Preparing the rheumatologists of tomorrow

Irish Society for Rheumatology President Dr John Ryan speaks to Catherine Reilly about the Society’s much-anticipated Spring Meeting

Educating the “consultants of tomorrow” will be a key strand of the Irish Society for Rheumatology (ISR) Spring Meeting. The conference takes place on 10-11 April in Sligo.

A training meeting for specialist registrars (SpRs), organised by Our Lady’s Hospital, Manorhamilton, will be held prior to the main conference. ISR President Dr John Ryan told the Medical Independent (MI) this forum will provide trainees with an opportunity to engage with experts who will be presenting at the Spring Meeting.

SpRs will also deliver clinical case presentations during the conference. Dr Ryan, a Consultant Rheumatologist at Cork University Hospital, anticipated that this “interactive” session will be of great interest to delegates.

“The clinical cases are an opportunity for our SpRs to highlight their expertise to the greater group of rheumatologists… it is always a very interesting session, because [the case] can be rare presentations of something common or a seemingly common issue caused by something quite rare, or complications of treatment. It is always intriguing.”

The ISR President also revealed that, at the conference, the Society will be launching a travel bursary aimed at SpRs.

“There will be three bursaries available to those in the Republic of Ireland and one in Northern Ireland to facilitate attendance or ideally a presentation at the ACR [American College of Rheumatology Annual Conference]. We will be inviting our SpRs who have submitted abstracts to ACR to apply for a bursary to attend ACR, so there is a great opportunity to gain exposure to what has been the premier international meeting and to also hopefully showcase Irish research at that meeting.”

Dr Ryan confirmed that rheumatology remains a “highly sought after specialty” among trainees in Ireland. “[Doctors] are enthused to enter it and it is competitive to enter, which is excellent to note. So we are really looking forward to having new trainees on board and to continue training those existing SpRs.”

Eclectic

The programme for the ISR Spring Meeting covers an eclectic range of topics. The first presentation on eye manifestations in inflammatory rheumatic disease will be presented by Prof Conor Murphy, Professor of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin.

Patients with rheumatic disease may experience eye manifestations, such as uveitis.

“We face a challenge in that often people’s systemic disease can be quiet, and yet their eyes can be active, and we are very dependent on our eye colleagues to keep us updated on the disease activity,” explained Dr Ryan.

It is important for rheumatologists to understand the approach of ophthalmologists in regard to eye manifestations, the types of treatment available, as well as the unmet needs.

“Prof Murphy has a special interest in uveitis so it is excellent to have him,” added Dr Ryan.

Myositis syndromes will be the focus of the next presentation from Dr Harsha Gunawardena, Consultant Rheumatologist, Autoimmune Connective Tissue Disorders and Vasculitis, Divisional Clinical Director, Neurosciences Musculoskeletal Division, North Bristol NHS Trust, UK.

“There has been a vast expansion in the antibodies that are available to try and identify the underlying cause of some patients presenting with muscle pain and weakness and… with the greater awareness there has also been greater opportunities to offer treatment earlier or decide when treatment is appropriate,” said Dr Ryan.

Dr Ryan confirmed that rheumatology remains a ‘highly sought after specialty’ among trainees in Ireland

“[Dr Gunawardena] has a large cohort of patients. They are rare conditions, so it is really useful to hear from somebody who is encountering them frequently….” Dr Ryan noted that it would be opportune to discuss issues such as the utility of some of the antibody testing and the requirement for muscle biopsy, which is somewhat controversial.

A satellite session covering updates in psoriatic arthritis, sponsored by Johnson & Johnson, will conclude the first day of proceedings. The speaker is Dr Richard Smith, Consultant in Rheumatology, Musculoskeletal and Sports Medicine, Salisbury NHS Foundation Trust and New Hall Hospital, Bodenham, UK. Dr Ryan said Dr Smith has expertise in psoriatic arthritis and his presentation would be of much interest.

The final day of the ISR meeting (Friday 11 April) opens with a clinical update on systemic lupus erythematosus by Prof David D’Cruz, Professor of Rheumatology, Guy’s and St Thomas’ Hospital, London, UK.

“The Guy’s and Thomas’ group have a large lupus cohort,” noted Dr Ryan. He added that Prof D’Cruz is at the forefront of treatment and his insights would also be helpful in the context of Ireland’s growing multi-ethnicity.

“Lupus in particular can be far more severe in people who have African ancestry and while it is rare in Asians, where it does occur it tends to be very severe,” he explained.

Prof Seán Gaine, Professor of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, and Director of the National Pulmonary Hypertension Unit, will share updates in the area of pulmonary hypertension.

Dr Ryan noted advancements in the treatment of pulmonary hypertension as well as a change in the disease definition. The ISR President said rheumatologists are interested in which patients will benefit from new therapies and the optimum time of referral to specialists in pulmonary hypertension.

“It is a rare condition, but it is more common in some of our patients with connective tissue diseases so we would be on the lookout for it,” he added.

What to do when all conventional rheumatoid arthritis treatment options are exhausted will be explored by Prof Dennis McGonagle, Professor of Investigative Rheumatology and Section Head of Experimental Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and Leeds Teaching Hospitals NHS Trust, UK.

Originally from Donegal, Prof McGonagle is a widely published academic rheumatologist who has won awards for his work. Dr Ryan anticipated that Prof McGonagle would be able to share insights and granular knowledge of what potential new treatments may be coming.

“It will be interesting to hear his thoughts as there are some interesting developments from Germany, in particular, about new therapies that we would hope to have access to once the data are confirmed in large groups,” commented Dr Ryan.

A satellite meeting (sponsored by CSL Vifor Pharma) focusing on emerging therapies in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis will close-out the conference. This topic will be presented by Dr Mark McClure, Consultant Nephrologist, Belfast Health and Social Care Trust.

Dr Ryan noted the HSE’s reimbursement of avacopan, which is a new therapy available for the treatment of certain forms of severe, active ANCA-associated vasculitis. “We are fortunate that the HSE has reimbursed this therapy. It has been a long-awaited reimbursement because ANCA vasculitis patients end up on a lot of steroid, with the risk of infection, but this agent allows a much lower dose of steroid to be used with great benefit in terms of reducing all the side-effects of steroids that become apparent years later.”

In conclusion, Dr Ryan extended his gratitude to all in the ISR who have assisted in the organisation of the Spring Meeting. He also thanked Dr Killian O’Rourke, Consultant Rheumatologist, Midland Regional Hospital, Tullamore, for his work arranging speaker invitations.