RheumNow - EULAR 2018 - Day 1 & Day 2 Save

Hi. I'm Doctor. Jack Cush, executive editor of rheumnow.com, coming to you from Amsterdam and the site of EULAR two thousand eighteen. This podcast is part of our expanded coverage of EULAR. You can find us on our daily email from RheumNow or by going to the website, eular18.rheumnow.com.

Now the podcast. This is gonna be a collection of audio reports from RheumNow faculty, key opinion leaders, or abstract presenters from the meeting. I hope you enjoy the podcast, and be sure to tell your friends to tune in to RheumNow, to follow these podcasts, and to subscribe. Take care. Hi.

I'm doctor Jack Cush, executive editor of rheumnow.com, coming to you from EULAR twenty eighteen. Today, I attended an interesting session on deck scanning dual energy CT scans in gout with a great lecture from Nicole Douthe. She began the lecture by telling us that this has been around for about ten years. The first reports appearing in 2007 and 2009. The role of this particular imaging modality is like other imaging modalities to help us with diagnosis and whatnot.

But she believes that the role of deck scanning is probably most important in diagnosis, especially where diagnosis is difficult, and also in the assessment of disease activity and or disease complications. It is not necessary to be done for most patients who have clear tophaceous gout, but it may be necessary if you feel that gout could be responsible for the complications a patient is exhibiting and whether you want to see if tophi and urate deposits may in fact be the cause of that. Interestingly, she showed us that the resolution of the lesions that can be found by deck scanning can be as low as 0.01, square centimeters, so it's really quite small. But it is important that those, crystals be in high concentrations and tightly packed together, otherwise it may not show up. So there may be negatives in patients with gout and there may be also be false positives including artifact from motion and whatnot.

Thick skin for instance, might be another reason for this. But she showed us some, good examples of where it shows up in joints, around joints, on tendons, actually in soft tissues. And basically said that this is a modality that has a fairly good sensitivity. The question is, which is a more sensitive and or more specific test, either ultrasound with its double contour sign and beating or the deck scan. An analysis that she showed that, between the two, I'm looking at the data here, ultrasound, ultrasound, deck, ultrasound, deck, deck, ultrasound, and deck, and deck.

It's split as far as sensitivity. When it comes to, specificity, they're both pretty good, maybe a little bit better with deck scanning, but these are both highly sensitive, highly specific, modalities that can be used. Obviously, ultrasound is a lot cheaper, a lot easier, a lot more portable, and has no radiation. Radiation exposure here is about that seen with a usual CT scan, so it is not inconsequential. So the question is, is this going to be the new standard of care or is this still a research tool or one that can only be used in the management of difficult patients.

So it has implications in monitoring. It's been shown, in one study that forty seven percent of patients in The UK who had, an SUA of less than six had no subcutaneous TOFI.

Hi, I'm Ben Knoll. I'm with the Global Healthy Living Foundation, the Kinky Joints Patient Community. And I'm here at ULAr twenty eighteen, and I'd like to tell you about a study that we did and we had a poster presented this year in Amsterdam. The study was on RA patients and the barriers to treatment optimization. So this was a study where we surveyed two forty nine patients within our arthritis power patient power research network, essentially a patient registry.

And we have information about these patients, for example, patient reported outcome data, the RAPID-three, several of the NIH PROMISE measures. This study in particular was a cross sectional study that we did where we asked some specific questions to try to understand sort of barriers to changing treatments, treatment optimization that were faced by patients and also patients perception of their own disease activity. So some of the things that we found were that of the proportion of the patients who were in high disease activity as defined by the Rapid three, we found that two thirds of those patients were actually not offered a treatment change. Among the patients who were offered a treatment change and decided to make a treatment change, it was because that their RA symptoms had not gotten better or were actually getting worse on the current treatment. Was the number one reason.

The second reason for that group of patients was that, again for more than half of them, was that their doctor recommended making change of treatment. What's interesting is that we also asked and examined for patients who decided to scale back their treatment. The number one reason they decided to scale back was also a doctor's suggestion. They said their rheumatologist had recommended it. And similarly for patients who decided to stay with the treatment they had, even if the patient was in eye disease activity, they were referring to their doctor and it was because their doctor said that it was okay to stay with their current treatment regimen.

We also wanted to examine in this study how patients' subjective self report of their disease activity just with a one item measure over the past ten days or the past seven days, how would you rate your disease activity a low, medium or high? We found that there was actually very weak correlation between that sort of one item measure self report, subjective, expression of their disease activity with their rapid three scores. So what we're finding is that, a couple kind of conclusions we're drawing from this, is that it seems that patients are still very deferential to their doctor's recommendations, that it might help to find ways of activating or educating patients to understand when they are in high disease activity and when it might be appropriate to talk about a treatment change with their doctor. And then finally that perhaps the Rapid three may not be the most relevant for at least the patients in this survey and this sample to reflect how they perceived or experienced they understood to be for themselves high disease activity.

Everyone, I'm Olga Petrina reporting from twenty eighteen EULAR meeting in Amsterdam. Today's plenary session opened with a presentation of a secondary analysis of CANTOS trial. This trial in the past showed beneficial effect of Kanakinumab in preventing cardiovascular disease in patients at risk. The secondary analysis was designed to see if patients who also suffer from gout would benefit in terms of decrease frequency of gout attacks or improvement of serum uric acid level. Patients in this group receive three doses of canakinumab, one of each fifty mg, one hundred and fifty mg, and three hundred mg once every three months.

Their serum uric acid level along with C reactive protein were checked every three months in year one followed by yearly afterwards. It's been shown in the study and in secondary analysis that in addition of decreased incidence of cardiovascular events patients in the study group experienced less gout attacks and their C reactive protein was decreased over time. This effect was unrelated to serum uric acid level which was not affected by the medication. If you would like to know more please follow us in RheumNow in the next couple of days.

Hi, I'm Jack Cush with RheumNow. I'm coming to you from Amsterdam, the site of EULAR twenty eighteen, where we have a lot of great presentations. I'm going to talk about the new EULAR ACR classification criteria for systemic lupus erythematosus. This is abstract OP 20 presented by Martin Ehringer, where they discussed the validation process for these new criteria. Along the way, they actually presented the potential limitations of past criteria.

The nineteen ninety eight ACR criteria most of you are familiar with, that's the 11 criteria, ANA, another immunologic parameter, hematologic, renal, etcetera. It's one we all know, four out of 11 criteria, make sure that you have, a diagnosis of lupus. That was improved upon, supposedly, in 2012 with the new SLIC criteria, where they basically went to a more complex system, one from column A, one from column B, and some weighting, that led to some improvements in the performance characteristics. The original performance of the ACR criteria has sensitivity of 80% to 90% and a specificity of 90% to 96%. When they did the SLIC, what it did was it increased the sensitivity, but it actually decreased the specificity of the new criteria.

This new exercise is meant to sort of rectify that and to take a new look at it. So what they did was, they had a consensus panel of experts, I think there are 50 authors on the abstract, that reviewed, the determinants, the key variables that they would look at. They required that everybody be an ANA positive of 180 or greater, and then they looked at a sort of weighted point system that they developed through sort of a Delphi process that gave a higher degree of value to something like biopsy proven nephritis that would get eight to 10 points versus lower, predictive value variables like oral ulcers, fever, and delirium, that got two points. It turns out in their weighting system, serologies got more points, five to six points, compared to clinical measures such as arthritis, and malar rash, you get four, five, or six points. So, when they finished with the project, they came up with this sort of complex system that was not sort of usable as far as I was concerned, but nonetheless, they did improve their performance characteristics.

Now, what they were able to do was to maintain a high level of sensitivity that was running around ninety six-ninety eight percent and their specificity was now improved over the previous SLC criteria up to now 96%. So, while this is, an advance, I think it's one for clinical trials and researchers and maybe lupus mavens. I think at the point of care, this is still too complex and gets further away from what we use in practice to make a diagnosis of lupus. Clearly, we want to stay away from just making it a serologic only diagnosis, we know that that doesn't work and that you need reliable clinical characteristics. These new criteria are somewhat like the RA new criteria that are again weighted and designed to get patients with more certain disease, maybe even more early disease.

How it will pan out is not clear at this point. It now goes to the ACR and EULAR for acceptance and then publication. Let's see where this goes. Tune into room now for more good videos and more good learning.

Hello, this is Olga Petrina reporting from the second day of EULAR meeting here in Amsterdam. I would like to share findings of the study presented by Doctor. Maroni from Italy on use of Canakinumab in women who became pregnant while on treatment. In this study six female patients who were treated with Kanakinumab one hundred and fifty milligram monthly after induction dose for at least forty five weeks before pregnancy and seven weeks into pregnancy to the point when the test became positive were evaluated for incidents of adverse events and pregnancy outcomes. And in this study there was no evidence of malformation or pregnancy complications.

In this study all of the newborns were presented with Apgar scores of more than eight except for one patient who had a low score after C section and improved after the first five minutes. All of the patients were able to maintain low disease activity before, during and after pregnancy with psoriatic arthritis activity scores of less than four. Overall doesn't seem to be any alarming signals, although the group of the patients is very small and I think it's definitely worth collecting more data going forward. Hi everyone, this is Olga Petrina reporting from the second day of the Annual Regular Meeting in Amsterdam. Today I walked through poster hall and two posters drew my attention.

Both are about use of serum calprotectin level in measuring disease activity in two somehow different inflammatory conditions. First poster six ten describes use of serum calprotectin in measuring disease activity in Behcet's disease. In this study, forty eight patients with active Behcet's were evaluated and serum calprotectin levels were compared to serum ESR and CRP levels along with Behcet's disease activity scores and across all scores and serum levels of ESR and CRP all patients with active disease had elevated levels of serum calprotectin. Authors of the study suggest using serum calprotectin as one of the disease activity measures in patients with active rashes. Similar poster was presented in psoriatic arthritis, poster number three zero eight, where authors try to measure serum calprotectin levels in psoriatic arthritis patients and rheumatoid arthritis patients and compare them to ultrasound findings of synovitis.

In this study while CRP levels correlated with high cloprotectin levels in both psoriatic and rheumatoid arthritis, in terms of ultrasound findings rheumatoid arthritis showed no correlation while psoriatic arthritis patients did show some small but significant correlation with serum calprotectin. So all in all it seems like serum calprotectin could be a promising new disease activity marker in the diseases where markers of objective disease activity are few and newer studies will be required to validate those two.

Hi. I'm Jack Cush with RheumNow, and let's talk about abstracts at big meetings. You know, abstracts are a key way that we can learn. In real life, we read the abstracts. We go to meetings and the abstracts that are presented are the heart of the meetings.

I can include both the live presentations but also the abstract floor. So I wrote this blog about the art of an abstract and how it should be presented, constructed, and viewed when you go to large meetings. So first, let's go into the presentations. In the blog, you can find it on roomnow.com, it goes over how you can construct an abstract, what the key elements are, how you can use a PowerPoint file as a template to construct these abstracts and your poster, and then lastly, how you can get it printed for little or no money. So it's an art, it's been done a million times before by others, those who have to do it for the first time, however, often struggle.

You can spend, again, very little money or you can spend hundreds and hundreds of dollars and weeks of manpower to try to put these together. I think if you look at the blog you'll get a template on how to march through it. Next is actually how to present the abstract, especially a poster on a big meeting floor like at ULAR or ACR. Most important thing besides looking good and wearing your interview suit is to be present, to be interesting, and to engage people in conversation. All too frequently, especially young, trainees and first time presenters sit there stiffly with their hands folded across their waist waiting for someone, praying that someone doesn't actually approach them because it's very frightening.

But you really need to learn interaction that can be both the most interesting, the most learning, and maybe the best thing for your research career and ultimately your publication. So, there, I think you need to use a pointer, a stick, something, a prop that you can manually throw around and actually use that as a way of garnering attention. The second way is to sort of be animated, to be lively, to smile, to project, to talk to people, to point at people. The best here is Doctor. Ted Pincus.

If you've never seen him present an abstract, you've missed the show in rheumatology. He's a master at it, I've learned from him millions and millions of times, even today I saw him at the poster session here at UR and he's got a big crowd around him. How does he do it? Well, walk by, he's a recognizable person and they stop just to say hello, but then the show takes over, his abstract, and he starts pointing and he starts waving his hands and being very animated and asking questions, and what would you do? I'll tell you what we did.

And before you know it, one person becomes three becomes 12 and now there's a logjam of rubber necking going on and people are straining their necks to see what's going on at that poster, oh, that's Doctor. Pincus. So again, you can learn from that, it may not be your style, but that style of engagement is truly important in learning, from the abstract experience. And lastly, how are you going to view and take in the abstracts when you're attending a meeting? It's important to, number one, do your pre work.

You need to map out the abstracts that you need to see. You can do that with the app from the Congress. They are very good at finding the subjects that you want to review, but you can also go through the abstract book, write down the numbers, basically make a hit list of what you need to see when you hit the abstract floor the next day. Then you need to navigate, where am I going to go, how am I going to get there? The one big problem and the one great benefit at the same time of the abstract floor is that you'll meet all your friends, you'll run into people you haven't seen in years.

Before you know it, you can spend half of your ninety minutes or most of your ninety minutes doing social things, which is just fine if that's what your intent is. However, if you want to learn, you need to keep the chitchat at a minimum. So being a planful, knowing your hit list, having a navigation plan, and avoiding the chitchat is really the best way to learn on the abstract floor. Be sure to go out there and learn. Be sure to tune in to RheumNow.