The American College of Rheumatology’s annual meeting can be an overwhelming experience your first time around
The American College of Rheumatology’s annual meeting can be an overwhelming experience your first time around.
There are up to 22 sessions running every hour.
Hordes of rheumatologists and researchers hurry from session to session, flicking through the conference’s daily newspaper or scrolling Twitter feeds to assuage their growing FOMO.
The poster hall is gigantic; there are six guided poster tours a day to help lost souls navigate the sea of research. Every day the hall is stripped down and re-loaded with hundreds of new posters.
There’s an armada of sponsor stalls with sweeping banners of every colour.
Most of the overseas travellers are jetlagged. And, because you’re in America, the coffee is objectively terrible.
But there’s also this buzz of people from distant lands connecting, sharing ideas, learning. You can almost hear the cogs of global scientific machinery turning.
Before Rheumatology Republic reporter Felicity Nelson hopped on a plane to Chicago last October, she had never been to any international conferences – let alone one with 15,000 attendees from 106 countries! It was an exhilarating, disorientating and fascinating experience.
While in Chicago, Nelson caught up with two trainee rheumatologists who were attending their first international conference too: Dr Queenie Luu, rheumatology advanced trainee at Wollongong Hospital; and Dr Joel Riley, rheumatology advanced trainee at John Hunter Hospital in Newcastle.
Nelson also spoke with Dr Drew Yates, a rheumatologist trainee at the Royal Brisbane and Women’s Hospital in Queensland who had previously attended one other ACR annual meeting.
Q: What did you learn from attending this conference?
Dr Riley: I learned, from a poster, that you can leave urate crystals sitting on the bench for seven days and still find them under a microscope, which was news to me. It’s important because what it means for people who practise remotely a long way from the lab. You might have thought that there is no point sending in the crystals off because they won’t get to the lab in time. But even when there’s a big delay you should always send your crystals off.
The other thing I learned was the importance of skin biopsy in diagnosing small fibre neuropathy. We use thermal threshold testing, at least in Newcastle we do. But it seems that, internationally, skin biopsy is more important. I don’t even know if our pathologists can do it but that’s the discussion I’ll be having when we get home.
Dr Luu: I learned that ultraviolent-induced skin lesions for patients with lupus actually can take up to three weeks to manifest. If a patient says, ‘I went out and had a lot of sun yesterday and then I came up in a rash’, then we can appreciate that it was sun-related. But if the rash doesn’t come up until three weeks after sun exposure, it makes it very hard to pinpoint that in the history.
Dr Yates: I think the most important presentation at ACR was the results of the PEXIVAS study, a large randomised control trial studying ANCA-associated vasculitis and treatment with plasma exchange. The study found there was no reduction in risk of kidney disease or death in patients with ANCA associated vasculitis treated with plasma exchange compared to the control group. However, even more important than that, it found that a low-dose corticosteroid regimen in patients with ANCA-associated vasculitis was non-inferior to a high-dose regiment. We have been waiting with bated breath for the outcome of this study.
Q: What has the experience been like?
Dr Riley: It’s quite overwhelming I’ve found. It’s my first big international meeting and there is so much on. The fact that there is ACR Beyond this year relieves the FOMO quite a lot because I know that if I can’t get to something, I can catch up later.
Dr Luu: I’ve been impressed by the quality of the speakers as well as the presentations.
Q: Did you get the opportunity to network with rheumatologists from overseas?
Dr Riley: I’ve met some of my heroes. It’s been fantastic.
Dr Luu: I saw quite a few people who we recognised as authors on big papers giving talks. On a more personal level, we got to meet some of our colleagues from interstate in Australia. We became friends and did a bit of sight-seeing.
Dr Yates: This was a great opportunity to meet other fellow trainees from other countries.
Q: What sessions did you enjoy the most?
Dr Luu: I went to a session on conflict resolution and leadership skills for the academic. I found that really useful. They said that to be a really influential person you should be comfortable using both the logical domain and the emotional domain. Each person, based on their personality, will have a preference for a domain and good leaders can identify that person’s preference.
Dr Riley: I really enjoyed the history of cortisone lecture. It was a really interesting story. I didn’t realise this but one of the discoverers of cortisone actually killed himself. He could never enjoy his Nobel Prize and became very depressed because there was an enormous public backlash to cortisone. Initially, it “cured” arthritis and they thought, ‘This is it! We’ve cured it forever!’ And, shortly afterwards, they found out about all the horrible side effects, which we know about today. Ever since then there has been this huge divide. You know how some people are really vehemently anti-steroid and other people are more pro-steroid? I think that traces back to this history.
Q: What advice would you give to someone coming to the ACR annual meeting for the first time?
Dr Luu: I found using the app really helpful because there are like 10-15 sessions running concurrently. If you narrow it down to two or three or one, if possible, then you know exactly what your schedule is for the day.
Dr Yates: The best advice I have is to plan your sessions in advance. There’s an overwhelming number of things at any given time and it can be a bit difficult to work out what sessions are going to be most useful. ACR beyond however does allow you to access all the recorded sessions after the event.
Q: What will you change or do differently after coming to the ACR annual meeting?
Dr Luu: One of the things I learned was that antisynthetase syndrome can present as a symmetrical polyarthritis and mimic seronegative rheumatoid arthritis for years prior to the development of lung disease. I don’t routinely check for those antibodies when I work up a polyarthritis. I would consider that as a differential in the back of my mind and I would actually check those antibodies. I would do the ENA panel. So that would be one of my practice-changing things.
Dr Riley: Well, there was one poster looking at people with cutaneous lupus. These were biopsy proven and the patients had negative ANAs. But 40% of them actually ended up meeting criteria for SLE despite their negative ANAs. So I am going to be more careful with people with cutaneous lupus and negative ANAs and not be as reassured that they are free from systemic manifestations of lupus.
Dr Yates: An interesting study examined mortality risk in patients with a diagnosis of gout. They actually found that reaching serum uric acid level targets reduced overall mortality. It’s more information we can present to patients with gout to encourage them to remain compliant with urate lowering therapy, not only to treat gout, but to lower their risk of death.
