Meeting of minds in rheumatology

Irish Society for Rheumatology President Prof Geraldine McCarthy speaks with Pat Kelly about the Society’s upcoming Spring Meeting and the overall health status of Irish rheumatology services.

Irish Society for Rheumatology, Spring Meeting, Sligo Park Hotel, 19-20 May 2022 

Irish Society for Rheumatology President Prof Geraldine McCarthy speaks with Pat Kelly about the Society’s upcoming Spring Meeting and the overall health status of Irish rheumatology services 

In common with almost all other specialties, rheumatology care in Ireland is still recovering from the effects of Covid-19 on patient care and timely diagnoses. However, as the threat of the pandemic has waned, a renewed sense of optimism and positivity is taking hold, and many societies are relishing the return to face-to-face conferences, with all the knowledge-sharing and networking opportunities that go along with that transition. 

The Irish Society for Rheumatology (ISR) is one such organisation. Ahead of its upcoming Spring Meeting at the Sligo Park Hotel, Sligo, on 19-20 May 2022, ISR President Prof Geraldine McCarthy spoke with the Medical Independent (MI) about her hopes for the conference and the prospect of returning to the face-to-face setting. 

“Covid was still happening while we were organising this so we just had our fingers crossed really that it would go ahead, because we had been very keen to do that,” said Prof McCarthy. “We had to ‘go virtual’ for so many meetings [during Covid] that it’s with great delight that we’re able to have this meeting in Sligo and we’re very grateful to our hosts, Dr Carmel Silke, Dr Miriam O’Sullivan, and Dr Bryan Whelan [ISR members], who have been simply terrific. We also have a really interesting and varied panel, with something for everybody,” she said (see programme, p36). “Prof David Kane, as National Clinical Lead [for Rheumatology], has been great in terms of keeping us all informed and he really helped us to maintain a united front during Covid,” she added. 

The varied line-up of speakers will include a discussion on the role of JAK inhibitors (JAKis) in psoriatic arthritis and ankylosing spondylitis delivered by Prof Xenofon Baraliakos, Professor of Internal Medicine and Rheumatology at the Ruhr-University Bochum in Germany. “JAKis are a relatively new class of drugs for our patients with inflammatory arthritis that we are gaining experience with,” she said. “Reviewing the evidence for any of these drugs is always useful.” Prof Hector Chinoy, Professor of Rheumatology and Neuromuscular Disease at the University of Manchester, UK, will address the meeting on the topic ‘Update in the management of inflammatory myopathy’. 

Dr Ronan Kavanagh, Consultant Rheumatologist at the Galway Clinic and Bon Secours Hospital in Galway, will speak on the enigmatically-titled subject of ‘The music of rheumatology’, whilst Dr Katherine O’Reilly, Consultant in Respiratory and Acute Medicine at the Mater Misericordiae University Hospital (MMUH) in Dublin, will speak on ‘Interstitial lung disease (ILD) in rheumatic diseases’. “ILD can happen with some of our conditions in rheumatology, and of course it can be life-threatening in some cases,” Prof McCarthy told MI. “Dr O’Reilly is one of my colleagues in MMUH and she is very expert in this area, and she has a lot of experience with our complicated patients. We’re glad that she is available to speak to our society, because I imagine people will be consulting with her a lot in the future because of her expertise in this area.” 

Comorbidities 

Aside from clinical case study presentations and prize-giving ceremonies, the meeting features a talk by Dr Nicola Goodson, Consultant Rheumatologist at Liverpool University Hospitals in the UK, who will present a talk titled ‘Comorbidities in axial spondyloarthritis’, and Dr Eoghan McCarthy, Consultant Rheumatologist at Beaumont Hospital in Dublin, will speak on the theme ‘Biologic use in SLE [systemic lupus erythematosus]’. “Dr Goodson will talk about comorbidities in axial spondyloarthritis, such as diabetes, obesity, and the increased risk of heart disease, so that’s an important topic too,” she said. “Dr McCarthy has recently returned from the University of Manchester, and he will speak about the use of biologic drugs in lupus. I was very keen to have a speaker who is newly returned to Ireland. It’s fair to say that in the past couple of years, we have also had a number of our wonderful trainees who found themselves in a position to come back.” 

While there will not be virtual access to the meeting, it will be recorded so that anyone who was unable to attend in person will have the opportunity to review the content at a later time, Prof McCarthy explained. 

She added that the rheumatology community in Ireland “has pulled together really well” during the upheaval of the past two years. “Myself and Prof Kane communicated a lot during Covid because there were a lot of things that we needed to consider, and these changed as time went on,” she explained. “In the beginning, we didn’t know how our patients would react if they got Covid, would the risk increase, and so on,” said Prof McCarthy. “In fact, we participated in an international database of patients with rheumatic diseases… various centres would be able to give ethical approval. You would submit a case history, what condition the patient had, what drugs they were taking, and their outcomes. This database has proved extremely useful. It helped us to manage our patients with Covid and to know what the risks were in terms of what drugs they were taking.” 

Vaccines 

“Then we had the vaccines,” she continued. “Then we had to consider what drugs we needed to pause, and what drugs we needed to consider… we had meetings to inform and discuss these issues. We also had to arrange for our patients to get the vaccines, and of course people were very keen to get them. I think our levels of anxiety eased once we knew our patients were vaccinated, because we knew they if they did get Covid, they weren’t going to be as sick. A few of my patients did get Covid and unfortunately one of them, after a long and difficult illness, died. He had a few comorbidities but his arthritis wasn’t actually that bad. So that was a very stressful time, particularly in the pre-vaccination period.” 

I think our levels of anxiety eased once we knew our patients were vaccinated, because we knew they if they did get Covid, they weren’t going to be as sick 

The circumstance also required a lot of virtual consultations, but Prof McCarthy acknowledged that compared to other specialties, rheumatology is a difficult discipline in which to manage and treat patients remotely. “We couldn’t see new patients at the time and certainly, there were some patients who were in a bad way by the time they got to see us,” she said. “But with return patients [in virtual consultations], if they are stable and if you can get their blood tests, it’s actually quite a useful way of doing things…. Because if you have a patient from Donegal, for example, who is perfectly well and whom we may only have to see once a year [it works well], and it will change how we practise. But in patients who are sick, personally, I feel at something of a loss because there is so much subtlety in a consultation in the room that you just can’t get online. Even if someone has a rash or a swollen joint, there can be distortion in an image, or sometimes the signal is not good… I was so glad when I could see my patients again.” 

Regarding rheumatology in the Republic overall, Prof McCarthy commented: “I would hope that people returning to Ireland in rheumatology and other specialties will be facilitated to keep doing research, because research funding has become very challenging,” she told MI. “It can be discouraging for people who are in a busy clinical role to continue to do research, and I think research really keeps us interested in our specialty. It’s a bit like ‘the rich get richer’ – those with large grants get more. I would really hope that people can be facilitated to continue doing their research. It’s all about trying to seek excellence, rather than just ‘okay’.” 

Backlogs 

In common with other specialties, rheumatology also faces backlogs due to the pandemic. “A lot depends on the centre you are in,” explained Prof McCarthy. “In our centre, we were able to get some NTPF [National Treatment Purchase Fund] funding, so we were able to employ a high-level colleague who has really done a great job in clearing our waiting lists. We also have an excellent MSK [musculoskeletal] service to physiotherapy, where we can refer patients directly to them, and about 90 per cent of the patients we refer to them need no further involvement with us. A percentage of them [physiotherapists] might come back to us to say ‘would you mind ordering an x-ray or blood tests’, and a minority would ask us to see the patient. But between both those angles, we have done very well. Having said that, the referrals keep coming in, so some people might be treading water, but our waiting lists have certainly improved. Having senior decision-makers makes a huge difference and that’s why the gap in consultant positions in Ireland has got to be addressed because the lists can get worse across all specialties, and it’s sad to watch. But rheumatology is in a relatively good place compared to other specialties.” 

Returning to the meeting, Prof McCarthy concluded: “I am looking forward to it tremendously. We are a very affiliative group – we have all missed seeing each other in person rather than virtually, so I think it’s going to be a wonderful meeting and it is very well subscribed.” 

Irish Society for Rheumatology, Spring Meeting, Sligo Park Hotel, 19-20 May 2022

AGENDA 

THURSDAY, 19 MAY 2022 

16.15-17.15	WELCOME  CAG Meeting – Chaired by Prof David Kane
17.25-17.30	Opening Address  Prof Geraldine McCarthy, President, ISR
17.30-18.15	Prof Hector Chinoy  Professor of Rheumatology and Neuromuscular Disease, University of Manchester, UK  Update in the management of inflammatory myopathy
18.15- 19.00	Dr Ronan Kavanagh  Consultant Rheumatologist, Galway Clinic and Bon Secours Hospital, Galway  The music of rheumatology

FRIDAY, 20 MAY 2022 

09.00- 10.00	AbbVie Satellite Symposium  Dr David Kiefer  Consultant Rheumatologist, Rheumazentrum Ruhrgebiet Herne, Germany  The role of JAKis in AS and PsA: Reviewing the evidence for upadacitinib
10.00- 10.45	Dr Katherine O’Reilly  Consultant in Respiratory and Acute Medicine MMUH, Dublin  Interstitial lung disease in rheumatic diseases
10.45- 11.15	Coffee
11.15- 12.15	Clinical Cases
12.15- 12.45	STC Meeting  Dr John Ryan  Consultant Rheumatologist, Cork University Hospital
12.45- 14.00	Lunch
14.00- 14.45	Dr Nicola Goodson  Consultant Rheumatologist, Liverpool University Hospitals NHS Foundation Trust  Comorbidities in axial spondyloarthritis
14.45- 15.30	Dr Eoghan McCarthy  Consultant Rheumatologist, Beaumont Hospital, Dublin  Biologic – Use in SLE
15.30- 15.45	Prize giving and close of meeting