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A meeting of minds in rheumatology

The Irish Society for Rheumatology (ISR) Spring Meeting 2017 will offer a balanced mix of key international and Irish speakers. These presentations include an update on the increasingly complex biologic landscape, as well as a discussion on what JAK inhibitors mean for everyday practice. Prof Gerry Wilson, Arthritis Ireland Professor of Rheumatology at University College Dublin, will also deliver a talk on the Rheumatoid Arthritis Biologics Registry of Ireland (RABRI).

President of the ISR, Dr Alexander Fraser, told the Medical Independent (MI) that the meeting will be both practical and informative. “It is great to have the meeting locally in Limerick, so it’s extra special. And it gives us a chance to show people a little bit of what we’re doing in Limerick.

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Dr Alexander Fraser, President, ISR

“The Spring Meeting tends to concentrate on a clinical agenda and allows clinicians to get exposure to cutting-edge practice. These presentations are of immediate relevance to the work they do, day-to-day. They are very helpful to those who are in clinical work and need to get an overview of what the current state of play is.”

Biologic landscape

Dr Fraser, who is a Consultant Rheumatologist at University Hospital Limerick, said he was delighted that Prof Maya Buch, Professor of Rheumatology and Honorary Consultant Rheumatologist at The University of Leeds, is speaking at the conference.

He said Prof Buch’s talk ‘Navigating the biologic drug landscape in rheumatoid arthritis — what progress have we made?’ is sure to be fascinating.

“Myself and Dr Joe Devlin and many other rheumatologists in Ireland trained and worked in Leeds, so most of us would know Prof Buch.

“She really has been at the cutting-edge of the biologics revolution since day one. She was a research registrar in the late 1990s when we were just starting to do the first biologic studies. She is very busy, so we’re delighted that she could attend.”

He continued: “This is a very important clinical area for rheumatologists. Ten or 15 years ago we had two, then three, biologics — all of them anti-TNFs. We had three to choose from and they were great, highly-effective drugs bringing a revolution in rheumatology.

“But since then there has been one new biologic after another and it has become a very complicated field. We will soon have dozens of biologics, not just against TNF but against various other targets available to us when we’re treating our patients.”

This proliferation means that it is not entirely clear which drug is best for which patient, said Dr Fraser.

“It will be great to hear from Prof Buch what the evidence is and which of the biologic drugs may be better for which person.”

Registry

The establishment of RABRI will also shed light on this rapidly-developing area. The registry seeks to document all RA patients attending rheumatology clinics in participating centres in Ireland who have been commenced on a new biologic therapy. The main objective will be to monitor response to therapy, safety, record adverse events and events of special interest.

“We have been trying to establish a registry for years,” said Dr Fraser. “It is something that is very important and thankfully in the last couple of years, we’ve managed to get it off the ground.

“Not all the centres are currently contributing to the registry but the aim is that all of them would soon. Part of this update is to show what data we have collected but also how we as the ISR can facilitate them.”

Dr Fraser said he was very aware of the pressures on doctors and understood how this might impede submitting data to the registry.

“We’re all under-resourced so any extra activities, no matter how important, require resources,” he said. “A lot of the centres around the country want to contribute but would struggle to find the time to submit to the registry. We’re trying to help, particularly the smaller centres, to come up with novel ways to help them contribute.

“We’re all trying to do our best for the patients with limited resources. Everyone acknowledges that this is a great idea. It’s off the ground; there’s money there to support it.”

JAK inhibitors

These discussions complement the presentation on JAK inhibitors, which will be given by Prof Howard Amital of the Sackler Faculty of Medicine, Tel Aviv University, Israel.

 “The next big revolution are the JAK inhibitors, which are really just being rolled out now. They are so exciting. But when you take an increasingly confusing biologics field and then add in the JAK inhibitors, clinicians need help in deciding what the best options are for patients.”

Pain and its management will also feature heavily at the meeting. Health psychologist Ms Nóirín Nealon Lennox and chartered physiotherapist Ms Helen Rooney will present on ‘Interdisciplinary group Acceptance and Commitment Therapy (ACT) for chronic pain in rheumatology Services: The evidence, model and processes’.

“Nóirín is a well-established leader in pain management or pain acceptance. She had run a programme in Waterford and wanted to set one up in Limerick and we assisted her in that,” said Dr Fraser.

“Nóirín worked in conjunction with other health professionals. What they have done is created a pain acceptance programme, mainly with patients with fibromyalgia but also for patients with pain coming from other sources. It has been an absolute revelation.”

Pain management can be very challenging, he added, but the eight-week programme has been an unmitigated success, even with hard-to-treat patients.

“The team has run a pain acceptance course for two or three years and it has been a huge eye-opener. It makes a big difference for hard-to-treat patients, patients for whom you feel very deeply. We don’t have a drug or surgical solution for them. Their lives are defined by their pain. However, following the course, the patients come back to us and the feedback is just remarkable.”

He added: “It’s not pain management in the traditional sense, which is administered by anaesthetists giving trigger point injections, medications, etc. This is psychology, physiotherapy and teaching people the structures by which they can accept their pain.”

Dr Fraser also noted that Ms Nealon Lennox has collected data showing the effectiveness and cost-effectiveness of the programme, “and we’re very keen for the HSE to look at funding it going forward”.

Dr Philip Hodnett, Consultant Musculoskeletal Radiologist, University Hospital Limerick, will give a one-hour talk on imaging of groin, hip and pseudo hip pain.

“Dr Hodnett was trained in New York to the highest possible standard and I am really looking forward to his talk.”

World leader Prof Austin Stack, Professor of Medicine and Consultant Nephrologist, University Hospital Limerick, will present on hyperuricaemia and chronic kidney disease.

“Prof Stack is a great speaker and he is at the world’s forefront in the study of high uric acid levels and uricaemia, not just as a cause of gout but increasing evidence that high uric acid levels are a risk factor for all sorts of things, including heart disease, stroke and kidney disease on its own,” said Dr Fraser.

“We are moving potentially to the area whereby we don’t just treat high uric acid levels in people to stop them having gout, but rather we treat it like you would treat high cholesterol or high blood pressure to prevent stroke and heart attack. The data there is very interesting.”

There have been a lot of registrations for the meeting and Dr Fraser hoped it would prove enjoyable and interesting to the ISR’s many members.

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