Dr. Dostrovsky is a 2020 ORADE Grant recipient.
I would like to thank the ORADE committee and the ORA for sponsoring me to virtually attend the 2020 ACR Review Course and the 2021 NYU Langdone Siminar in Advanced Rheumatology I had planned to attend the 2020 NYU course in person in March 2020, but it was cancelled as it coincided with the beginning of the Covid pandemic. Although I missed the chance to travel to New York, both the 2020 ACR Review Course and 2021 NYU course were valuable learning experiences and included a mix of basic science and clinical topics. I will summarize some of the topics I found particularly informative:
New lupus treatments:
Richard Furie and Susan Manzi (NYU course) and Dr. Liz Lightsone (ACR review course) discussed new treatments for lupus. These included Anifrolumab which has variable but overall promising phase III trial results, particularly for cutaneous lupus, and is being assessed for approval by the FDA in the USA. There are also three potential adjuvant/add-on treatments for lupus nephritis with promising results Belimumab and Voclosporin (phase III results) and Obinutuzumab (phase II) that hopefully will allow better control of lupus nephritis and ultimately less renal fibrosis and damage.
Review of cutaneous lupus:
Ruth Ann Vleugels (NYU course), a dermatologist from Harvard, gave a concise review of cutaneous lupus including pearls for treatment. She emphasized the importance of sun protection and particularly suggested sunscreen with either zinc or titanium for all lupus patients. She also highlighted how smoking exacerbates cutaneous lupus, and showed photos of patients’ rashes improving with only smoking cessation. She noted that for most patients with cutaneous lupus, particularly discoid lupus, topical agents are not sufficient to prevent scarring. If patients fail 1st line systemic treatment with antimalarials, she suggested using either methotrexate or mycophenolate. She also discussed thalidomide and lenalidomide for refractory cutaneous lupus and noted she had found it very helpful for her patients. However, I’m not sure it these are accessible for cutaneous lupus treatment in Ontario
Update on CPPD
Ann Rosenthal (NYU course), a rheumatologist and researcher from the medical college of Wisconsin, gave an interesting talk about CPPD. Although I see CPPD relatively frequently in my office, I generally hadn’t thought about crystal arthritis as being significant from a health care funding perspective. She showed data that in France, crystal arthritis was estimated to cost the health care system 82 billion euros or close to 126 billion Canadian dollars annually, mostly due to patients requiring hospital admissions or by extending hospital admissions.
She also addressed the challenges of diagnosing CPPD through microscopy and discussed some new technologies that are being studied including semicomputational microscopy which does not require polarized light as well as chemical methods to help improve crystal detection.
Finally, I found the part of her talk about management of chronic inflammatory CPPD helpful. This is a rare manifestation of CPPD, and although I only have several patients in my practice with it, I find treating them challenging. Dr. Rosenthal noted there was not much evidence but suggested using a mixture of medications including either colchicine or hydroxychloroquine (whichever patients tolerate) and the lowest dose of prednisone that is effective to control pain. In patients with a polyarticular pattern of CPPD, she also has found methotrexate helpful.
Steven Abramson (NYU course) gave a sobering talk about the current treatment paradigm for osteoarthritis, notably that none of the many trials of potential disease modifying osteoarthritis drugs (DMOADs) have been successful. He did identify some promising areas of future research which may (hopefully) lead to development of better treatments in the future. In particular, he showed that only a subset of osteoarthritis patients have progression, and so trials that target all osteoarthritis patients may have their results dampened by non-progressors. There are biomarkers, including our usual inflammatory ones such as TNF, IL-1 and COX-2 that seem to help identify those patients that are more likely to progress, and may in the future help with patient selection for osteoarthritis trials, which he speculated would increase the chances of successful trials.