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A virtually indispensible gathering

President of the Irish Society for Rheumatology Prof Geraldine McCarthy speaks with Pat Kelly about the Society’s upcoming Autumn Meeting going ‘virtual’ and the importance of rheumatology in Irish healthcare

The resurgence in the number of Covid-19 cases has required versatility and nimble footwork on the part of the Irish Society for Rheumatology (ISR), which had planned to hold its 2020 Autumn Meeting on a face-to-face basis. Presentations will be delivered on a virtual basis. Online attendees will have the opportunity to access all the content online. While this is a practical and valuable alternative, this year’s attendees will miss out on the networking and personal contact opportunities usually afforded at such events.

President of the ISR Prof Geraldine McCarthy is also Clinical Professor of Medicine at the School of Medicine and Medical Science at University College Dublin and Consultant Rheumatologist at the Mater Misericordiae University Hospital in Dublin. She outlined to the Medical Independent (MI) the significant reorganisation that has been required due to the recent surge in the number of SARS-CoV-2 cases in Ireland.

Prof Geraldine McCarthy

“The conference was initially going to be held in Belfast but as the situation developed, we realised that this would not be possible,” she said.

“We then hoped we could have a face-to-face meeting in Dublin but that is not possible now either so we are, like many other organisations, going virtual with our conference. That has been challenging but we already had an excellent line-up of speakers and I think it will still attract a sizeable audience.”

The conference was originally scheduled to run over two days, but this has been curtailed due to the absence of the normal coffee breaks, networking and dinners that would usually occur.

“That’s a shame, because we all love the opportunity to see each other, exchange ideas and discuss solutions to various problems,” Prof McCarthy told MI.

“In the end, the decision to change the format wasn’t that difficult, but it created a lot of work for other people. However, now we have total control over social distancing and there is no risk to anybody.”

The same invited speakers will deliver their presentations online and the same abstracts will be presented. The ISR is currently deciding which posters will be presented online. While international speakers are normally invited, this year, all the speakers are from Ireland but “all of our speakers are international-standard Irish speakers, and I think that says something,” said Prof McCarthy.

Waiting lists

She also touched on the effects of Covid-19 on clinical practice in rheumatology overall.

“The waiting lists were already unacceptably long, and now they are even longer. Covid restrictions mean that we can’t see as many patients in one session, but one upside is that we have started to embrace virtual consultations, and there is certainly a role for them in suitable patients,” she added.

“In our catchment area, there are ‘no-shows’ all the time. In our hospital, we called all the patients who had a scheduled appointment and we maintained that list. Anybody who needed a prescription got one, and we arranged to see urgent cases very quickly but we were only seeing patients whom we already knew, so there was a build-up of urgent new ones.

“So when we finally had our first face-to-face clinic of limited numbers, two patients who had really been suffering terribly stood out to me, and if I had been able to see them three months earlier, they would not have had to suffer like that. I’m sure there are many more patients like them,” Prof McCarthy explained.

In common with other specialties, rheumatology suffers with a lack of consultants that are required to deal with both existing workloads and the extra pressure brought about by Covid-19.

“We simply don’t have enough,” she commented.

“The new-entrant consultant contract discourages consultants generally from coming back to Ireland, because many of them are in very good positions abroad and feel they simply can’t afford to come back; also, it’s simply not fair. Secondly, there needs to be more jobs created and advertised and positions filled.

“When we see patients face-to-face, particularly in rheumatology, we can be really efficient in terms of decision-making and getting people discharged, so it’s a false economy to not have enough rheumatology specialists in Ireland.”

Non-consultant doctors are very astute in choosing their specialty and when they are doing a rheumatology rotation, they spend “so much time doing general medicine — I think rheumatology is one of medicine’s best-kept secrets,” said Prof McCarthy.

“There has been so much improvement in terms of what we can do and drug therapies, for example — what we can do for people is amazing but the specialty is ‘out of sight, out of mind’.”

Misdiagnoses

However, rheumatology has become an increasingly important specialty, bearing in mind the ageing population. “I am particularly interested in crystal arthropathies,” explained Prof McCarthy.

“Much of the focus in rheumatology tends to be on rheumatoid arthritis, which can be very debilitating, but the most common form of inflammatory arthritis is gout, particularly in males. It is the most misdiagnosed and mistreated rheumatology condition, and that is a fact worldwide. I am part of an international group [G-CAN — Gout, Hyperuricaemia and Crystal-associated Disease Network] that is trying to make a difference to that, both locally and internationally, because gout is unusual in that it is actually curable.”

In terms of the future of the Society, it is working on enrolling new members and Prof McCarthy expressed a desire to collaborate more with national clinical lead Dr David Kane.

“We work very well together and I hope that would always continue,” she told MI.

“I would also like to link more with the RCPI and we had a meeting about this before Covid-19… I would also like to encourage clinical research in as many hospitals as possible… and of course, I would love to see many more consultant rheumatologists in the next few years.”

Regarding the conference, Prof McCarthy said she hoped to see an equal amount of participants logging-in as would attend a face-to-face event. “Everything will be streamed and will be available for review later. Another good outcome from the conference would be a greater recognition of the expertise we have in Ireland and I would love to see some collaborations established between some of the speakers and attendees.

“I consider rheumatology to be medicine’s best-kept secret,” Prof McCarthy concluded. “I have been in the business for a very long time and I still love my job.”

The Irish Society for Rheumatology (ISR) is an organisation of about 150 members with specialist training in rheumatology. Some are consultants, others are trainees, with some members being scientists and researchers. The Society includes those who are based in the Republic of Ireland, Northern Ireland, the rest of the UK and some from further afield.

Thursday, 24 September

16.00-16.24

Oral Short Clinical Papers (1-3)
3 x 8 mins each

16.25-16.50

‘Update from the Covid-19 Global Rheumatology Alliance’
Dr Richard Conway, Consultant Rheumatologist, University College Dublin

16.50-17.15

‘Vitamin D – the case for supplements beyond bone health? Evidence from TILDA’
Prof Rose-Anne Kenny, Professor of Medical Gerontology, Trinity College and St James’s Hospital, Dublin

17.15-17.40

‘Biomechanics, Subchondral Bone and Post-Traumatic OA (and Clocks!)’
Dr Oran Kennedy, Bio Engineer, RCPI

17.40-17.55

Young Investigator Award
Top Abstract Submission as decided by the Abstract Review Panel

18.00-19.00

AbbVie Satellite Meeting
‘Striving for remission in RA patients’
Chair: Prof Geraldine McCarthy; Prof Gerd Burmester, University of Berlin; and Dr Grainne Murphy, Cork University Hospital

Friday, 25 September

10.00-10.24

Oral Scientific Papers (4-6)
3 x 8 mins each

10.25-10.50

‘Interactions between T-cells and fibroblasts in RA’
Prof Jean Fletcher, School of Medicine, Trinity College Dublin

10.50-11.15

‘Cytokine Storm: Clinical Cases and Targeted Therapies’
Dr John Stack, Consultant Rheumatologist, Mater Hospital, Dublin

11.15-11.40

‘How marketing and the food lobby trigger population obesity and what medical professionals can do about it’
Dr Norah Campbell, Lecturer in Critical Marketing, Trinity Business School

11.40-12.05

‘Adolescent SLE’
Dr Nicola Ambrose, Consultant Rheumatologist, Blackrock Clinic, Co Dublin

12.05-12.35

‘Attitudes to medicines innovation – A European perspective’
Prof Denis Ostwald, Managing Director and Head of Research in Health Economics, WiFOR Institute, Germany

‘Innovation Ireland – From Rhetoric to Reality’
Dr Peter Robbins, Assistant Professor of Innovation and Entrepreneurship, Dublin City University Business School

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