The ACR’s annual State-of-the-Art Clinical Symposium (SOTA) takes place in Chicago, April 4–6. Attendees can network and collaborate as they learn about key diagnostic and therapeutic applications from experts. Here is a sneak peek at some of the topics speakers will explore.
Pregnancy & Reproductive Health in Rheumatology
Dr. Sammaritano
For rheumatology patients, pregnancy often carries increased maternal and fetal risks. Both rheumatic conditions and their treatments can affect multiple aspects of reproductive healthcare.
Because many rheumatology patients have active disease and/or are taking teratogenic medications, it’s important that rheumatology providers be knowledgeable about safe and effective contraception.
“Rheumatologists, OB-GYNs and patients should all be aware of potential medication interactions and risks,” she says. “In general, rheumatic disease should be under good control, with the patient on pregnancy-compatible medications, before pregnancy is attempted.”
Dr. Sammaritano will also discuss antiphospholipid antibodies (aPL), which may increase the risk of blood clots. This finding makes positive aPL antibodies one of the most important risk factors in reproductive health, given the already increased risk of thrombosis from high levels of estrogen from pregnancy and some contraceptives, fertility treatments or menopause therapies.
Relatedly, Dr. Sammaritano will touch on the 2024 revisions to the Centers for Disease Control and Prevention’s U.S. medical eligibility criteria for contraceptive use with respect to patients with systemic lupus erythematosus (SLE) and/or aPL.2
“These criteria are now closely aligned with the ACR recommendations, and this [change] should allow OB-GYNs to feel more comfortable with current recommendations for use of certain contraceptives in our patients, in particular the use of most types of progestin contraceptives for patients with aPL,” says Dr. Sammaritano.
Dr. Strand
Considerations in Biosimilars
In another presentation on April 5, Vibeke Strand, MD, MACR, FACP, will discuss the introduction of biosimilars in rheumatology and their potential impacts on patients and the field. Dr. Strand is a biopharmaceutical consultant and an adjunct clinical professor in the Division of Immunology and Rheumatology at Stanford University School of Medicine, Palo Alto, Calif.
Among other topics, Dr. Strand plans to give technical definitions of biosimilars and interchangeability, discuss what is known about switching from reference products to biosimilar products, discuss approved rheumatology biosimilars and explore the current, relative lack of biosimilar uptake in the U.S.
The recent rollout of various biosimilars in rheumatology may ultimately increase prescribing choices. In other cases, however, it may limit physician and/or patient choice, based on insurance reimbursement restraints. Currently, 31 different biosimilar products are approved by the U.S. Food & Drug Administration (FDA) for the treatment of rheumatic conditions, including 10 different biosimilars of adalimumab.
Theoretically, biosimilars may provide a means of overall savings in the healthcare marketplace. Biosimilar development partly relies on already established efficacy and safety data from the original reference product. Thus, overall development costs are lower for biosimilars, and, theoretically, these savings could be passed on to consumers or payors. Biosimilars have led to large price reductions and impressive increases in availability in many countries, especially developing and middle-income countries.
However, the costs of biosimilars vary widely in the U.S. In the U.S., pharmacy benefit managers will play a large role in determining ultimate availability and cost.
“Whether cost savings will be passed on to patients largely remains a mystery to us,” Dr. Strand says.
IgG4-Related Disease
Dr. Stone
IgG4-related disease (IgG4-RD) is a rare, immune-mediated fibroinflammatory disorder first recognized as a unique disease in 2003. John H. Stone, MD, MPH, the Edward A. Fox Chair in Medicine at Massachusetts General Hospital and professor of medicine at Harvard Medical School, Boston, will explore key lessons learned about the condition.
Dr. Stone notes that IgG4-RD can present similarly to many other conditions rheumatologists evaluate. “It is sometimes quite difficult, for example, to differentiate IgG4-RD from ANCA-associated vasculitis, Sjögren’s disease, [SLE], sarcoidosis, aortitis and others,” he says. “Thus, if rheumatologists believe they are not seeing this condition, it is likely they are either missing it altogether or mistaking it for another disease, as I did for many years.”
Although no therapies are specifically approved by the FDA for IgG4-RD, the disease is treatable. Moreover, Dr. Stone notes, the treatment of IgG4-RD differs substantially from that of many conditions in the differential diagnosis.
“Therefore, a thorough knowledge of the subtleties and nuances of this condition [is] very important for all practicing rheumatologists,” he says.
Dr. Stone and his colleagues at Massachusetts General Hospital have created an effective bedside-to-bench research program that has achieved many important insights into IgG4-RD. “Progress has been relatively swift, but there remain many tantalizingly unanswered questions,” he says. Example: It’s unclear why the disease has a marked predilection for men—an unusual characteristic in an autoimmune disorder. It’s also unclear whether IgG4-RD is a vasculitis, and, if so, whether it should be considered a primary or secondary form.
Dr. Stone will also discuss the newest work from his research group, which recently published promising phase 3 data from a double-blind, placebo-controlled clinical trial of IgG4-RD. In the study, inebilizumab, which targets CD19 and results in B cell depletion, reduced the risk of disease flares of IgG4-RD.3
Dr. Tanner
Challenging Cases in Osteoporosis
Rheumatologists regularly encounter patients with osteoporosis, some of whom pose evaluation and treatment challenges. In another presentation, Bobo Tanner, MD, will explore specific osteoporosis case studies to help attendees employ a thorough approach in evaluating and managing patients with possible bone disease.
Dr. Tanner, director of the Vanderbilt Osteoporosis Clinic and an assistant professor of medicine in the Division of Rheumatology and Immunology at Vanderbilt University Medical Center, Nashville, plans to demonstrate why lab work is important using patient examples. He’ll review actual dual-energy X-ray absorptiometry (DXA) bone density images and discuss treatment selection.
“Rheumatologists are keen to learn as much as possible about the evaluation and management of patients with osteoporosis, not only because of the use of [glucocorticoids to treat many rheumatic conditions], but also because rheumatic conditions can increase the risk of fracture,” Dr. Tanner says. Example: Rheumatoid arthritis is embedded in the FRAX (fracture risk assessment tool) calculator as an independent risk factor for fracture.
Dr. Tanner notes that rheumatologists have long been leaders in the field of osteoporosis, dating back to the 1990s when the ACR created a guideline for the evaluation and treatment of glucocorticoid-induced osteoporosis, most recently the 2022 ACR Glucocorticoid-Induced Osteoporosis Guideline.4 A guideline such as this one and the osteoporosis guideline from the American Society for Bone and Mineral Research can be very helpful to clinicians, especially when they are updated over time.5 “But we must remember they are just guidelines,” he says.
In addition to his extensive clinical experience with osteoporosis, Dr. Tanner has worked on clinical trials and guideline development. He is currently involved in research projects that use non-DXA techniques, such as magnetic resonance imaging or microindentation, to evaluate bone health and predict fracture risks to hopefully find more precise ways of establishing at-risk patients who may need treatment.
Lupus Across Skin Tones
Dr. Khattri
SOTA attendees will also view clinical images and learn about the varying dermatologic presentations of lupus across patients with different skin colors from from Saakshi Khattri, MD, MBBS, FAAD, FACR. Dr. Khattri is a practicing rheumatologist and dermatologist and an associate professor in the Icahn School of Medicine at Mount Sinai, New York.
Skin manifestations in rheumatology present differently in people of color compared with those of lighter skin. “Our textbooks predominantly have images that disproportionately show skin pathology in white skin,” Dr. Khattri says. “As a result, residents and fellows do not learn skin manifestations across the spectrum of skin tones, which does a disservice to our community at large.”
Partly because of this approach in education, Dr. Khattri points out that the diagnosis of skin changes in connective tissues diseases in people with darker skin tones can be more challenging than in those of lighter coloring (e.g., Fitzpatrick skin types 1, 2 or 3). Moreover, combined rheumatology and dermatology clinics are rare, so rheumatologists don’t typically have quick access to dermatologic expertise.
Thus, these patients are at increased risk of delayed diagnoses and greater scarring and permanent skin changes. This experience is especially the case for discoid lupus erythematosus, notes Dr. Khattri, which has a higher incidence in people who are Black.
“I’m hoping the audience will be able to use the tips from the lecture in their own practice for earlier diagnosis and, thereby, management,” Dr. Khattri says.
How to Sign Up
Registration for SOTA 2025 is now open.
The programming on April 4 is designed for rheumatology fellows in training, with more general programming on April 5 and 6 appropriate for trainees, rheumatologists and rheumatology professionals. Additional presentations will provide education on such topics as large vessel vasculitis imaging, spondyloarthritis treatment, polychondritis, pain and fatigue in lupus, hypermobility spectrum disorder, cancer screening in myositis, non-inflammatory back pain, rotator cuff disease and liver disease in rheumatology.
Ruth Jessen Hickman, MD, a graduate of the Indiana University School of Medicine, is a medical and science writer in Bloomington, Ind.
References
- Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Rheumatol. 2020 Apr;72(4):529–556.
- Nguyen AT, Curtis KM, Tepper NK, et al. U.S. medical eligibility criteria for contraceptive use, 2024. MMWR Recomm Rep. 2024 Aug 8;73(4):1–126.
- Stone JH, Khosroshahi A, Zhang W, et al. Inebilizumab for treatment of IgG4-related disease. N Engl J Med. 2024 Nov 14. doi: 10.1056/NEJMoa2409712.
- Humphrey MH, Russell L, Danila MI, et al. 2022 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheumatol. 2023 Dec;75(12):2088–2102.
- Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: Report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2016 Oct;31(10):1910.
