10 Rheumatologists Walk Into a Bar…er, Meeting
10 Rheumatologists Walk Into a Bar…er, Meeting
The recent American College of Rheumatology (ACR) 2014 Annual Meeting in Boston was well attended, informative, and cold. While walking the conference floor I was able to briefly interview some attendees and get their take on the meeting.
Josef Smolen, MD, Professor, Medical University of Vienna, Vienna, Austria
I think it is a really great meeting. Apparently we will have totally new strategies for our patients who, up to now, could only be treated with certain TNF blockers. We now have three more options for our patients with psoriatic arthritis and some new options for ankylosing spondylitis patients, which is terrific.
We saw IL-6 inhibitor data. We saw anti-TNF data that are interesting. I think that rheumatology is about to take another jump. Also, ACR has updated its recommendations. There are still some gaps between opinion- and evidence-based medicine, but the two have come much closer together than they were, so I think it is terrific. It is a joy to be here. It is a joy to see colleagues, to see people like you again after many years, and to run into people. Everyone is in a good mood. I think it is a great meeting.
Dr Wei: So, Josef, tell me: Do you like living in the US or Europe better?
Dr Smolen: My hometown is Vienna. That is the number-one city in the world for me. I love the US. I have great memories of our time in Bethesda. It was one of the best times of my life, and my wife says the same. We came with one child and we left with two and a half children, so also from a family perspective, it was a great time.
When you are at the meeting, you have no time to do sightseeing. I didn't even get to the museum, which I usually do.
Paul Plotz, MD, Research Faculty, National Institutes of Health, Bethesda, Maryland
It's my feeling that almost all rheumatologists come to this meeting. It is a hugely inclusive meeting. There are people from all over and lots of people who are not physicians—for example, nurses and physical therapists.
And as the intention of the meeting has always been to be inclusive of a whole range of subjects, there were very good papers on therapy, particularly in rheumatoid arthritis and lupus. Those are two real focal points at the moment, and there is some very good basic science being talked about.
I always find this a stimulating meeting, and I love seeing all my old friends, too.
Leonard Calabrese, DO, Vice Chair, Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
It's always a great meeting. This year it's extraordinarily comprehensive. I'm really impressed by the cardiovascular data on treat-to-target. It looks like treating to target is good not only for your bones but for your heart as well.
Les Schrieber, MD, Associate Professor, North Sydney Sports Medicine Centre, Sydney, Australia
I am a regular attendee at ACR meetings, and I think this one is as good, if not better, than any other ones that I have been to in recent years. As usual, it is very well organized. The main challenge when you have such a big meeting is negotiating it; you have to look carefully through your program to work out what you are able to get to. But it's always educational.
I find value not just in the scientific sessions—which generally have been of a very high standard—but in the opportunity to catch up with colleagues and friends, from within Australia as well as from other parts of the world, and to interact with them. It's always a wonderful forum. It really is the international rheumatology meeting, and I look forward to coming each year.
If I come away with some new, fantastic fact, then that is a bonus, especially if it's something that might even change my practice. But if this proves not to be the case, I still will regard the meeting as a worthwhile experience, and I plan to continue coming while still in active practice.
Naveed Chaudry, MD, Research Fellow, Hospital for Special Surgery, New York, New York
Dr Wei: Tell us about your poster.
Dr Chaudry: Our work is a small study based on our clinical practice. My supervisor, Dr Kirou, provided me with all of the data, which we analyzed. The patients were identified on the basis of olecranon bursitis diagnosis; we looked at the ICD-9 diagnosis 726.33 in our practice from 2011 to 2014. And we recorded the patients' demographic information, their clinical examination findings, bursal fluid analysis, and response to glucocorticoid injections.
We defined the cases as inflammatory and noninflammatory on the basis of their bursal analysis finding as well as the clinical exam finding. Bursal fluid was defined as infectious when it was positive for the culture or it was positive for a Gram stain.
Hemorrhagic bursitis was identified when bursal fluid had the appearance of pure blood. The size was divided into large (> 5 cm), intermediate (2.5-5 cm), and small (< 2.5 cm).
We had nine patients with this diagnosis; six of them had a noninflammatory appearance and were also negative on culture and further examination. The remaining few had an inflammatory appearance, so on the basis of all of the analyses, we found out that hemorrhagic bursitis is not uncommon and should be suspected when there is no inflammation on examination. Middle-aged men, especially those who have higher BMIs and perhaps those on anticoagulation, appear to be at a higher risk.
Our experience suggests that an injection with methylprednisolone 40 mg is an effective treatment strategy and leads to resolution or marked improvement within a few days to a few weeks. We did not experience any side effects like skin atrophy or secondary infection, so we recommend that patients who don't have inflammation and have a hemorrhagic appearance on aspiration should be tried with methylprednisolone injection. It should help.
William J. Arnold, MD, Private practice, Skokie, Illinois
Edmund J. Maclaughlin, MD, Private practice, Cambridge, Maryland
Dr Arnold: It's a great time, as always. A lot of good science, a lot of good clinical work, and good friends. Networking is very important for this meeting.
Dr Maclaughlin: I think this meeting is instructive as we all try to figure out how to deliver cost-effective quality care with the change in the healthcare paradigms now and in the future. I've been working on that. My office's manager is working on that. This is a great place to come and everybody is here. You get a more comprehensive view from this meeting than from any of the meetings that currently exist when you're trying to make an interface of the business of medicine with clinical medicine.
Lawrence J. Leventhal, MD, Private practice, Huntingdon Valley, Pennsylvania
It is exciting to be here—lots of great new information, data on new drugs, better ways of documenting electronic medical records, new developments in regard to biologics and nonbiologics. We have to keep up the good work, and I love the fact that there is an international flavor.
Gary S. Firestein, MD, Professor of Medicine, University of California, San Diego
It's awfully cold here, so I am looking forward to going back to where it is warm. But in terms of the content of the meeting, I think it has actually been quite good—some new concepts have emerged, particularly in regard to treating diseases. There's been some interesting basic science, too.
John R. P. Tesser, MD, Arizona Arthritis and Rheumatology Associates, Phoenix, Arizona
Well, I am from Phoenix, so aside from it being cold and rainy—although it stopped raining today—the meeting is noisy, boisterous, and full of new and interesting information.
Thoughts From ACR
The recent American College of Rheumatology (ACR) 2014 Annual Meeting in Boston was well attended, informative, and cold. While walking the conference floor I was able to briefly interview some attendees and get their take on the meeting.
Josef Smolen, MD, Professor, Medical University of Vienna, Vienna, Austria
I think it is a really great meeting. Apparently we will have totally new strategies for our patients who, up to now, could only be treated with certain TNF blockers. We now have three more options for our patients with psoriatic arthritis and some new options for ankylosing spondylitis patients, which is terrific.
We saw IL-6 inhibitor data. We saw anti-TNF data that are interesting. I think that rheumatology is about to take another jump. Also, ACR has updated its recommendations. There are still some gaps between opinion- and evidence-based medicine, but the two have come much closer together than they were, so I think it is terrific. It is a joy to be here. It is a joy to see colleagues, to see people like you again after many years, and to run into people. Everyone is in a good mood. I think it is a great meeting.
Dr Wei: So, Josef, tell me: Do you like living in the US or Europe better?
Dr Smolen: My hometown is Vienna. That is the number-one city in the world for me. I love the US. I have great memories of our time in Bethesda. It was one of the best times of my life, and my wife says the same. We came with one child and we left with two and a half children, so also from a family perspective, it was a great time.
When you are at the meeting, you have no time to do sightseeing. I didn't even get to the museum, which I usually do.
Paul Plotz, MD, Research Faculty, National Institutes of Health, Bethesda, Maryland
It's my feeling that almost all rheumatologists come to this meeting. It is a hugely inclusive meeting. There are people from all over and lots of people who are not physicians—for example, nurses and physical therapists.
And as the intention of the meeting has always been to be inclusive of a whole range of subjects, there were very good papers on therapy, particularly in rheumatoid arthritis and lupus. Those are two real focal points at the moment, and there is some very good basic science being talked about.
I always find this a stimulating meeting, and I love seeing all my old friends, too.
Leonard Calabrese, DO, Vice Chair, Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
It's always a great meeting. This year it's extraordinarily comprehensive. I'm really impressed by the cardiovascular data on treat-to-target. It looks like treating to target is good not only for your bones but for your heart as well.
More Musings
Les Schrieber, MD, Associate Professor, North Sydney Sports Medicine Centre, Sydney, Australia
I am a regular attendee at ACR meetings, and I think this one is as good, if not better, than any other ones that I have been to in recent years. As usual, it is very well organized. The main challenge when you have such a big meeting is negotiating it; you have to look carefully through your program to work out what you are able to get to. But it's always educational.
I find value not just in the scientific sessions—which generally have been of a very high standard—but in the opportunity to catch up with colleagues and friends, from within Australia as well as from other parts of the world, and to interact with them. It's always a wonderful forum. It really is the international rheumatology meeting, and I look forward to coming each year.
If I come away with some new, fantastic fact, then that is a bonus, especially if it's something that might even change my practice. But if this proves not to be the case, I still will regard the meeting as a worthwhile experience, and I plan to continue coming while still in active practice.
Naveed Chaudry, MD, Research Fellow, Hospital for Special Surgery, New York, New York
Dr Wei: Tell us about your poster.
Dr Chaudry: Our work is a small study based on our clinical practice. My supervisor, Dr Kirou, provided me with all of the data, which we analyzed. The patients were identified on the basis of olecranon bursitis diagnosis; we looked at the ICD-9 diagnosis 726.33 in our practice from 2011 to 2014. And we recorded the patients' demographic information, their clinical examination findings, bursal fluid analysis, and response to glucocorticoid injections.
We defined the cases as inflammatory and noninflammatory on the basis of their bursal analysis finding as well as the clinical exam finding. Bursal fluid was defined as infectious when it was positive for the culture or it was positive for a Gram stain.
Hemorrhagic bursitis was identified when bursal fluid had the appearance of pure blood. The size was divided into large (> 5 cm), intermediate (2.5-5 cm), and small (< 2.5 cm).
We had nine patients with this diagnosis; six of them had a noninflammatory appearance and were also negative on culture and further examination. The remaining few had an inflammatory appearance, so on the basis of all of the analyses, we found out that hemorrhagic bursitis is not uncommon and should be suspected when there is no inflammation on examination. Middle-aged men, especially those who have higher BMIs and perhaps those on anticoagulation, appear to be at a higher risk.
Our experience suggests that an injection with methylprednisolone 40 mg is an effective treatment strategy and leads to resolution or marked improvement within a few days to a few weeks. We did not experience any side effects like skin atrophy or secondary infection, so we recommend that patients who don't have inflammation and have a hemorrhagic appearance on aspiration should be tried with methylprednisolone injection. It should help.
William J. Arnold, MD, Private practice, Skokie, Illinois
Edmund J. Maclaughlin, MD, Private practice, Cambridge, Maryland
Dr Arnold: It's a great time, as always. A lot of good science, a lot of good clinical work, and good friends. Networking is very important for this meeting.
Dr Maclaughlin: I think this meeting is instructive as we all try to figure out how to deliver cost-effective quality care with the change in the healthcare paradigms now and in the future. I've been working on that. My office's manager is working on that. This is a great place to come and everybody is here. You get a more comprehensive view from this meeting than from any of the meetings that currently exist when you're trying to make an interface of the business of medicine with clinical medicine.
Lawrence J. Leventhal, MD, Private practice, Huntingdon Valley, Pennsylvania
It is exciting to be here—lots of great new information, data on new drugs, better ways of documenting electronic medical records, new developments in regard to biologics and nonbiologics. We have to keep up the good work, and I love the fact that there is an international flavor.
Gary S. Firestein, MD, Professor of Medicine, University of California, San Diego
It's awfully cold here, so I am looking forward to going back to where it is warm. But in terms of the content of the meeting, I think it has actually been quite good—some new concepts have emerged, particularly in regard to treating diseases. There's been some interesting basic science, too.
John R. P. Tesser, MD, Arizona Arthritis and Rheumatology Associates, Phoenix, Arizona
Well, I am from Phoenix, so aside from it being cold and rainy—although it stopped raining today—the meeting is noisy, boisterous, and full of new and interesting information.
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