- The changes proposed in the (drafted) ACR/Arthritis Foundation treatment guidelines for children with JIA manifesting with non-systemic polyarthritis, sacroiliitis and/or enthesitis;
- The probabilistic principal components analysis for recategorizing JIA subtypes via computer modeling; and
- The utility of subtyping chronic arthritis in children and adults based on shared genetics rather than age of onset.
ACR: Pediatric Rheumatology Year in Review & Awards
12:30–2 p.m.
The Pediatric Rheumatology Year in Review is a fantastic opportunity to get a high-yield summary of the latest and most impactful clinical, translational, and basic science research in pediatric rheumatology. Anyone who cares for children with rheumatic disease in any capacity, whether as a full-time pediatric rheumatology clinician or an adult rheumatologist who sees an occasional child, will find something of interest in this session. Berent Prakken, president of the Pediatric Rheumatology European Society, will present on translational and basic research, and Pam Weiss, the director of clinical research at the Children’s Hospital of Philadelphia, will present on clinical research. They are both dynamic, engaging speakers who will tell you what you need to know to provide the best care for your pediatric patients and let you know what is on the horizon.
Also, awards will be presented to some of the most outstanding members of the pediatric rheumatology community. These include the ACR Fellows Awards, as well as the AAP James Cassidy Award, which is the most prestigious award in the pediatric rheumatology community.
ACR: Sjögren’s Syndrome: Beyond Dryness: A Comprehensive Approach to Diagnosis & Management
12:30–2 p.m.
The diagnosis of Sjögren’s syndrome is guided by the 2016 ACR/EULAR Classification Criteria for Primary Sjögren’s Syndrome, but must take into account the bias of these criteria toward more advanced disease and the difficulty of securing requisite testing in the community (such as ocular surface staining scores and focus score measurement). Nonetheless, several criteria are adaptable to clinical practice. These criteria can be applied to patients with sicca symptoms, but also to patients with unexplained, unclassified autoimmune disease.
Symptoms of dry eye can arise from decreased tear flow, meibomitis, superior limbic keratoconjunctivitis or poor lid closure. Symptoms of dry mouth and dental decay are also multifactorial. A good understanding is required for effective topical treatment. Systemic treatment can be directed at the stimulation of glandular function or immunologic intervention, where new tools are in clinical trial.
This session is directed at the practicing clinician. Attend if you wish to get a grip on Sjögren’s syndrome for the purpose of both diagnosis and management. You will learn what you can do for these patients and what you need to know about exciting new treatments on the horizon.
ACR/ARHP: Randomized Trials for Clinical Researchers 101: Design & Analysis Overview
1–2 p.m.
This session will focus on randomized trials and target clinical researchers, health professionals and clinicians who read the research literature; only a basic statistical background is assumed. The speakers intend to provide an overview of the important issues involved in the design and analysis of randomized trials and will describe the salient features of randomized trials, as well as compare and contrast the benefits of randomized vs. non-randomized studies.
The session will include extensive use of rheumatological examples by referencing published manuscripts; this will facilitate the audience’s ability to draw direct connections between the material presented and the type of the interpretation that may matter most to them.
ACR: The Great Debate: Guidelines for SLE: HCQ Dose Should Be No More Than 5 mg/kg in All Patients
2:30–4 p.m.
Why attend the 2018 Great Debate? Multiple studies show that hydroxychloroquine (HCQ) has many benefits in SLE. These benefits include prevention of disease flares, including renal and CNS lupus, and cardiovascular benefits, such as reducing coronary artery risk and decreasing thrombosis risk. HCQ is the only drug shown to prolong survival in lupus.
Recent ophthalmology guidelines point to potential retinal risks of long-term HCQ use. The guidelines have recommended newly available screening tests and limiting the dose of HCQ. Many rheumatologists are confused by the guidelines, the screening tests and their interpretation.
In this session, Nathalie Costedoat-Chalumeau, MD, PhD, of the Cochin Hospital, Paris, will introduce the topic. Michelle A. Petri, MD, MPH, from Johns Hopkins will review the many benefits of HCQ. Finally, James T. Rosenbaum, MD, a practicing rheumatologist who chairs Oregon Health & Science University’s ophthalmology department, will discuss the rationale for the new guidelines.
Attendees will increase their understanding of the benefits and risks of using HCQ in SLE and the role of the recent guidelines.
ACR/ARHP: Interdisciplinary Management of Chronic Musculoskeletal Pain in Older Adults
2:30–4 p.m.
Older adults with chronic musculoskeletal pain present unique treatment challenges in comparison to younger patients, including an increased number of co-existing chronic medical conditions, the presence of multisite pain in 75% of older adults, increased psychosocial considerations and limitations in traditional pain pharmacotherapies. Especially for older adults, it is important to consider non-pharmacologic, interdisciplinary, collaborative care that ideally involves a biopsychosocial approach.
In this session, Una Makris, MD, MSc, of University of Texas Southwestern Medical Center and Dallas VA Medical Center, and Kelli Allen, PhD, of the Thurston Arthritis Research Center, University of North Carolina, and Durham VA Health Care System, will discuss why it is important to consider shifting the paradigm toward a biopsychosocial (including behavioral), interdisciplinary approach to pain management in older adults. They will discuss evidence-based models of, and key players (i.e., primary care providers, subspecialists, clinical psychologists, physical therapists, PharmDs) in achieving collaborative care in real-world settings.
ACR/ARHP: Psychiatry for the Rheumatology Practice
2:30–4 p.m.
Rheumatologists frequently care for patients with psychiatric conditions that are a consequence of their rheumatic disorder or, in some cases, a causal factor. Because access to psychiatric care is so limited, rheumatologists often find themselves managing these conditions. In spite of how commonly this occurs, little instruction in rheumatology training programs addresses these issues, and a surprising lack of literature on this subject exists.
This 90-minute presentation by two experienced rheumatologists and one psychiatrist will review the primary psychiatric conditions that rheumatologists encounter and management that should be within their purview. Additionally, they will cover red flags for circumstances where emergency psychiatric consultation is needed.
The presentation is directed toward practicing rheumatologists, advanced practice providers and trainees.
ARHP: Sustainable & Accessible Healthcare in Rheumatology: International Perspective
4:30–6 p.m.
Attention all rheumatology health professionals—doctors, nurses, PTs/OTs, psychologists, pharmacists, researchers, budding trainees and students, and anyone with a general interest in integrated healthcare. Don’t miss this international dialogue on improving patient access to care. This session will provide a glimpse of the vast contrasts in the U.S., Canada and Europe among patients accessing care, the role workforce shortages play, the strategies being used to implement alternative models, a view of the integrated team and a peak into patient outcomes.
ACR/ARHP: The Pain Chronicles: National Strategies to Address &
Manage Pain
4:30–6 p.m.
Strategies for addressing the dual epidemics of chronic pain and the adverse effects of opioids are, and continue to be, in flux in the U.S., and will be addressed in a session on pain at the 2017 meeting. The ACR/ARHP community is directly affected because patients with musculoskeletal conditions comprise the majority of those who receive prescribed opioids.
In this session, national leaders of efforts to address these problems from the NIH, CDC, HHS and the American Pain Society, including Bill Maixner, DDS, PhD, APS president, will discuss efforts to find the right balance for managing these problems. This will include talks touching on the relationship of the opioid and chronic pain epidemics, as well as updates on relevant policy, pain and translational research, and the implications for ACR/ARHP members seeking to manage chronic pain safely. The session will also offer an opportunity for attendees to share relevant experiences and opinions with these national leaders.
Monday, Oct. 22
ACR Clinicopathologic Conference: Under the Microscope: The Evolution of a Diagnosis
7:30–8:30 a.m.
One of the main reasons people pursue a career in rheumatology is that they love the detective work and interdisciplinary nature of the field. This session is testament to the importance of collaborating with other healthcare providers and integrating all facets of a patient’s presentation to best manage patient care.
This session will review a complex case with discussion from rheumatology, pathology and radiology. The presentation will highlight the importance of questioning initial assumptions and the necessity of revisiting a patient’s diagnosis using a different lens.
This session will interest clinicians, clinical educators, fellows and those who love detective work, specifically, providers interested in pulmonary and dermatologic manifestations of rheumatologic disease, vasculitis and pathology.
ARHP: Daltroy Memorial Lecture: What Matters in Patient-Provider Relationships? Values, Attitudes
& Beliefs
7:30–8:30 a.m.
History, life experiences and perspectives informed by race, culture, ethnicity and family of origin can play an important role in patient-provider relationships. The experiences and values of the patient have a profound impact on the medical encounter, approach to treatment decisions and adherence. Adena Batterman, LCSW, and Jillian Rose, LCSW, MPH, will discuss the importance of the clinician’s own self-awareness and understanding of the patient’s experience from a multicultural perspective. They will provide clinical tools and best practices to help providers work from this framework to uncover what matters most to the patient to optimize clinical outcomes.
Workshop: Ultrasound in Large
Vessel Vasculitis
7:45–9:45 a.m.
Asuspected diagnosis of giant cell arteritis (GCA) or Takayasu’s arteritis should be confirmed by imaging or histology. New EULAR recommendations indicate ultrasound of temporal and axillary arteries as the first modality, particularly in patients with suspected cranial GCA.
Ultrasound is widely available in rheumatology practice. In addition to examining musculoskeletal structures, you and your collaborating colleagues can scan arteries in your patients with suspected large vessel vasculitis. Fast-track clinics are being established by rheumatologists worldwide, because timely diagnosis and treatment reduce the incidence of vision loss.
This workshop will provide updates on new developments in ultrasound for large vessel vasculitis and advice on how to adjust your machine, scan and avoid pitfalls. Ultrasound machines will be available for practical scanning.
ACR: AFLAR: Out of Africa: Of Rheumatic Diseases: Pattern,
Genetics & Advocacy
8:30–10 a.m.
Three speakers with different perspectives will give presentations in this session. Rheumatic diseases were thought of as rare on the African continent. The first speaker will address the seeming cocoon against these diseases in Africa, which is attributed to a lack of awareness, scarce medical resources, limited diagnostics and ingrained, sociocultural fear of these diseases.
The huge burden of musculoskeletal diseases is often eclipsed by the more recognized infectious diseases. This means rheumatic conditions tend to be relegated to the background, with patients experiencing worse outcomes in Africa.
Despite increasing reports in academic literature, public perception of these diseases is that they are nonexistent, and without advocacy, getting African governments to dedicate resources to them and letting patients know it’s okay to come out as having these conditions are uphill tasks.
What is the advocacy story from Africa, and what is the role of our patients? The second presentation will put the spotlight on The Rheumatology Initiative (tRi) from Ghana, as well as other initiatives.
The global perspective on the spectrum of rheumatic musculoskeletal diseases in the African setting is generally obscure. Emerging evidence suggests similarities in the spectrum of rheumatic musculoskeletal diseases across Africa with that obtained in other parts of the world. These data were obtained largely from hospital-based studies in urban populations. However, little is known about rheumatic musculoskeletal diseases in rural African communities.
This session will draw the attention of the international rheumatology and global health community to the increasing burden of rheumatic musculoskeletal diseases in a rural African context. It will expand on the challenges and roadmaps to sustainable efficient rheumatology care in a poor-resource environment.
The third speaker will address tuberculous (TB) and nontuberculous mycobacterial infections. Skeletal TB refers to that affecting the bones and/or joints. It’s an ancient disease that has been found in Egyptian mummies dating as far back as 9,000 years. Musculoskeletal involvement in TB is rare and is seen in just 1–3% of patients with TB. About half of these cases affect the spine, and the rest affect extraspinal osteoarticular joints, such as in Poncet’s disease, or tubercular rheumatism that presents during acute TB infection as a nondestructive polyarthritis without evidence of direct mycobacterial involvement of the joints nor any other known cause of polyarthritis detected. Approximately one in nine new TB cases occur in individuals who are infected with HIV. In Africa, which has a higher prevalence of HIV infection, data show that up to one-third of adults with osteoarticular infections are HIV positive.
ACR/ARHP: Pump Up Your Presentation: Graphics, Tables & Talks
9–10 a.m.
When you present your work, you need to ask yourself: What is the message, and who is the audience? Your presentation can be an article, a poster or a talk. Each has its own pros and cons, and best practices.
This workshop will focus on the principles of good table and graph design to answer the following questions: Which of the messages in your research results requires a graph and which a table? Tables are powerful to show precise numbers, graphs to visualize relationships. How can you best convey the message?
Clear vision means choices in graph or table type, ordering and sequencing information, scaling, discriminating of data series, minimizing non-data ink and avoiding chart junk.
Clear understanding means telling the story. Is the graph truthful? This session will help you avoid ambiguity and misinterpretation by keeping graph and data quantities directly proportional, avoiding certain forms, using clear labels and keeping data in context.
ACR/ARHP: Get Smart: Mobile & Wearable Technology in Rheumatology
9–10 a.m.
Due to the changing landscape of medicine, 21st century technology advancements are affecting rheumatology. In this session, attendees will explore the use of wearable technologies in clinical care settings, research, rehabilitation and other digital health advances; identify where patient-generated and wearable data can benefit clinical practice; gain an understanding of future opportunities and challenges with integrating patient data into clinical settings; and learn how to incorporate wearable technologies to measure physical activity in rehabilitation. You will walk away with a framework for how to tailor and progress physical activity in rehabilitation. Last, but not least, participants will learn the pros and cons of targeting physical activity in rehabilitation.
ARHP: Utilizing PROMIS for
Research & Clinical Care
9–10 a.m.
Rheumatology health professionals may be challenged with finding tools to efficiently assess patient needs. This session introduces patient-reported outcome measures (PROMIS) as a tool to assess patient needs and assist with treatment planning. The presenters, Anna Kratz, PhD, and Dinesh Khanna, MBBS, MSc, University of Michigan, will introduce the measures and explain how they can be used for Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requirements and applied in clinical practice and research.
ACR: Rheumatic Immune-Related Adverse Events from Cancer Immunotherapy
11 a.m.–12:00 p.m.
Checkpoint therapy for cancer was clinically introduced in 2011 and is now established as a major pillar of cancer therapy. With six approved agents and scores more in clinical development, the field of cancer immunotherapy has finally arrived. As a byproduct of this unbreaking of an exhausted immune response is a remarkable array of autoimmune and or autoinflammatory complications affecting virtually every organ system, including rheumatic complications, and has been referred to as the potential Achilles heel of this evolving therapeutic armamentarium.
Understanding the clinical spectrum of immune-related adverse events (irAEs) can be facilitated by examining their basic biology in both health and disease. Early basic observations suggested a critical role of immunologic checkpoints by studying various knockout models resulting in autoimmunity. In humans, lessons have been derived from recently described monogenic primary immune deficiency diseases involving checkpoints that are associated with an array of autoimmune clinical complications.
Finally, recent translational research has elucidated the function and importance of checkpoints in rheumatic diseases, including RA, giant cell arteritis and others, suggesting checkpoint function may be an important factor in pathogenesis. From a purely clinical perspective, it appears that rheumatologists may be specially positioned to participate in research and care in a new multisystem autoimmune set of diseases.
Meet the Professor:
Pediatric Rheumatology for Adult Rheumatologists
12:45–2:15 p.m.
Do you have questions about how to care for pediatric patients with rheumatic disease? You have probably heard that “pediatric patients are not small adults,” but what is different about taking care of a patient with rheumatic disease under the age of 18? This Meet the Professor session, led by Patience White, MD, will be relevant to all rheumatologists—whether they have just started their rheumatology careers or are somewhere on the spectrum.
This interactive, case-based session will highlight the key issues an adult rheumatologist should keep in mind when seeing young patients with rheumatic diseases. Many timely topics will be discussed, such as rheumatic disease effects on growth and development, knowing the right medication and dose at the best time for pediatric patients with rheumatic disease, how to effectively integrate young adults into your care and some pearls on the differences between specific pediatric and adult rheumatic diseases.
Tuesday, Oct. 23
ARHP: Collaborative Initiative (COIN): A Rheumatology Resource Toolbox
7:30–8:30 a.m.
Rheumatology health providers with innovative ideas and skills may need support and resources in their quest to develop or implement a project. This session provides a review of an ACR program designed to support rheumatology health professionals with project development and execution through collaboration. According to the presenters (S. Sam Lim, MD, MPH, Emory University, Atlanta; Irene Blanco, MD, MS, Albert Einstein College of Medicine, New York City; and Amanda Sammut, MD, New York City Health and Hospitals), this unique ACR program can help enhance how health professionals engage with academics, patients and public and private organizations in their fields of interest.
Meet the Professor: Integrating Complementary Therapies into
Your Practice
7:45–9:15 a.m.
Arthritis and musculoskeletal problems constitute the most common reason for seeking complementary or alternative (CAM) therapies. It is likely that over 30% of people seeking symptomatic relief will use a CAM modality. Unfortunately, most of these therapies are self-prescribed by consumers, and their decisions are often based on misleading information in the media, along with clever marketing. Rheumatologists and other caregivers have a responsibility to be informed about the uses, safety and efficacy of popular CAM therapies so they can provide information and guidance to patients.
This workshop will highlight commonly used, evidence-based therapies that may be helpful for patients with musculoskeletal issues. The speaker will discuss published, evidence-based reviews of popular integrative therapies (dietary supplements; herbal preparations; nutritional interventions; and acupuncture) and provide practical advice regarding the introduction of these modalities to your patients. In addition, he will provide trusted resources to allow rheumatologist to learn more about integrative medicine.
Workshop: Mindfulness for the Physician: Techniques & Skills
7:45–9:45 a.m.
Physician burnout is a significant issue in the healthcare system. Consequences of burnout include depression and anxiety, as well as decreased productivity and increased medical errors. Mindfulness meditation has been shown to reduce burnout, stress, anxiety and depression, as well as improve personal well-being and patient-related care. This interactive session will introduce participants to the foundations of mindfulness practice as a means to stress reduction and improved well-being.
Participants will learn the basic constructs of mindfulness, research findings supporting mindfulness meditation for health and well-being, and practice several mindfulness meditation exercises. Methods and resources to apply mindfulness to daily life will also be presented and discussed. Anyone interested in learning strategies to deal with the stresses associated with working in the healthcare system should attend this session.
ACR: Ethical Issues in Clinical Practice: Providing the Best Care & System Challenges
8:30–10 a.m.
In the current medical landscape, healthcare providers face myriad challenges when trying to provide the best care for their patients. Inherent systemic factors, such as social inequalities, are associated with worse health outcomes. Additionally, modifiable systemic factors within a healthcare provider’s control may help improve care for patients, but they require additional time and effort on top of an already strained workload.
This essential ethics-focused session will help providers of rheumatologic care identify disparities in medical care, develop an approach to help minimize and manage health disparities, and consider the rheumatologist’s ethical obligations to a patient’s medical care in light of the challenges they face in the current medical reimbursement system. The session will encourage audience participation by using an audience response system and a panel discussion with our speakers.
ARHP: The Empowerment Resources
for Lupus Minorities
9–10 a.m.
How can we better educate and empower patients? This session will emphasize the importance of utilizing several platforms as resources to support lupus communities. According to the presenters (Sheryl McCalla, JD, the ACR, Atlanta; Cristina Drenkard, MD, PhD, Emory University, Atlanta; Karen Mancera-Cuevas, MS, MPH, CHES, Northwestern University, Evanston, Ill.), providers and patients need to be better educated on the types of social support and self-management resources available. For example, social media is emerging as a cost-effective model to disseminate culturally relevant messages among hard-to-reach populations and foster social support. Additionally, the MONARCAS Program serves as a model in developing community-based lupus education programs in Spanish-speaking communities that are challenged by language barriers, as well as limited access to care.
ACR: JIA-Associated TMJ Arthritis: New Guidelines for Evaluation,
Scoring & Management
11 a.m.–12 p.m.
The temporomandibular joint (TMJ) is unique. This session addresses the different aspects of this difficult-to-treat joint. Similar to other joints, the TMJ can be actively involved in the disease process, or it can be affected by damage due to previous TMJ inflammation. The diagnosis, evaluation and treatment of the TMJ can differ on the basis of disease activity and damage accrual. Treatment options consist of local or systemic drug therapies, physiotherapy, functional appliances and/or surgical interventions. Management of TMJ involvement mandates a multidisciplinary approach.
The session will be given by a pediatric rheumatologist and an oral maxillofacial surgeon, and provide a broad overview of all the JIA-associated TMJ-related issues. It will be of interest for both the pediatric and the adult rheumatologist.
ACR: Antiphospholipid Antibody Syndrome: The Scary Stuff
12:30–2 p.m.
Antiphospholipid antibody syndrome (APS) is a systemic autoimmune disorder of thrombosis and/or pregnancy complications. In this symposium, experts in the field from rheumatology, obstetrics and hematology will come together to provide clinicians with the most cutting-edge insights in APS and highlight diagnostic and treatment conundrums. The session, moderated by Saira Sheikh (University of North Carolina Chapel Hill) and Paul R. Fortin (CHU de Québec–Université Laval), will be divided into three parts and focus on topics and clinical scenarios that present the most challenges for the practicing rheumatologist: non-obstetric stuff, obstetric stuff, and is APS management scarier than the other stuff?
This is a great opportunity for attendees to refresh their knowledge on the full spectrum of APS, recognize unusual APS manifestations and be able to refine the approach to diagnosis and treatment of thrombotic and obstetric APS.
ACR: Leadership Skills for the 21st Century Rheumatologist: Extend Your Sphere of Influence
12:30–2 p.m.
Developing leadership skills allows you to influence others in important ways, such as by leading trainees in learning more efficiently and effectively, leading clinical staff and patients to optimize outcomes, or leading colleagues to improve their work unit. This session will teach several theories and skills to enable you to become a more successful leader.
Using R. Kevin Grigsby’s 2015 article, “Enhancing the Behavioral Science Knowledge and Skills of 21st-Century Leaders in Academic Medicine and Science,” and research and guidance from the Center for Creative Leadership, this session will expose you to behavioral protocols and case studies to focus attention on identifying behaviors to enhance your leadership skills, such as giving and receiving feedback, and influencing others.
ACR/ARHP: My Chromosomes & Me: Talk to Patients About Consumer Genetic Tests
1–2 p.m.
This session will discuss direct-to-consumer genetic testing and its implications for clinical care and disease. Access to this testing is expanding and proliferating, and patients often bring the reports in with questions for physicians. “Am I at risk for this disease? What does this result mean? What can I do, doc?” This topic can be uncomfortable for physicians unfamiliar with these tests and the genetic data the tests provide. This session will cover what information is provided in these tests, what can be said clinically and the limitations of this type of testing.
Study Group: Developing Support & Education Programs for People with Rheumatic Diseases
1–2 p.m.
People with chronic rheumatic illness face many challenges related to coping with the emotional impact and management of their illness. It is well documented that support and education programs provide skills and coping strategies for patients and their families to assist them in effectively meeting these challenges.
This study group, now in its third year at the ACR/ARHP Annual Meeting, is the first to focus on these issues specifically. The speakers, Hospital for Special Surgery clinical social workers with decades of experience in this area, will engage participants in an interactive dialogue on evidence-based and promising practices including:
