Blog: My experiences from EULAR

by Tazeen Ahmed

Let me first say that this brief blog can’t capture the enormous amount of research and best clinical practice covered during the 2015 Congress of the European League Against Rheumatism (EULAR), held in Rome.

These are my personal highlights, and I have to say I often struggled to decide which of the many parallel streams to attend and was glad of the excellent highlights summary on the last day of the conference. The EULAR smartphone app was immensely useful in planning my days and provided access to a wealth of abstract information at my fingertips. 
For me the first day’s highlight was the HOT (“How To Treat”) session on Raynaud’s and systemic sclerosis. Combination therapy with ambrisentan (an endothelin receptor blocker) and tadalifil (a phosphodiesterase type 5 inhibitor) showed an improvement in the 6 minute walk test over monotherapy (AMBITION trial). Exercise training resulted in better outcomes on the 6 minute walk test than sildenafil, iloprost or bosentan. Mycophenolate has also shown promise in reducing skin involvement and stabilising lung function. Rituximab used off label showed decreases in skin score and improvement of lung function. This was followed by a how to treat session on Sjögren syndrome which highlighted the evidence for pilocarpine and cevelimine in helping with dryness and also provided tips on ameliorating side effects.

The session on imaging in early arthritis was interesting, supporting the use of ultrasound in the diagnosis and treatment of early arthritis patients - 87% of whom are non-erosive on conventional X-rays. Power Doppler shows prognostic promise in determining likelihood of progression. The following imaging session by Georg Schett reiterated the importance of power Doppler in predicting relapse after tapering medication.

"For me the first day’s highlight was the HOT (How To Treat) session on Raynaud’s and systemic sclerosis."
EULAR recommendations for women’s health in lupus and antiphospholipid syndrome were enlightening. Assisted reproductive techniques should only be recommended if the woman has been stable. Ovarian hyperstimulation should be avoided. It was useful to know what can and cannot be used during a flare during pregnancy. The role of hormone replacement therapy was also clarified.

There have been steps forward in rheumatoid arthritis therapy. These include the negative study result of ustekinumab and guselkinumab bringing into question the role of IL23 and IL12 in rheumatoid arthritis and the positive study with mavrilimumab, an anti-GMCSF antibody.

New targets in systemic lupus erythematosus include the IL6 pathway, with positive results from an anti IL6-L with 3 out of 4 patients with active disease responding to a 10mg dose Tabalumab, an anti-BAFF (B-cell activated factor) antibody, showed mixed results but had a good safety profile. There was new data presented further supporting the safety and efficacy of hydroxychloroquine in pregnancy.

Rohit Aggarwal presented a thorough review of current treatments in refractory myositis and emphasised the need for more randomised controlled trials in this rare and hard to treat group of diseases. This was followed by a randomised controlled trial of exercise in myositis, demonstrating clear benefits on muscle strength and even histological cross-sectional area of muscle fibres.

New biologics in ankylosing spondylitis are ustekinumab and secukinumab but there is still no evidence that anti-TNF medication halts structural progression, except maybe with early treatment.

The clinical highlights session was a good roundup of the congress and covered some topics that I had just not managed to get to. The news regarding hydroxychloroquine and hand osteoarthritis was disappointing. The use of romosozumab (anti-sclerostin ) for two years then denosumab ( anti-RANKL) for one year showed an improvement in bone mineral density but not yet fracture risk.

I haven’t even mentioned the many interesting and varied posters that I read during the conference - both on the poster rounds and on my own. Highlights included the use of abatacept in myositis, new evidence supporting physical activity and self-management programmes in a wide range of diseases, and further health economic data regarding the effects of drugs on work productivity. There was bad news regarding non-adherence to medication, with a significant effect on DAS 28 in rheumatoid arthritis but also good news that statins work in a rheumatoid population with an effect equivalent to that seen in the general population.

EULAR 2015 was an amazing experience with so much on offer it was difficult to see everything. I hope I’ve given you a flavour of the multiple areas of rheumatology practice that I experienced. Hope to see you at EULAR 2016 in London!

Tazeen Ahmed is a locum consultant in Rheumatology at Croydon University Hospital. Her interests include early arthritis and joint ultrasound. She completed a PhD exploring novel small molecule targets in Rheumatoid arthritis.