ACR2024 - Day1a Save

Hi, everyone. Jack Cush. I'm on the floor of the ACR Exhibit Hall. It's ACR convergence twenty twenty four. We're in Washington DC.

This is day one, morning one. We're excited to be here. Looks like a lively meeting. Lots of folks, lots of buzz. The exhibit floor and our booth is really happening.

If you're here at the meeting, come by, visit us. We'd love to meet you. Say hello. Give you one of the new RheumNow pens. Hope you like that.

I want to talk to you about what I think you should be doing and what's new at this meeting. You know, the meeting is is really the same meeting. Right? It's face to face and that's what people want. Some things are new.

And we have the same old sessions, the great debate. This morning they had the the year in review. We're gonna have knowledge bowl and other highlights including a wrap up at the end. But plenary sessions are have flipped. They're in the morning at 09:00, and the posters are beginning right about now at 10:30.

So that's something that's new. I think for you watching this video, how am I gonna learn the ACR? I'm gonna give you a few pointers that I think you should pay attention to. Number one, come to the meeting. See us at the booth.

Go to your favorite sessions. Number two, if you're at home, I'd I'd recommend that you follow us on Twitter. On Twitter, you're gonna get this constant stream of information and what's happening really right to the minute. And it's almost like watching a ticker tape of what's going on at the meeting. I think that's kind of exciting, but maybe you're not a Twitter person.

And maybe you wanna get a feel for what happened at the meeting. I'm gonna give you three ways that you can do that. Number one, that is at the end of every day at 6PM eastern time. We're going to live stream a daily recap where it's going to be me and three or four of the faculty, and we're going to review the happenings of that day and what was notable, exciting, and something you want to take home. Number two, starting next week when you get home, you can view the video that's gonna be called the lupus topic panel or the RA topic panel or the PSA.

We have topic panels with me and four experts in lupus, RA, etcetera. And we're gonna do RA, PSA, SPA, lupus, JAK inhibitors, tick inhibitors, and IL seventeen drugs. And so that's like six different videos that you'll be able to look at. And the third way that makes the most amount of sense is this go to the RheumNow website and you might already subscribe and get a daily email or a weekly email, But if you're an RA person or a lupus person, we have an email list and you can sign up, check the box. I want the topic email list that'll come out once a week.

And if you check the box on whatever topic you like, you're gonna get an email after ACR and all the lupus stuff that we produce. So you'll have that in your inbox to review. By the way, everything I just said that's in video form will also be in podcast form. You can listen to the daily recap podcast. You can listen to the topic panels in a in a podcast.

And you can also listen to podcast accumulated podcast reports from all our faculty who are here covering the meeting for you. Hope you enjoy this meeting. I'm going to. We'll talk more.

Hi. I'm doctor Jana Pope here at RheumNow at ACR twenty twenty four in Washington. I wanna talk about a big important question is, are we under monitoring in scleroderma associated ILD? What do I mean by that? There's no consensus when your patient has clinically relevant interstitial lung disease of how frequently to do the pulmonary function test.

So abstract number six seventy eight was actually a nice way to answer this question. So this was a sub analysis of the census trial. So these were to reorient you patients with clinically relevant scleroderma ILD that was progressing or had pulmonary fibrosis and they were randomized to get an intendinib or placebo and it was added to standard of care which might have been MMF or no other care. And what they looked at now in the sub analysis was what proportion, at various time points would be progressing in their ILD. And a bit shocking to me was twenty five percent of patients had worsened their FVC, their forced vital capacity by six months.

Well, what does that mean to me as a clinician? If my patient has scleroderma associated interstitial lung disease that I think is clinically relevant enough to want to treat the patient, I think we should probably be doing every six monthly pulmonary function tests because if they're worsening I'm going to add or change therapy. So I thought that was clinically relevant. That's not all patients with scleroderma, it's those with ILD that you think is clinically relevant. There's one other shout out if we're going to talk about the lung and scleroderma.

Abstract seven zero six looked at pulmonary arterial hypertension. So there are yet again new guidelines. And the question was, are scleroderma patients with pulmonary arterial hypertension, how do they perform with these guidelines? And sadly, they perform equally poorly compared to the old guidelines because a lot of our patients are mixed. Have pulmonary arterial hypertension, a bit of left ventricular diastolic dysfunction, some ILD, so it's hard to know what group they're in.

So we'll keep our eyes on this space, I will change my practice doing PFTs more often in my scleroderma patients with real and important clinically relevant ILD. Thanks, and join us for more news. Thank you.

Hi. This is Eric Dine at RheumNow, Convergence day one, from from New Jersey here on-site in DC, and I'm joined with Joshua Shay. So Joshua is a sophomore in high school who did a fantastic job and contributed a poster presentation, Abstract four seventy four. So I wanted to hear a little bit about, tell me about your study.

Thanks, Eric. What we did in our study was we conducted a systematic layered review looking at the association between rheumatoid arthritis and cancer patients survival. To start this process we conducted a search within three databases and collected a total of about 2,000 studies and between myself and two of my colleagues we narrowed this down to 10 relevant studies to our question and from there, from those 10 studies, we abstracted data from them. And then my mentor, Doctor. Singh, she helped us line up our abstractions.

And from this data we saw, we found that due to the heterogeneity and small number of studies, we couldn't do a meta analysis on these studies. That being said, we did find a ratio for lung cancer patients in a subgroup of lung cancer patients and we found that there was no significant difference in mortality in lung cancer patients at RA.

Yes, I saw that the hazard ratio was one point zero four, so essentially no difference in survival. So, I guess that means that if we were talking to patients about what their survival risk would be for lung cancer, we'd say, based on the studies, that there really wasn't a significant difference. But it sounds like the biggest problem was just that there wasn't enough studies to do too much analysis for.

Yes, that's correct. I think one of our main takeaways from the study was that since there weren't very many studies out there and they were very conflicting, it shows the necessity for future large scale studies that look at this association between rheumatoid arthritis and cancer. So I think it really stretches that importance for the future.

Yeah, and we know that rheumatoid arthritis is a risk factor for development of some cancers, it's really helpful that if we could get that data and see what can we say to our patient that has a new diagnosis of cancer on their survival. I'm encouraged that with lung cancer that there was no clear signal and hopefully use this research and use it as an impetus to do more studies and get more information. Thank you very much. It's wonderful to have a high school student here with us and really phenomenal that you're on it. So hopefully, and hopefully medicine that we can get you in the fold into the rheumatology field early.

The best of luck with your training.

Hi everybody, it's Mike Putman. I'm at ACR twenty twenty four in Washington DC and I wanted to tell you about Abstract seven seventy four which reported the results of the TAPIER study. This was a study that evaluated a really important question to me, is how and when can I get people off of steroids? We know that in a lot of our diseases, lupus, rheumatoid arthritis, that last five milligrams is a challenge. In the context of ANCA associated vasculitis, and specifically granulomatosis with polyangiitis, or GPA, that this study evaluated, there's been an open question how and when we can try and get people off that last five.

This was a really interesting study. It was presented at the plenary session today and they looked at a strategy, they randomized people to either taper off of five milligrams of prednisone. Patients had to do it in the first year of an acute flare and they had to have started therapy. Or they had to continue prednisone five milligrams going forward. Very interesting study design, I love the randomization.

They got one hundred and forty three patients in this study. What did they find? In the people who tapered off that last five milligrams of prednisone, the rate of flares was sixteen percent compared to people that continued prednisone where the rate of flares was four percent. So that's a relatively meaningful difference for rheumatologists and I could see someone reading these data and say, it's kind of bad, but there are some important caveats here. The first one is that the folks who are receiving rituximab for maintenance therapy, which I think is the standard of care and that's what most of us are doing these days, actually didn't really experience much of a difference.

So this difference in flare rates seem to be more pronounced over people who are getting other DMARD therapies. Now, the second one is that of those flares, the vast majority of them were considered non severe. I think there was ninety three percent were non severe. So people might flare, but this isn't necessarily someone developing diffuse alveolar hemorrhage or glomerulonephritis. These are folks with things that you could probably manage with a quick bump of steroids.

And then of course the last thing that I always talk about whenever you do these flare studies. So we said that we tapered people off steroids and sixteen percent flared, flip that around, that means eighty four percent of people tapered successfully and would have been continuing steroids unnecessarily. So whenever you see a study like this, you have to ask yourself, what would my patient actually want? And I could see a lot of folks saying, you know, a sixteen percent risk of flare if I taper off, that would be worth it to me to try to get off steroids. So I think a very useful and informative trial, one that informs mostly how I've been practicing already, although I will say that I've been a little sticky on that last five milligrams of steroid and tend to continue probably longer than I need to.

So great study, great start to the meeting. Hope you all enjoyed hearing about it. Please continue to follow in at RheumNow for all of our coverage of the meeting.

Hey, this is Doctor. Len Calabrese from the Cleveland Clinic. I'm here at ACR 24 Convergence, and I wanted to update you about a session that I participated in this morning where I addressed the question, is COVID-nineteen associated or causal for autoimmune disease? This was really an interesting session. It was really packed.

Our conclusions from this is that, you know, COVID nineteen has been around for four years. We now have the Academy of Medicine's definition, which includes not only unexplained signs and symptoms, but also incident end organ disease. May explicitly name diseases such as RA, Sjogren's, and Rheumatoid. It's up to us to use our clinical judgment as to whether these qualify as long COVID, and thus, we need the data, and we need to know how to critically appraise it. I summarized this in over thirty minutes, and I said that number one, it's unequivocal that COVID-nineteen is associated with autoantibody response.

The sicker you are, the more autoantibodies you make. The milder the infection, the less that you make. Number two, these antibodies are functional. Can bind to cytokines, they can bind to cytokine receptors, they can neutralize, stimulate, they're important. Three, when you try to correlate them with symptoms, in other words, those that completely recovered versus those that haven't recovered, it's not so simple.

And they don't segregate with recovery or nonrecovery. And then finally, there's emerging data that all of us, no matter whether it's COVID nineteen or whether you had flu, bacterial infection, mixed microbial infection, or just were in an intensive care unit without an infection, pour out autoantibodies that are functional. I raised the issue that we should be thinking about why are we making autoantibodies naturally? And many people, a lot smarter than me, have proffered theories that these are part of an immunoregulatory network. More at a separate time.

The second point we explored was, is COVID-nineteen associated with autoimmune diseases, lupus, rheumatoid, Sjogren's and beyond? And there are at least 30 studies that have looked at this, they're EMR based. While there are trends to show that, there are many studies that fail to show that, and actually other studies that show the other way, that it may be protective. At the minimum, we think that this is a work in progress, and it's premature to just say that incident autoimmune disease after COVID nineteen is due to COVID. So a lot more work to be done.

It's a very exciting space. Follow me along on Twitter and I'll keep you informed.

Hi. I want to propose a different way, a better way to learn from our national convention, ACR convergence. You know, every year when we go to ACR, I always publish the ACR Playbook. Been doing that since 2014. I tell you my tips for how to prepare yourself, how to get your information, how to design your strategy to learn at a gigantic meeting.

I mean, the meeting has over 2,000 abstracts. There'll be fifteen, sixteen thousand people there. It'll be nonstop wall to wall sessions and posters, starting on Saturday and going through until Tuesday. And the question is, how do I do it? How do I choose?

What should I go after? So, again, the ACR Playbook was designed to give you a strategy by which you could get the most out of what was basically a fire hose of information. And I do think that, you know, you can go back and read some of our past, playbooks. But I wanna say that really we're at a different point now. Education is changing.

And you need to have a way of dealing with what ACR is. You know, it's not just a fire hose, it's emblematic of information overload. Right? It's estimated that, the sum of all human information doubles every eight months. There's over 30,000 journals and over 2,500,000 papers a year.

How can you tackle all of this? Well, one way to tackle it is by, you know, going with what's new, using your cell phone. Right? Having digital learning methods, you know, relying on peer to peer learning, and small group learning. So, again, the reasons to change are many.

It is overwhelming. And education does evolve. No one buys journals anymore. No one reads journals anymore. No one buys books or reads them.

You know, it's all digital. It's all on the fly. And you need to be competent as far as digital learning. You know, your face to face time with drug reps is really limited. It's not ever since the pandemic, that's gone downhill a lot.

And we rely more on, again, this on the fly way of learning, and using digital means. So, like, whether you're going to your local meetings, regional meetings, or this big ACR or UR meeting, you've got to find success and tailor it to you. I want to let you know that since we've been doing RheumNow, I think we started in 2013, you know, RheumNow has been every year number one or number two in social media coverage of the meeting. You know, the meeting is gigantic. The amount of tweets from the meeting has grown from a low of around six, seven thousand tweets at each meeting to as high as 28,000 in 2021.

The number of impressions, the number of people that that actually reaches has gone as high as a as a 100,000 people. There have been years, during the COVID years, when RheumNow was accounted for, I think it was 25% of all the digital education. What do we do at RheumNow when we're covering the meeting? Obviously, you know RheumNow for I put out tweets all the time, you know, thousands every year. But during the meeting, I go to the RheumNow faculty.

I got the idea back in 2013 to hire young fellows, young graduates from fellowship programs. They were a little bit more adept at doing videos and tweeting than were the, you know, the standard, well known, key opinion leaders in every field. And when, you know, now when I go to ACR, I employ about 15 to 20 young faculty reporters. And their job is to go out and attack the meeting and learn as much as they can. They work alongside another dozen or so KOLs that will help guide them and help shape some of the content.

For all these people that work with RheumNow during the meeting, the goal is number one, have fun. Number two, learn a lot. And number three, share. And use the tools at your disposal to share. So in the past, it was wandering around and saying, gee, I think I'll go to this session versus that session.

And what happens? You go home, either you never discuss the meeting again, or if you're a fellow, you have to present your one abstract in front of everyone at grand rounds on on, following the ACR. That's not what we do. By the way we actually have our faculty work, these are the best examples, of how you learn the ACR. Our faculty has told me multiple times, one, they love doing the meeting our way.

Two, they love working in teams, and they love doing this peer to peer cross talk, small group effort. So we set up teams, right? We have a team that's going to cover, you know, psoriatic arthritis. We got a team that's going to cover, rheumatoid arthritis, etc. And our teams are usually made up of a KOL who's going to be our topic leader, and then three or four of our young faculty.

And they get together and they look at all the content in that topic area, like rheumatoid arthritis, and they say, Who's going to cover what? And they go out and then they do it. And then we bring them back together for them to share and to learn the content. And then we record it. And then we share that with everyone else.

So it's teams, it's digital sharing, it's having a plan for how you're going to meet up, and how you're going to meet up after the meeting to educate your peers. So again, it's all about engagement. The more engagement you have with the information, and the people who have perspective on the information, the more you're going to learn. So what do you need? You need groups.

And your groups can be me and my buddies. It can be your peers that you work with. It can be like minded individuals who are either attending the same journal club, or study group, or are in the same research project. Within a rheumatology division, you're set up to build teams. You've got faculty, and you've got fellows.

You can form teams, and you can go out and attack the ACR meeting. You'll learn more by covering more. We learn more as a group than we do as an individual. And the group is very involved in peer to peer sharing. Why do you learn more?

Well, there's more discussion. There's more debate. Ultimately, there's more consensus. So, in the past, when you've gone to a meeting, the meeting was done on the day the meeting was done. That's not the case when you build with Teams, and you cover with Teams, and you have a digital footprint of your coverage.

Now it goes on for weeks after the meeting. So, at this meeting, you'll need to change by having a team that you form, or that you're a part of, that's either dedicated to a topic, or a session, or a lecture. Okay? The team should have a leader. That can be, in the case of a fellowship program, a faculty that will lead several fellows, and that that team is gonna be assigned to cover the plenary sessions on days one and two.

Another team might cover the plenary sessions on days three. Another team might be covering late breaking abstracts. Another team might be covering JAK inhibitors, and TYK2 inhibitors. You see, go after these select areas, and if you have a large group, can cover a lot of different areas. Each of you can specialize on that one area, and then share your information in the end.

So you have to plan. You've got to go through. When you get your team, you're going to go over your content and plan what you're going to go for go cover by having a hit list of the posters I'm going to see, the sessions I'm going to attend. What am I going to do as far as sharing it? So again, I want to say the things that make for good content at the ACR are the plenary sessions.

This year it's different. They meet at 09:00 in the morning, not at ten or 11:00 like they used to. The late breaking abstract's usually on the last day. And then other key sessions like the great debate, or knowledge bowl, or the year end review. Or your teams can be based on topics like RA, PSA, SPA, lupus, vasculitis, ILD, osteoporosis, or based on therapeutic targets, TNF inhibitors, JAK inhibitors, IL-seventeen inhibitors.

So with that, you can cover almost a curriculum for the meeting. I tell everybody on the team, you gotta tweet. If you don't know about tweeting, it's easy. It'll take you two minutes to learn. Get a Twitter account, go to a poster, take a picture of some key figure, and give the bottom line, give a teaching point, and then reference the poster.

So your tweet will always say, hashtag ACR twenty twenty four. It'll also say abstract number five zero nine, and it's gonna have an image and whatever. Everybody tweets. Doesn't matter if everybody tweets on the same abstract or same poster. You'll get the same message delivered in multiple ways by multiple people.

But when you're on a team, you wanna maybe say that one person's going to cover the this abstract in a plenary session. And another one and that may be that you'll do a video, you'll write an article, you do something like that. So again, you just everybody can tweet, but then everyone's gonna come back together. And you can meet informally. Let's meet at lunch and cover some ground, figure what we did today.

Or let's meet at lunch tomorrow, and we'll do a day one recap. Everyone gets to present their favorite thing from day one. Or let's meet at the end of the day at McIlurney's pub down the street, and we'll have a beer, and we'll discuss the highlights of the day. Let's go around the table. What did you think?

What did you think? And there but you gotta come prepared with notes. I wanna talk about the plenary session on neonatal Fc receptor monoclonal antibody, nikolimumab, being used in Sjogren's syndrome. And you say, was plenary session number or abstract number, and then you give the bottom line, And people will add to your discussion. People will ask you questions.

People will critique. The group goes away with consensus. Right? So you can meet afterwards. You can meet the next day.

You can meet when you go back home. I like to tell everyone, come prepared when you have your meetings to discuss two or three of your favorite abstracts from that day, or on that topic, or from that session. Okay? And then I want you to do something where you're gonna make a permanent digital record of that. You're doing that partly by tweeting every day.

You can do that better by having a Zoom meeting. So go home to your hotel rooms, or if you're watching it virtually, and then meet at 7PM that night and recap the day. Or meet tomorrow, and we'll cover the plenary session from day one. And you shoot your fifteen minute video. You got a faculty member or a leader, and two or three other faculty.

If everybody presents one abstract in one minute, and a few minutes of discussion, and then they present another one, and do a shorter presentation a second time around, that can be a fifteen minute video. When you're done, you can then save it and share it to your local city rounds group, your journal club team, your faculty and division at the medical school. And then if you have multiple people doing that, and it just goes around, well, you'll be doing a lot of what we're doing at RheumNow. But here's the deal. By you becoming the reporter, by you becoming the expert, by you engaging in the content, you're gonna learn 10 times more than you would if you did it any other way, including the old playbook way, including the usual medical school way.

This is the right way to do the meeting. I strongly urge you, get a team together, and go tackle the ACR. Number one, have fun. Number two, teach and share. Number three, what?

Meet, get together, and distribute. Alright? Enjoy ACR.