One major event in the world calendar of rheumatology

Scientists, patients, rheumatologists and other health professionals met at the IFEMA Centre to discuss recent advances in research and care in the diagnosis and treatment of RMDs. Sunny Madrid is a popular destination for rheumatologists having hosted EULAR on three out of the last seven editions of the conference. Despite the routine focus on rheumatoid arthritis (RA), other topics have shone in recent years, including co-morbidities, patient engagement, and digitalisation in diagnostics and care.

EULAR returns to Madrid

Memorable talks attended

Checkpoint inhibitors, compounds that improve survival in multiple cancers, concurrently increase numbers of adverse immune events. These include incidences of rheumatoid arthritis as soon as one month after the start of treatment. David Pisetsky and Henrik Schulze-Koops discussed the impact of these medications on B and T immune cells, respectively. Both debated whether these treatments might be uncovering latent forms of rheumatism in patients through modulation of various immune subtypes. Beth Helmink followed up by explaining the importance of the microbiome in mediating checkpoint treatment, as exemplified by faecal transplants in immuno-deficient mice significantly boosting cancer treatment success.

Comorbidities with RMDs were once again at the center of attention at this year’s EULAR. Despite increased awareness of comorbidities amongst rheumatologists, some reported to me that a lack of communication between specialist clinicians and scarcity of resources prevent adequate treatment of multiple conditions. This critical issue was covered in BMC Rheumatology’s recently published Thematic Series “Comorbidities in rheumatic diseases – from clinical to translational approaches”.

EULAR village for exhibitions and posters.(Courtesy of EULAR Press Office)

One impressive example of these comorbidities was reported by Piero Ruscitti whose team found that remission in patients with RA was associated with an 80% drop in the incidence of negative cardiovascular outcomes.

“Cannabis for the joints?” is how Serge Perrot concluded his benefit-risk analysis of treating arthritis with cannabinoids, thus generating a wave of smiles amongst delegates. Alongside David Finn and Steve Alexander, they established a discussion on the history, science, and ethics of cannabis given the current grey-zone clinicians face. Current knowledge indicates that there is insufficient evidence to suggest that medical cannabis is a viable treatment for rheumatism, although use in pain, insomnia, and anxiety may be reasonably considered on a patient-by-patient basis.

Emerging trends in rheumatic and musculoskeletal disorders

Interactive poster tours were a new addition to EULAR 2019, whereby selected presenters were given three minutes to introduce their poster in front of a screen and 20+ delegates with some time afterwards for questions. I attended as many as I could, and I was particularly impressed by the advances in musculoskeletal imaging methods. Chaired by Valentin Schafer and Xenofon Baraliakos, advancements in technologies such as machine learning and algorithms to better diagnose rheumatic conditions were well explained.

A presenter uses the new interactive poster format to illustrate their work for an on-looking crowd

It is in this context that both BMC Rheumatology & BMC Musculoskeletal Disorders will run a cross-journal collection on advances and challenges in imaging musculoskeletal disorders until the end of 2019.

Patient engagement in research and development was definitely a recurring theme throughout this conference

Digitalization has additionally enabled more effective communication between health care professionals and patients. For example, Susanne Karlfeldt (Karolinska Institute, Sweden) spoke of Stockholm City Council’s development of personalized, e-health solutions for patients. She outlined how mobile/web applications and regular communication between clinical, patient consultants, and patients can streamline consultation periods and improve patient satisfaction.

Patient engagement in research and development was a recurring theme throughout this conference. One of EULAR’s main activities and related advocacy in coming years will be to increase participation in its work with patients of RMDs. The push to ensure that research and clinical practice is geared towards the needs of patients, as well as involving them more, is something that EULAR and the general scientific community is beginning to consider more seriously. This even more evident by the sessions dedicated to People with Arthritis and Rheumatism in Europe (PARE), which featured a mix of researchers, rheumatologists, and patient advocacy groups such as Arthritis Foundation and Osteoarthritis Foundation International.

Perfect conditions for exchanges of knowledge and ideas

The open interactions between the different partners that comprise EULAR/PReS – scientists, health professionals & patients – was great to see. I believe that this exchange of ideas could, and should, be applied more to other research fields, including my own background of neuroscience.

Space was also given to a series of sessions for individual groups. One of the most productive is the EMEUNET (Emerging EUlar NETwork) working group, who provide both educational and entertaining events for the young-at-heart involved in rheumatology.

Weather and hospitality conditions were ideal in Madrid for EULAR 2019, and it is easy to see why the rheumatology community keeps coming back again and again. BMC will attend EULAR 2020 in Frankfurt (3 – 6 June), something this field and journals can look forward to in anticipation.