Eular 2014Highlights from the Scientific

Programme

Loreto CarmonaInstituto de Salud Musculoesquelética

Madrid, SPAIN

Disclosures

• I was not paid by a drug company to come here.• I have no actions neither special interests in any drug

company.• I have my own company of research on

musculoskeletal health, but will not present anything related to our results (despite it’s nothing on medications).

• I have received money sometimes for conferences or courses on mtehodology from drug companies, such as Pfizer, MSD, Abbvie, BMS

Highlights from the Scientific Programme

Tweets, pictures, facebook, e-mails….

EULAR Science

Methodology

Public health

Children

Basic science

Clinical science

Education

Diseases

Pain – Gary MacFarlane

OA - twitter

Osteoarthritis Also Jessica Bertrand (WIN OA):“Verapamil [used in hypertension] reduces inflammation in OA models in mice”“Clues to early OA:- Alteration of lymphatic vessels around

knee joint- Infrapatellar fat pad related to

inflammatory processes in knee OA“news in genetics of OA:- Evidence on interaction gene-

environment- COLL1A1 and VEGF genes related to hip

OA- BMP4 (involved in retinoid signaling)

related to hand OA

Psoriatic arthritisHarald Burkhardt (WIN on PsA):

“We now know much more on underlying mechanisms in PsA. The recently untangled TH17-driven effector pathways (IL-12/IL-23) are being targeted by therapies.”

“Three new drugs have been approved for PsA (ustekinumab, certolizumab, apremilast) after years of desert, and many are coming”

“The TICOPA study in the UK shows that the use of early and intensive treatment in PsA in routine clinical care leads to an improved clinical and radiographic outcome”

RA - twitter

RA – guidelinesJosé María Álvaro-Gracia

• “There are up and downs in guidelines”• “We may not adhere to them because we

have no time, we don’t know them, or… yes, because we disagree”

• “Sometimes it is very difficult to apply to individual patients: it is the patient’s social situation, his mode of life, limitations in measuring tools, patient profile, comorbidities…”

RA – Strategy trialsIf you start early enough with treatment, whatever you do is efficacious

SLE - twitter

SLE – Jaime Calvo

• “It is possible to stop (slowly) the corticoids”

• “Triple therapy with MMF + tracholimus + GC is the present”

• “Check the sunscreen whether the SPF/PPD is less than 3”

Gout – twitter & Fernando Pérez

Gout

PMR – GCA MA González-Gay• “Maria Cid talked on the pathogenesis. It is

not only TH-17 cells but the TH-1- IFN-gamma axis is now playing a key role in the risk of ischemic events associated with GCA.”

• “Dr Pipitone highlighted the importance of new imaging techniques, such as FDG-PET, in the diagnosis of aortitis in the setting of large vessel vasculitis. He also made clear that temporal artery doppler US is a complementary technique to the temporal artery biopsy for the diagnosis.”

PMR – GCA MA González-Gay

• “I discussed the pivotal role of steroids as the cornerstone of the therapy in the management of giant cell arteritis, and the potential use of biologic therapies, in particular anti-IL6 (tocilizumab), in the management of large vessel vasculitis refractory to conventional therapy.

•Hydroxychloroquine in Giant Cell ArteritisNCT00430807

•HECTHOR: Humira to Spare Steroids in Giant Cell ArteritisNCT00305539

•A Study of the Safety and Effectiveness of Infliximab (Remicade) in Patients With GCANCT00076726

•Abatacept for Treating Adults With Giant Cell Arteritis and Takayasu's ArteritisNCT00556439

•Tocilizumab for Patients With Giant Cell Arteritis NCT01450137

•Tocilizumab Effect iN pOlymyalgia Rheumatica (TENOR)NCT0171384

•A 3-arm Proof of Concept Study of AIN457 (secukinumab), ACZ885 (canakinumab) or Corticosteroids in Patients With Polymyalgia RheumaticaNCT01364389

http://www.clinicaltrials.gov

GCA THERAPYthe new & the old

Scleroderma

Children

Children – Dani Clemente

• “We need criteria that take into account some aspects of the clinical picture not included now” (Alberto Martini)

• “Regulatory-T-cells are involved in the pathogenesis of JIA” (Berent J Prakken)

• “Alarmins (Danger-associated molecular patterns (DAMPS) molecules) regulate inflammation in JIA”(Johanes Roth)

• “Four years results of the Strive register: Treatment modulates genetic expression”

PReS session (15:00-16:30) on advances in pathogenesis and classification criteria in JIA

Children – Seza Ozen

• “Management of patients with Familial Mediterranean Fever can be “tuned-up” safely by genotype”.

• “Lots of large studies going on: EULAR Projects in paediatric Rheumatology, PRINTO, Pharmachild, Eurofever, EPOCA…”

• “Lots of new criteria: Pediatric Behçet’s, macrophage activating syndrome, response criteria for polymyositis- dermatomyositis, autoinflamatory disease activity index…”Autoimmflamatory diseases (13:30-15:00)

“Check IgG4

abstracts!”

IgG4 related disease

• A systemic disease• Affects glands• Similar to Sjögren’s• May cause aorta

rupture or liver failure• Treated with corticoids

and IM

The “battle” on corticoids

GlucocorticoidsMaarten Boers

• “Good news: the bone loss after a year due to glucocorticoids in RA is much lower than what they used to say”

Bad news?

Glucocorticoids as confounders

Frank Buttgereit talked about how good steroids could be to bone.Will Dixon talked about the complexity of corticoid-related infections.

Angela Zink playing petanq

Comorbidity

Comorbidity Nemanja Damjanov

Comorbidity – Will Dixon

• Things can be good in a patient and bad in other.

• It is important to understand the context and to know the strength of association

• What association is stronger? – Statins protective effect?– NSAIDs effect on CV

health?

Comorbidity – Will Dixon

• “Data is clear: Stop smoking is much a stronger protective factor than statins”

• “Very few clinics have a program to quit smoking”

Comorbidity – Will Dixon

• “Dual benefits: corticoids may be good for many things; quit smoking also”

• “COMORA showed that depression is very frequent.”

• “Depression has an important impact on RA.”

• “We do not know how to detect and to diagnose depression.”

Measurement

Biomarkers

Biomarkers: useful or a waste of resources

Ted Pincus making his point that no good biomarker yet exists. Only what the patient says is still the best biomarker

Imaging

Imaging - Esperanza Naredo

The youngsters and the methodologists

“René Toes explained the inflammation process and where do therapies act.”

“Helen Leavis explained the microbiome its functions. Disbiosis [aletartion of bacteria in the gut] may alter equilibrium among Treg and Th17 cells and cause diseases”

Trials today

Basic Epidemiology explained

Johan Askling

1

23

Patient Primary care Rheuma

• “Talk to your GP” (Christian Mallen)• “Some strategies to reduce delay are

more cost-effective than others” (Bruno Fautrel)

• “Yes, but it may be worth it to know why patients do not come earlier”

Public health – GBD session

Thank you all!