Developments and guidance in rheumatology

Paul Mulholland speaks to President of the Irish Society for Rheumatology Prof Geraldine McCarthy about the upcoming highlights of the Society’s Spring Meeting

The Irish Society for Rheumatology (ISR) Spring Meeting takes place from 4 to 5 May in Hotel Kilkenny, Kilkenny.

A clinical advisory group meeting, chaired by Prof David Kane, HSE National Clinical Lead for Rheumatology, is the first item on the agenda on Thursday 4 May.

President of the ISR Prof Geraldine McCarthy will then give the opening address.

Speaking to the Medical Independent (MI), Prof McCarthy said Covid-19 highlighted the value of face-to-face meetings.

“Connection is really important,” Prof McCarthy, who is also Consultant Rheumatologist in the Mater Misericordiae University Hospital, Dublin, told MI.

“It was something that during Covid was a little bit lacking. The education aspect became more important. The educational part is very important to keep people up to date with guidance. I just think it is really valuable for colleagues to meet each other. It also allows trainees to meet consultants and see a roadmap for themselves. Since Covid, people are really appreciating these meetings even more.”

Prof McCarthy said the meeting will feature a “nice mixture” of high-quality national and international speakers, who will inform attendees about the latest developments in rheumatology.

The first presentation will be delivered by Prof Mike Putman, Director of the Vasculitis Programme, Medical College of Wisconsin, US. From a research perspective, Prof Putman conducts meta-research, epidemiology research, and participates in vasculitis clinical trials. He also hosts the Evidence-Based Rheumatology podcast and is an Associate Editor of the journal Rheumatology.

The title of Prof Putman’s talk is ‘Misconceptions and opportunities: Evidence-based medicine in rheumatology’.

Registries

The following presentation is on the subject of the recently established rheumatology registries in rheumatoid arthritis and ankylosing spondylitis. It will be delivered by Dr Michele Doran and Prof Barry O’Shea, Consultant Rheumatologists, St James’s Hospital, Dublin. In 1993, Dr Doran graduated from the Medical School at University College Dublin (UCD). She completed her general and specialist training between Dublin and Bath, UK, and conducted a research Fellowship at the Mayo Clinic, US, on the epidemiology of rheumatoid arthritis.

Prof O’Shea graduated from UCD in 1996. He was the inaugural recipient of the ISR/Wyeth Travelling Fellowship award. This facilitated the completion of his training in the University of Toronto and Toronto Western Hospital, Canada. He went on to undertake a research Fellowship in Toronto with Dr Robert Inman with a focus on patients with ankylosing spondylitis and psoriatic arthritis.

“Registries have been running for a number of years in the UK and it is something that is important for us,” Prof McCarthy said, concerning this presentation.

“We will get an update on where we are at with our own registries. They have started up to a point, but they need to be expanded. Hopefully, the presentation help draw attention to them, and help publicise them, so we can advance the area.”

One of the benefits of registries is that they contain information about biologics, a relatively new treatment option.

“They allow us to get a feel for the real-world data, and long-term outcomes, both positively and negatively,” according to Prof McCarthy.

Other speakers

The next speaker is Prof Gaye Cunnane, Consultant Rheumatologist in St James’s Hospital, and Director of Health and Wellbeing, RCPI, who will give a presentation entitled ‘In the direction of flow’. After completing medical school at Trinity College Dublin, Prof Cunnane undertook her intern and senior house officer training at St James’s Hospital and its affiliated sites. She then specialised in general internal medicine and rheumatology, before completing her clinical and research training at the University of California, San Francisco, US. Her PhD, examining early prognostic markers in inflammatory arthritis, involved laboratory training in the UK, the Netherlands, Sweden, and Switzerland.

Prof Cunnane spent 18 months as senior lecturer/Consultant Rheumatologist at the University of Leeds, UK, after which she moved to Dublin to take up her current post. She was the National Specialty Director for Rheumatology Training in Ireland from 2005-2012; Programme Director for Basic Specialist Training with the RCPI; and, concurrently, Director of Postgraduate Education at St James’s Hospital from 2009-2017.

Prof Cunnane has recently written a book on the history of rheumatology in Ireland, which will be published in the near future.

After Prof Cunnane’s talk, a satellite meeting will be held.

The first presentation on Friday 5 May is entitled ‘What rheumatologists need to know about the kidneys’. It will be delivered by Dr Brenda Griffin, Consultant Nephrologist, St James’s Hospital.

Dr Griffin trained in multiple Irish and UK centres (GN Fellowship in Imperial College London) and gained specialist registration in 2012. Dr Griffin worked as locum Consultant Nephrologist in Cork University Hospital and the Queen Elizabeth Hospital, Birmingham, UK, before taking up her current post in 2016.

“An awful lot of our diseases involve the kidney, such a lupus and vasculitis,” Prof McCarthy said.

“Also, some of our drugs have to be prescribed in the context of renal impairment. So, it is a very helpful topic for discussion.”

The next speaker is Prof John Pauling, Consultant Rheumatologist, University of Bristol, UK. He qualified from Nottingham University Medical School in 2002. After completing general medical training, he commenced specialty training in rheumatology in 2005. He developed a clinical interest in the connective tissue diseases early in his specialty training, particularly in relation to Raynaud’s phenomenon (RP) and systemic sclerosis (SSc), a rare multisystem disease of unknown aetiology characterised by vasculopathy, fibrosis and autoimmunity.

His PhD research evaluated the potential contribution of platelets to microvascular dysfunction in primary RP and SSc.

This work has helped Prof Pauling to develop an interest in outcome measures in SSc research, particularly in relation to peripheral microvascular dysfunction in scleroderma. Prof Pauling has interests in non-invasive methods of measuring tissue perfusion, such as infra-red thermography and laser-derived imaging modalities. He has undertaken early validation studies of laser speckle contrast imaging in RP and SSc. He is interested in the relationship between peripheral microcirculatory function and circulating vascular biomarkers.

Prof Pauling is working with the British Society of Rheumatology Biologics Register to identify factors influencing treatment responses to biologic therapy in rheumatoid arthritis.

His talk concerns the challenges in vascular ischaemia relating to scleroderma.

“Scleroderma is a very challenging condition,” Prof McCarthy said. “We don’t have a drug that ‘fixes’ scleroderma. It really affects your vascular system and we don’t have any ‘magic bullet’. So, the presentation will be very interesting to take us through some of these issues.”

Dr Natasha Jordan, Consultant in Adolescent Rheumatology, St James’s Hospital, and Children’s Health Ireland, will give the final presentation of the meeting. It will concern the management of pregnancy in systemic lupus erythematosus (SLE). Dr Jordan’s major clinical and research interests are autoimmune connective tissue diseases and systemic vasculitis.

She studied medicine at UCD followed by higher specialist training in general internal medicine and rheumatology. Dr Jordan subsequently worked for five years at the Louise Coote Lupus Unit, St Thomas’ Hospital, London, UK, initially as a clinical research Fellow and then as an honorary consultant. She has been the recipient of an Arthritis Research UK Fellowship and the Graham Hughes Clinical Research Fellowship allowing her to undertake research in the areas of SLE and vasculitis. She obtained her PhD from King’s College London, UK, investigating the genetics of lupus nephritis.

Prof McCarthy said Dr Jordan has an international profile regarding SLE, and “a specific expertise in pregnancy” and SLE.

“She gave a similar talk at the British Society of Rheumatology last year, which was excellent.”

Specialty

Prof McCarthy also highlighted the clinical case presentation section of the meeting, which takes place on the Friday. Overall, Prof McCarthy said the specialty continues to progress, but that work is ongoing to attract more medical students and NCHDs into rheumatology.

“Not enough of them are being exposed to it, and many of them don’t realise what a great specialty it is,” she said.

“However, we have a sense the situation is becoming better. It is so interesting and we have amazing drugs.”