With more than 130 scientific sessions and more than 1000 abstract presentations, it’s hard to pick, but we had a go.
The annual European Alliance of Associations for Rheumatology (EULAR) congress 2024 has wrapped up in Vienna.
Now in its 24th year, the EULAR European Congress of Rheumatology attracted more than 18,000 delegates from more than 130 countries, including medical doctors, scientists, people with arthritis/rheumatism, health professionals and representatives of the global pharmaceutical industry.
The EULAR 2024 Congress had an extensive program including more than 130 scientific sessions, two dedicated EULAR Recommendations Sessions and more than 1000 abstract presentations.
These covered the most up-to-date rheumatology research, practice and recommendations. Symposia led by experts from around the world provided invaluable insights into the most recent developments and future advancements in diagnosing, treating, and managing rheumatic and musculoskeletal diseases.
Here are some of the highlights.
ADVANCING PRP INVOLVEMENT IN RHEUMATOLOGY
In 2011 EULAR published the first set of recommendations focused on how best to involve patient representatives in scientific projects.
The recommendations also defined the input of patient research partners (PRP), but their role has since evolved and in more recent years the benefits of involving PRPs have increasingly been recognised.
To address this, EULAR engaged a taskforce of 13 researchers, two healthcare professionals and 10 PRPs to update its 2011 PRP recommendations.
The group completed a literature review to collect up-to-date information on the definition and role of PRPs, as well as to make recommendations on their recruitment, selection, and monitoring – and evaluate how much value they add to a project.
The task force developed five new OAPs, updated seven existing recommendations and formulated three new recommendations. The updated recommendations were published in the June 2024 issue of the Annals of the Rheumatic Diseases.
The OAPs address the definition of a PRP, the contribution of PRPs, the role of informal caregivers, the added value of PRPs and the importance of trust and communication in collaborative research efforts, the authors wrote.
The recommendations address the research type and phases of PRP involvement, the recommended number of PRPs per project, the support necessary for PRPs, training of PRPs and acknowledgement of PRP contributions.
New recommendations concern the benefits of support and guidance for researchers, the need for regular evaluation of the patient-researcher collaboration and the role of a designated coordinator to facilitate collaboration. Agreements within the task force were high and ranged between 9.16 and 9.96.
“This is a significant step forward in advancing PRP involvement in research,” the researchers wrote.
“Importantly, these recommendations provide a framework for the whole rheumatology research community to improve research practices and culture, and foster collaborative research. Moreover, these recommendations may be applicable in other specialties beyond rheumatology.
“However, challenges remain, such as reporting limitations and lack of evidence regarding the added value of PRPs in specific research projects and the role of a PRP coordinator. Further efforts are needed to address these challenges, gain consensus on the research agenda and fully implement the updated recommendations.”
NEW UNDERSTANDING OF NOVEL PATHWAYS IN SJÖGREN’S DISEASE
Two abstracts looked at Sjögren’s disease, specifically around furthering the understanding of the role of the salivary glands.
Sjögren’s disease primarily affects the salivary and lacrimal glands, resulting in tissue inflammation characterised by the formation of tertiary lymphoid structures (TLS) and a loss of glandular function, and consequent dryness of the eyes and mouth, fatigue, and poor health-related quality of life.
TLS are accumulations of lymphoid cells that share similar cellular compartments, organisation, and function as secondary lymphoid organs. Importantly, the presence of these structures in inflamed salivary glands associated with active disease, increased autoantibody production and malignancy risk.
In the first abstract, University of Birmingham researchers presented their work on Sjögren’s disease, specifically around furthering our understanding of the role of the salivary glands.
“To treat patients effectively, comprehensive understanding of the salivary gland microenvironment is needed, but current profiling efforts often struggle to capture high-plex ‘omics data while preserving the spatial architecture of the tissue,” said research team member Dr Saba Nayar.
The team, which included Dr Nayar, Professor Ben Fisher and Dr Jason Turner from the University of Birmingham’s Institute of Inflammation and Ageing and the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, mapped both identified cell types and novel populations, clustering tissue architectural features to define eight so-called neighbourhoods.
Some of these were enriched with epithelial cells, but others were associated with different immune cell populations. One neighbourhood was enriched with IgA plasma cells and was associated with myeloid populations – in contrast to other IgG plasma cells niches.
“Our innovative spatial mapping work has the potential to reveal previously unknown cellular landscapes and their interactions in patients, paving the way for targeted therapeutic approaches in managing Sjögren’s disease,” said Dr Nayar.
A second abstract focused on salivary gland epithelial cells (SGEC), which are already known to play a pathogenic role in Sjögren’s disease. Research is underway to develop and characterise differentiated organoids of SGEC derived from minor salivary gland biopsies of both patients and sicca controls. Organoids were shown to form and differentiate in both groups, with comparable self-renewal capacity of organoids for long-term culture.
The organoids expressed epithelial ductal and acinar markers and recapitulated the epithelial diversity. Exposure to pilocarpine-induced increased calcium levels – suggesting a capacity to secrete saliva in response to a cholinergic stimulation – but this effect was reduced in organoids derived from Sjögren’s patients compared to controls.
In conclusion, researcher Loïc Meudec said “additional characterisation investigations are ongoing to develop immuno-organoids that can be used to study the crosstalk between epithelial cells and immune cells and to test the effect of drugs on this crosstalk”.
IS FISH INTAKE LINKED TO JIA?
Juvenile idiopathic arthritis (JIA) results from a complex interplay of genetic and environmental factors, but past efforts to identify environmental risk factors have been restricted due to limited high-quality data and small sample sizes, mirroring the rarity of the disease.
In 2019, a Swedish prospective birth cohort study of over 15,000 children showed that consuming fish at least once a week during pregnancy and during the first year of life was associated with up to a five-fold increased risk of JIA, compared to those with fish consumption less than once a week.
This increased risk was primarily attributed to elevated exposure to heavy metals. Now, new research shared at EULAR is investigating the association between the risk of JIA and maternal fish consumption or dietary mercury exposure during pregnancy.
The large, population-based prospective cohort used data from the Norwegian Mother, Father, and Child Cohort Study, which recruited pregnant women in 1999–2008.
JIA cases were defined via linkage to the national patient registry. Maternal fish consumption was assessed using a food frequency questionnaire that covered the first half of pregnancy.
High fish consumption was defined as exceeding the 90th percentile – or 252g per week for lean and semi-oily fish, 157.5g per week for oily fish, and 427g per week for total fish intake. Dietary mercury exposure was estimated from the fish consumption data.
High mercury intake was classed as more than 20μg per week. Associations were adjusted for maternal factors, including age, education, pre-pregnancy body mass index, parity, daily caloric intake, inflammatory rheumatic disorders, as well as parental smoking in pregnancy.
The sample included 73,819 mother-child pairs and 218 cases of JIA in the children. The median total fish intake was 218g per week, and there was a positive association between JIA and high consumption of lean and semi-oily fish versus those with low consumption. No clear associations were observed between JIA and high consumption of oily and total fish.
Notably, no association was found between JIA and high mercury intake versus low.
“We found increased odds of JIA when the maternal intake exceeded 252g of lean or semi-oily fish per week compared with low intake,” said lead researcher Vilde Øverlien Dåstøl, a doctoral student at Oslo University Hospital in Norway.
“But the magnitude of our effect estimates was substantially smaller than the Swedish study and we found no association between total fish consumption or estimated dietary mercury exposure and JIA.
“It is crucial to emphasise that while our data indicates an association, causation cannot be definitively inferred. Therefore, we cannot caution pregnant women against consuming fish solely based on this study in regard to JIA risk, especially considering other research highlighting the positive impacts of a marine diet.”
PROTECTING CHILDREN WITH SLE
Childhood-onset systemic lupus erythematosus (cSLE) is a chronic, severe autoimmune disorder known to carry a risk of early organ damage.
Identifying specific predictors in children is vital for preventing such damage. EULAR ran a session on paediatric rheumatology that showcased new work on the factors associated with damage accrual in cSLE, with a focus on corticosteroid regimens and maintenance of low disease activity.
cSLE is a rare multisystem disorder with significant associated morbidity, but evidence-based guidelines are sparse, and as such management is often based on clinical expertise.
The EULAR/ACR-2019 criteria have shown sensitivity in cSLE patients, which could allow earlier recognition of patients with single or major organ involvement, but identifying specific predictors in this vulnerable group is vital for preventing long-lasting damage.
The new work, presented at the congress, aimed to show how clinical, demographic, and treatment variables correlate with damage accrual in cSLE.
Maria Hanif and colleagues hoped that stratifying patients according to average disease activity levels over the disease course would help them to identify independent predictors of damage –even in children with low disease activity.
To achieve this, data were collected in 430 children taking part in the UKJSLE Cohort Study. Analyses were performed across the entire cohort, as well as in two sub-groups based on disease activity – including low activity and moderate-to-high activity.
Over a median follow-up period of 46 months, 23% of children experienced organ damage. Within the entire cohort, multivariable analyses showed that three factors were associated with damage accrual: methylprednisolone exposure, time-adjusted mean Physician’s Global Assessment (PGA) score, and Adjusted Mean SLE Disease Activity Index (AMS) score. When looking only at the moderate-to-high disease activity sub-group, 28.1% experienced damage, but the same three factors were identified as predictors.
Within the low disease activity subgroup, 20.5% of children accrued new damage, and again methylprednisolone exposure and time-adjusted mean PGA score were associated with damage accrual, but not AMS score. This study underscores the role of corticosteroid exposure as a significant and potentially modifiable risk factor in cSLE, and suggests there is a need to review paediatric dosage limits which typically exceed adult recommendations.
Additionally, a direct link was found between disease activity and damage, with every 1-unit increase in SLE Disease Activity Index (SLEDAI) raising the risk of damage by 13–15% in those with moderate-to-high activity.
This was not observed in patients with an AMS of 4 or less, suggesting that low disease activity maintained via treat-to-target strategies could substantially reduce damage risk.
These findings highlight the need for updated treatment protocols that limit corticosteroid use whilst still effectively managing disease activity.
