity. Preliminary data from a lupus pregnancy LEGACY cohort presented at EULAR 2023 raise concern.
      Day 2 at the international EULAR Congress meeting is always bigger and busier. There were sessions on JIA therapies, crystal arthritis, novel drugs for SLE and Sjogren's, early RA and preclinical RA interventions, IgG4 disease, osteoporosis and the growth and application of artificial intelligence in medicine and rheumatology.
      An artificial intelligence model to assess pre-RA hand MRIs has confirmed what human readers have known before: that bone marrow edema and tenosynovitis are objectively the best predictors of future RA development in patients with clinically suspect arthralgias or undifferentiated arthritis.
      There has been an explosion of trials in SLE, including nonrenal and glomerulonephritis studies. But, what about the JAKis and Tyk2 oral drugs in SLE?
      Adult onset still's disease (AOSD) is an autoinflammatory condition characterized by fevers, arthritis, and rash. It is considered an orphan disease because of its low prevalence - it is reported anywhere between 16 to 40 per ten million. Traditionally, a bimodal distribution by age has been reported with peaks at the ages of 15 to 25 and between 36 to 46. 
      EULAR 2023 launched today to crowds of attendees.  The opening Plenary session and presidential address by Dr. Ian McInnes was followed by a number of overview and review sessions with but a half-day of abstracts presentations, on several therapeutic areas including osteoarthritis, JIA, COVID and more.  The following are a few of the presentations that caught my eye.
      The pharmacology treatment in SLE is a rapidly expanding field of research that provides excitement and optimism to both the patients and the clinicians. We now have three licensed targeted therapies (belimumab and voclosporin in active lupus nephritis and anifrolumab in non-renal SLE) over the last 3 years compared to one therapy (belimumab in non-renal SLE) in the previous 50 years. What are other promising therapies on the horizon? 
      In the last 2 years, there has been more caution and vigilance with the use of JAK inhibitors in the treatment of rheumatoid arthritis due to the risk of CV events, including MACE and VTE. The ORAL surveillance study, a post-approval safety study conducted in RA patients aged ≥50 years with ≥1 CV risk factor, has resulted in increased caution and greater emphasis on assessment of MACE and VTE risks in patients starting JAK inhibitors.