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Latest advances in rheumatology

The forthcoming Autumn Meeting of the Irish Society for Rheumatology (ISR) promises to be a stimulating and informative gathering for medical professionals working in rheumatology. The meeting is due to take place in the Kilashee Hotel, Naas, Co Kildare, on 15 and 16 September.  As ever, the meeting will feature a range of interesting presentations from expert speakers about the latest research and guidelines in the area.

Dr Frances Stafford, Consultant Rheumatologist at the Blackrock Clinic, Dublin, and Honorary Secretary of the ISR, spoke to the Medical Independent in advance of the meeting.

“The ISR is a wonderful association,” Dr Stafford said.
“In general, it is very welcoming of all medical staff involved in rheumatology with respect to education and encouragement of all professional development.”

As regards the meeting, Dr Stafford said that the first plenary session, which will be delivered by Prof Sean Gaine, Consultant Rheumatologist in the Mater Hospital, Dublin, on the management of pulmonary hypertension, will be of great interest.

“It is an illness seen in a percentage of our patients with scleroderma or other connective tissue disease,” she said.

“The medical treatment of it has advanced greatly in the last 10-15 years. Also, life expectancy, which was very poor 25 years ago, has improved dramatically, with the introduction of variety of medicines.”

Dr Stafford also highlighted the second plenary session, which will be delivered by Prof Dennis McGonagle, who is Professor of Investigative Rheumatology with the Leeds Institute of Rheumatic and Musculoskeletal Medicine, UK. Prof McGonagle is internationally recognised for his work in microanatomy and imaging to elucidate the pathogenesis of inflammatory diseases and for his work in the biology of mesenchymal stem cells in arthritis and their role in pathogenesis/repair in rheumatic diseases. His major interests include imaging to understand pathogenic mechanisms of arthritis in men and using this imaging knowledge to define the cellular and molecular basis for disease initiation. He will speak about enthesitis and dactylitis at the meeting.
“Prof McGonagle has done a huge amount of work in the imaging of these with MRI and his talk is highly anticipated,” according to Dr Stafford.

The third plenary session will be delivered by Dr Bruce Kirkham, Consultant Rheumatologist at Guy’s and St Thomas NHS Foundation Trust, UK, who will speak about MOA development and potential targets for IL-17.
“It is an area of more recent discovery and improvement in treatment, especially in psoriatic arthritis, but also may apply in other associated rheumatic diseases,” Dr Stafford said.

“The anti-TNFs were the first biologic therapies and they have been available for about 15 years. Following that, a number of other antibodies were introduced, and more recently IL-17 was found to be particularly worth targeting for patients with psoriatic arthritis and also ankylosing spondylitis.”

The fourth plenary session is titled ‘Getting it right first time — predictive factors for initiating biologic therapy’, and will be delivered by Dr Patrick Kiely, Consultant Rheumatologist in St George’s Hospital, London, UK. The final plenary session will be delivered by Prof Donal O’Shea, Consultant Endocrinologist in St Vincent’s University Hospital, Dublin, on the links between obesity and inflammatory arthritis and inflammation.

“They feed into each other,” according to Dr Stafford.
“In all our illnesses, it is important to be cognisant of other aspects that compound a bad outcome, such as obesity and metabolic syndrome, and cardiovascular risk factors.”

In addition to the plenary sessions, there will also be poster presentations and awards.

“These presentations are of excellent quality and it improves every year,” she said.
Similarly, Dr Stafford believes that the entire field of rheumatology is improving,” even if that improvement may be incremental. Research gains are always incremental,” she said.

“A huge advance 15 years ago was the anti-TNFs. Since then, it has been smaller steps, but very steady progress. It was an exponential leap, finding out that these biologic agents are safe and work as well as they do, with a very acceptable safety profile. Since then, there have been a lot of further developments in that area that are clinically applicable. And we are seeing real changes in a whole variety of immune and inflammatory diseases.”

A number of years ago, the ISR stated that all inflammatory arthritis patients should be seen within six weeks of referral. Early treatment is vital in order to halt progress of the condition.

“I think GPs were already aware of the importance of early referral, but it highlighted the importance of patients with inflammatory arthritis being seen early by a rheumatologist, because we are the ones most familiar with the treatments and medications that prevent long-term damage of the joints. And since I began doing this many years ago, the outcomes have improved greatly because we have a better understanding of how to use the treatments and we also have newer agents to add to the traditional treatments, which have made a big difference.”

Dr Stafford, who has been based in the Blackrock Clinic for the past 20 years, said that while the private sector has an important role to play in seeing patients with rheumatological problems, she would like to see access improved in the public system.

“There are some areas in which the public sector does best and some areas in which the private sector does best,” Dr Stafford said.

“I think it would be nice if everybody had access to all care and that should be the ideal, and that was the Government’s [goal], to aspire to universal healthcare, but obviously we have a long road to get there.”

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