Participation in the American Congress of Rheumatology 2016, Washington, D.C.

The American Congress of Rheumatology (ACR) 2016 was held in Washington, D.C. (District of Columbia), the capital of the United States. The venue of the Congress took place in the recently built downtown Convention Centre, consisting of two imposing three-story buildings. This year’s ACR Congress was the 26th to date, and had approximately 17,000 attendees from all over the world. It was truly a great experience to take part.

The seemingly endless program of the congress could be downloaded as an application long before the opening of the Congress. As well as taking part in the different sessions, attendees could get in touch and meet colleagues from the field, after signing up with their profiles. Half of the lectures required extra registration and a fee to be paid; namely, pre-meeting courses, different workshops and ‘Meet the professor’ sessions. Extra registration was also required for guided poster tours although no extra fee had to be paid. Congress registration included the ACR sessions only; however, this covered the entire spectrum of rheumatology.

The majority of the program was on inflammatory rheumatic diseases, but osteoarthritis, soft tissue rheumatism, osteoporosis and numerous other topics were also discussed. The  plenary lectures were excellent. A separate session was organized for the knowledge competition among universities, the final of which was named Knowledge Bowl in a nod to the Superbowl, the American Football Final. Young rheumatology fellows also had a competition, presenting their interesting case reports (Thieves’ Market). The Congress officially was to last for three and a half days, but the Exhibition Hall had to be closed one day earlier. A large thanks has to go to the pharmaceutical companies for the sponsored symposia, which were organized every night during the Congress (including dinner), and in the post-congress afternoon (including lunch). Sponsored symposia took place in the different lecture rooms of a 6-star hotel attached to the Convention buildings. Future drugs, and molecules under development were introduced in the Innovation Theatre, with a buffet lunch served for those present. From among the pharmaceutical companies, special mention has to be given to Abbvie, Pfizer and the American Genentech for the outstanding role they played.

It would be too much to list the entire scientific program here. Biological therapies of the chronic inflammatory arthritides should be mentioned, debate of tapering and planned guidelines concerning anti-rheumatic medication use and joint replacement surgery in RA patients. JAK enzyme inhibitors given orally are alternatives of the parenteral anti-TNF drugs. Exercise therapy is key in maintaining physical activity. Loss of muscle mass and strength is accelerated in RA and there is a change in body composition, patients tend to have more adipose tissue, which is just as important as how many swollen and tender joints they have and how damaged their joints are. Resistance exercise and a protein-rich diet are an essential part of the RA treatment.

New treatment modalities emerge from DNA studies of the human “microbiom”; changes of our bacterial flora are in correlation with autoimmunity and systemic autoimmune diseases, such as chronic polyarthritis. Oral bacteria detected in periodontal disease play a role in hypercitrullination, production of citrullinated auto-antigens and anti- CCP antibodies, thus leading to RA induction.

Crystal-induced arthritides, gout and other calcium crystal diseases were also discussed. Targeting and maintaining adequate serum urate levels with urate lowering therapy as early as the first presentation of the disease is a crucial perspective of the present guidelines.

Polymyalgia rheumatica (PMR) is a systemic inflammatory disease in patients over the age of 50 with a typical rheumatic syndrome presentation. As a member of the American and European Work-Group, I took part at the yearly meeting and discussed new research with my expert-colleagues. Polymyalgia is associated with a much more dangerous disease, a kind of systemic inflammatory vasculitis. The only effective drug of treatment is steroid, long-term morbidity of which is substantial. For steroid-sparing, new clinical trials are under way. Results of an American and European multicentre study prove that an anti-IL 6 biological therapy could be a powerful steroid sparing agent, maintaining steroid-free sustained remission.

Polymyalgia and “giant cell arteritis” (GCA) were also discussed at the pre-meeting ACR Review Course. My favorite lecture compared these associated diseases to the shipping-fishing way of life in Chesapeake Bay, the region of Washington, D.C.

Interesting lectures and posters of “web-rheumatology” were on display. We could learn about some parts of the new American health care system called Medicare (AKA Obamacare), and hear the debates of its payment reform MACRA.A special focus of the congress was the presidential election 2016 of the United States, which had been held just a week before. Although some critical remarks could be heard at the congress, we hope that rheumatology, as any other specialty, remains independent of  political influence.

Finally, we must not forget the sights of Washington, the Jefferson and Lincoln Memorials, the statue of Martin Luther King, the War Memorials, the White House and Capitol Hill and we will always remember Washington’s Eye, the obelisk, and the home of George Washington, the first President of the United States. We certainly had a great time!