press review issue 1 - emeunet...has been licensed for psoriatic arthritis, showed no effect in a...

THE EMERGING EULAR NETWORKEDITION SEPTEMBER 2015

Annals of the Rheumatic Diseases

Arthritis and Rheumatology

Arthritis Care & Research

Arthritis Research & Therapy

Rheumatology (Oxford)

The Journal of Rheumatology

Miscellaneous

PRESS REVIEW ISSUE 1

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DIRECTORY

SEPTEMBER15

EDITORIAL

PAGE 2

Dear young rheumatologists andresearchers in rheumatology,

We are happy to present you the first issue of a new

format of EMEUNEWS: the Press Review.

The Press Review, planned to be released three times

a year, aims at providing you with an overview of most

relevant articles published both in top rheumatology

journals and in most important general medicine

journals during the previous 4 months.

The selection is totally personal and therefore very

limited and incomplete, but it still might give an

overview of hot topics that have been discussed and

investigated in the most recent literature.

If this is your first contact with EMEUNET, we invite

you to explore more and join us. If you are already part

of our community, we kindly remind you that sharing is

caring. Spread the word about our activities and work,

and help us reach more young rheumatologists and

researchers.

We hope that you enjoy reading this Newsletter and

would be happy to receive any comments and

suggestions for future issues.

The EMEUNET NEWSLETTER SUBGROUP

PRESS REVIEW

Annals of the Rheumatic Diseases 3

Arthritis and Rheumatology 4

Arthritis Care & Research 5

Arthritis Research & Therapy 6

Rheumatology (Oxford) 7

The Journal of Rheumatology 8

Miscellaneous 9

EULAR REGISTERS AND OBSERVATIONAL

DRUG STUDIES (RODS) 11

EULAR ON LINE COURSES 12

EULAR IMMUNOLOGY COURSE 13

SOCIAL MEDIA AND ABSTRACT DEADLINES 14

More information about EMEUNET can be found in

http://emeunet.eular.org

You can also reach us through the following email

[email protected]

www.facebook.com/EMEUNET

www.twitter.com/EMEUNET


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ANNALS OF THE RHEUMATIC DISEASES

PAGE 3

Francesco is

consultant at the

Department of

Internal Medicine,

ASL 1 Avezzano,

L’Aquila, Sulmona,

and research

associate at the

Rheumatology Unit,

University of

L’Aquila, Italy. His

main interests are

Sjögren’s syndrome,

B-cell targeted

therapies,

spondyloarthritis and

musculoskeletal

ultrasonography.

ANNALS OF THE RHEUMATIC DISEASES

Volume 74 Issues 5-8

Francesco Carubbi, MD PhD

Concerning recommendations and disease specific scores, the Paediatric Rheumatology

International Trials Organisation (PRINTO) and Eurofever Project developed and validated a set of

clinical criteria for the classification of patients affected by periodic fevers (pp 799-805); the EULAR

Sjögren's Task Force validated the EULAR primary Sjögren's syndrome disease activity (ESSDAI)

and patient indexes (ESSPRI) (pp 859-866); EULAR recommendations for the use of imaging in the

diagnosis and management of spondyloarthritis in clinical practice were released (issue 6 pp 1327-

1339); Kiltz U. reported about the development of a health index in patients with ankylosing

spondylitis (ASAS HI) (pp 830-835). In the field of biologic therapy in inflammatory arthritides,

results from the ARTIS study group obtained in over two thousand patients with either ankylosing

spondylitis or undifferentiated spondyloarthritis revealed that the use of conventional synthetic

disease modyfing anti-rheumatic drugs (DMARDs) comedication was associated with better 5-year

retention to the first TNFi. (pp 970-978). In addition, real life data from the SWITCH-RA study

demonstrated that, switching to rituximab (RTX) after discontinuation of an anti- TNF was associated

with significantly improved clinical effectiveness compared with switching to a second anti-TNF,

mainly in seropositive patients and in those switched because of inefficacy (pp 979-984). Yun JH

investigated hospitalized infection rate in over ten thousand RA patients receiving biologic therapy

for at least 1 year and reported that abatacept and etanercept were associated with the lowest risk of

subsequent infection compared to other compounds (pp 1065-1071). In addition the BSRBR Control

Centre Consortium observed that the addition of anti-TNFi to csDMARD does not change the risk of

cancer in RA patients included in the British Society for Rheumatology Biologics Register (1087-

1093). The PRINTO and the Pediatric Rheumatology Collaborative Study Group (PRCSG) carried

out a phase 3 randomised double blind trial to evaluate tocilizumab in juvenile idiopathic arthritis

(JIA) and observed a consistent clinical efficacy and a safety profile similar to that of adult RA

patients (pp 1110-1117). Biologics are also increasingly used in other rheumatic conditions, the

European Vasculitis Society (EUVAS) observed no differences at 24 months in rates of the

composite outcome of death, end-stage renal disease and relapse between RTX and

cyclophosphamide (pp 1178-1182). RTX was also found effective in systemic sclerosis (SSc) by

improving skin fibrosis and preventing worsening of lung fibrosis compared to untreated patients

from the EUSTAR database (pp 1188-1194). The well-known cardiovascular risk burden in

rheumatic diseases was further supported by Aulie HA who reported that adult patients with JIA with

long-term active disease have altered arterial haemodynamics (pp1515-1521). In addition, Berg IJ

demonstrated that baseline C reactive protein and AS disease activity score (ASDAS) are

associated with future arterial stiffness in AS (pp 1562-1536). Finally, metabolic syndrome appears

to be driven by renal involvement, active inflammatory disease and damage are disease-related

factors in SLE as reported by Parker B. (pp 1530-1536)

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ARTHRITIS AND RHEUMATOLOGY

PAGE 4

Richard has

completed specialist

training in

rheumatology and

general internal

medicine and is

currently a vasculitis

fellow at University

College Dublin,

Ireland. His major

research interests

include giant cell

arteritis and meta-

analysis

ARTHRITIS AND RHEUMATOLOGY


Richard Conway, MD

Despite the ever increasing armamentarium available to rheumatologists in the treatment of

rheumatoid arthritis (RA), there remains a group of patients who are resistant to currently available

treatments. Therefore the continued development of novel agents remains important. Genovese et

al. (pp 1424–1437) report the result of a phase 3 double-blind randomised controlled trial of the anti–

IL-6Rα monoclonal antibody sarilumab in methotrexate inadequate responders. Sarilumab

demonstrated significant improvements in clinical, functional and radiographic outcomes of a similar

degree to other biologic agents. In contrast the oral phosphodiesterase 4 inhibitor apremilast, which

has been licensed for psoriatic arthritis, showed no effect in a randomised controlled trial of

methotrexate inadequate responders with RA (pp 1703–1710).

Teng et al. (pp 1703–1710) report on the associations of dietary intake with gout in an Asian

population. The majority of studies associating gout with diet have been performed in Western

populations and it may not be correct to extrapolate these findings to other settings. In their study of

an ethnically Chinese population the authors reported significantly elevated risk for physician

diagnosed gout with hazard ratios (HRs) of 1.27 for total protein and poultry intake, and 1.16 for fish

and shellfish intake. Soy food intake and non-soy legumes were associated with a decreased risk of

gout, with HRs of 0.86 and 0.83 respectively.

There has remained some concern over the safety of the co-administration of denosumab with other

biologic agents in patients with RA and osteoporosis. Curtis et al. (pp 1456–1464) provide

reassurance in this regard. In an analysis of 5814 patients they demonstrated no increased risk for

hospitalised infections in biologic treated RA patients commenced on denosumab compared to

those commenced on zoledronic acid.

Systemic sclerosis is a heterogenous disease and the ability to predict those at risk of disease

related complications is desirable. Hoffmann-Vold et al. (pp 2205–2212) report on the value of a

baseline high resolution CT scan in the prediction of the development and progression of pulmonary

fibrosis. IgG4-related disease remains a relatively new disease with ongoing development of our

understanding of its features and optimum management strategies. The recent consensus statement

by a group of international experts led by Khosroshahi is therefore valuable to those treating this

entity (pp 1688–1699).

Predicting the success rate of total joint arthroplasty is an important factor in the decision making

process around this surgery. Brummett et al report that characteristics of fibromyalgia even in the

absence of a definitive diagnosis predict worse outcomes for total hip and knee arthroplasties (pp

1386–1394).

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ARTHRITIS CARE & RESEARCH

PAGE 5

Mislav is Assistant

Professor of Internal

Medicine and he is

currently working in

the Division of

Rheumatology and

Clinical Immunology

University Hospital

Split, Croatia. His

scientific and clinical

interests are

systemic sclerosis,

osteoarthritis,

vasculitis,

epidemiology and

imaging tools in

rheumatology.

ARTHRITIS CARE & RESEARCH


Mislav Radić, MD PhD

Registers are extremely important in the field of rheumatology. Radner et al. (pp. 1219–

1229) have performed web survey which was sent to 27 European RA registers/clinical

cohorts, requesting information on which specific data items were collected, how and with

what frequency they were collected, how often data were missing, and if the items

collected were regarded as useful for research. The final conclusion of this article was that

even though certain items are regularly collected, the mode of data collection and the data

definition are heterogeneous. Harmonization of data collection across European clinical

RA data sources is therefore pivotal for future collaborative studies. It is obligatory to

remember the necessity of registers. Furthermore, what about gout, in my opinion it is

underestimated. Taylor, et al. (pp.1304-1315) have updated Gout Classification Criteria.

Systemic lupus is still a mystery and we desperately need some new finding in purpose to

understand the pathophysiology of this disease. Previous cross-sectional studies have

observed that muscle weakness is associated with worse physical function among women

with systemic lupus erythematosus. Andrews et al. (pp.1070–1077) have examined

whether reduced upper and lower extremity muscle strength predict declines in function

over time among adult women with systemic lupus. One hundred forty-six women from a

longitudinal systemic lupus cohort participated in this study and the results were that lower

extremity muscle strength strongly predicted changes over 2 years in physical function

even when controlling for covariates. This study has showed that reduced lower extremity

muscle strength predicted clinically significant declines in physical function, especially

among the weakest women. Diet as a drug, fact or fiction? White et al. (pp. 965–971),

have examined whether an intensive lifestyle intervention (ILI) prevents incident knee pain

compared with a diabetes mellitus support and education (DSE) comparison group among

overweight adults with diabetes mellitus. Age, sex, and body mass index were similar

among ILI and DSE participants with no knee pain at baseline. At year 1, ILI participants

were 15% less likely to develop knee pain compared with DSE participants (RR 0.85, 95%

confidence interval 0.74–0.98). At year 4, this difference decreased to 5% and was no

longer statistically significant. An ILI of diet and exercise may prevent the development of

knee pain among those at high risk in the short term. Health care providers may consider

recommending diet and exercise as a means to prevent the development of knee pain

among those at high risk.

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ARTHRITIS RESEARCH AND THERAPY

PAGE 6

Joanna works as

senior assistant at the

Jan Biziel Hospital in

Bydgoszcz, Poland.

Her main area of

research focuses on

RA, Sjogren

Syndrome,

Hashimoto disease,

effectiveness of

radiation

synovectomy in

rheumatic diseases,

SLE and vasculitis.

ARTHRITIS RESEARCH AND THERAPY

Volume 17 Issues May-August

Joanna Zalewska, MD PhD

Smolen et al (245) reported the safety and benefits of certolizumab pegol (CZP)+methotrexate

(MTX) treatment for almost 5 years in patients with rheumatoid arthritis (RA) in randomized

controlled trial (RAPID). The authors noted the clinical improvements (mean DAS 28, ESR and ACR

20/50/ 70 responses 68.4%/47.1%/25.1%). They also observed no radiographic progression at

Week 128 in a group of 73.2% patient. Some authors decided to prove the immunological and

genetic association with RA in such aspects as ethiopathogenesis, disease progression and the risk

of joint damage. Steenbergen et al (244) noted association IL2RA-rs2104286 minor allele with a

higher chance on remission. Lopez-Lasanta et al (242) observed association of genetic variation at

IL6R gene with joint damage in RA. Hensvold et al (239) investigated the relationship between

RANKL and ACPA in patients with early untreated RA (RA). These findings give further support for

an early direct pathogenic link between ACPA and bone destruction in RA. In opinion of Habets et al

(222) ACPA can mediate an FcgammaRIIa-dependent activation of platelets. Systemic sclerosis

(SSc) and mixed connective tissue disease (MCTD) are chronic immune-mediated diseases

complicated by vascular organ damage. Reiseter et al propose that endostatin might indicate the

degree of vascular injury in SSc and MCTD patients. In the study (231) endostatin levels were

elevated in patients with SSc and MCTD, especially in SSc patients with pulmonary arterial

hypertension and scleroderma renal crisis, and in MCTD patients with digital ulcers. The other group

of potential biomarkers for clinically significant pulmonary vascular disease in patients with

scleroderma are the circulating growth factors basic fibroblast growth factor, placental growth factor

(PlGF), vascular endothelial growth factor (VEGF), hepatocyte growth factor, and soluble VEGF

receptor 1 (sFlt-1), as well as cytokines (interleukin [IL]-1beta IL-2, IL-4, IL-5, IL-8, IL-10, IL-12, IL-

13, tumor necrosis factor-alpha, and interferon-gamma) (201). Gordon et al (213) assessed the

safety, efficacy, and molecular change associated with treatment of patients with diffuse cutaneous

SSc with the nilotinib (TasignaTM). Significant modified Rodnan Skin Score improvement was

observed in these early, active patients. Seror et al (241) suggest that two distinct subsets of pSS

may exist: one with a predominant type I interferon (IFN)-BAFF-B-cell axis, representing good

responders to belimumab and the second one with a predominant type II IFN-NK cell axis,

representing non-responders. The authors Alunno et al noted that IFI16 protein may be involved in

the pathogenesis of glandular inflammation occurring in primary Sjögren’s syndrome (208). Mackie

et al (195) noted that variation in population HLA-DRB1*04 frequency may partly explain variations

in GCA incidence and that HLA-DRB1*04 could be a potential prognostic or predictive biomarker.

Chen et al (129) investigated the association of complement factor H (CFH), a key regulator of

ANCA-associated vasculitis. In authors’ opinion plasma CFH levels are associated with disease

activity and, to some extent, could be associated with composite outcomes of patients with MPO-

ANCA-associated vasculitis. Patients with gout have a lower risk of developing dementia. This

phenomenon exists for both non-vascular and vascular types of dementia (139).

SEPTEMBER15


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RHEUMATOLOGY (OXFORD)

PAGE 7

Barbara currently

works in the

Research

Laboratory and

Academic Division

of Clinical

Rheumatology,

Department of

Internal Medicine,

University of

Genova, Italy. Her

interests are

connective tissue

diseases,

spondyloarthritis

and ultrasonography

in rheumatology.

RHEUMATOLOGY (OXFORD)


Barbara Ruaro, MD

Byng-Maddick R et al (pp.768-75) reviewed numerous reports suggesting that biologic

therapies have an impact on Treg and that this may contribute to their beneficial effects.

The results of the study of Naredo E et al (pp.1408-14) suggest that the presence of

Doppler-detected synovitis may predict biologic therapies tapering failure in RA patients in

sustained clinical remission. The objective of the study of Rosales-Alexander JL et al

(pp.1459-63) was to assess drug survival and the reasons for switching anti-TNF-α therapy

in SpA patients in a Spanish nationwide study. In conclusion the main reason for switching

anti-TNF therapy was lack or loss of efficacy. Switchers were more frequently women and

had higher disease activity parameters at the time of the study than non-switchers. The

aim of this study González-Álvaro I et al (pp.1200-9) was to establish guidelines for the

optimization of biologic therapies for health professionals involved in the management of

patients with RA, ankylosing spondylitis and psoriatic arthritis. In conclusion they

established recommendations to provide advice on how to improve the risk:benefit ratio

and efficiency of such treatments and to reduce variability in daily clinical practice in the

use of biologic therapies for rheumatic diseases. Pamfil C et al (pp.1270-8) observed a

good concordance between EULAR recommendations for neuropsychiatric systemic

lupus erythematosus and usual clinical practice. They have also identified a number of

issues (such as overutilization of brain MRI, suboptimal evaluation of cognitive dysfunction,

and frequent use of immunosuppressives in cerebrovascular disease) that need to be

investigated further. Fernandes das Neves M et al in their study (pp.1403-7) observed that

the renal histology with WHO class IV predicted a poor long-term remission rate.

Interesting age, sex, ethnicity, serological parameters and treatment received did not

predict long-term remission. It is also important the observation that renal flares can occur

up to 15 years after a patient has gone into remission. In patients with ANCA-associated

vasculitis treated with Rituximab, Alberici F et al (pp.1153-60) identified these risk factors

for further relapse: PR3-associated disease, the switch from ANCA negative to positive

and the return of B cells within 12 months of the last Rituximab administration. The

validation of a diagnostic rule for gout without joint fluid analysis was presented in the

prospective study of Kienhorst LB et al (pp.609-14). Wilson N et al in their study (pp.860-7)

evaluate the drug utilization in patients with osteoarthritis. They observe a decrease of

new users of paracetamol and oral NSAIDs in contrast with an increasing use of opioids

and COX-2 inhibitors.

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THE JOURNAL OF RHEUMATOLOGY

PAGE 8

Mike has been a

clinical and research

fellow in the

Department of

Rheumatology and

Clinical Immunology

at the Charité

Medical Faculty in

Berlin, Germany,

since 2007. He

earned a MSc

degree by doing

immunology

research at the Sir

William Dunn School

of Pathology, Oxford

University, UK. His

main interests are

connective tissue

diseases, especially

systemic sclerosis.

THE JOURNAL OF RHEUMATOLOGY


Mike Becker, MD

An international expert panel (pp.1548–55) did a systematic research on quality indicators to assess

the cardiovascular risk in rheumatoid arthritis and performed a Delphi procedure to find the most

appropriate instruments. They identified 11 cardiovascular quality indicators for patients with RA that

will be further validated. In a prospective, controlled study, Södergren et al. (pp.935-942)

investigated the prediction of subclinical atherosclerosis (as assessed by intima-media thickness

(IMT) and flow-mediated dilation (FMD)) in 71 RA patients and 40 control persons. A model

including age, smoking, BP, and blood lipids at baseline significantly predicted the observed value of

IMT after 5 years. When the inflammatory load over time represented by the DAS28 (over 5 years)

was included, the observed value of IMT was predicted to a large extent. Li et al. (pp.1413–17)

compared in a small (89 patients), randomised controlled trial the effect of TNFa-inhibitors

(etanercept and adalimumab) on bone mineral density in patients with active (mean BASDAI>5)

ankylosing spondylitis. After 1 year, they found a significant increase in spine and femoral neck

BMD (mean SD 14.9% and 4.7% respectively) in the study group. In the control group there was a

significant decrease in spine and femoral neck BMD (mean SD –8.6% and –9.8% respectively).

Steiman et al. (pp.810-816) investigated anti-dsDNA and antichromatin antibodies in patients with

systemic lupus erythematosus (SLE) that were clinically inactive as defined by the SLEDAI-2K.

They found that clinically inactive patients had persistent or even rising antibody levels, thus

questioning the prognostic value of autoantibody fluctuations for flare prediction. In a prospective,

multicentre cohort study of patients with giant cell arteriitis (GCA), Kermani et al. (pp.1213-1217)

investigated relapses. 34% of patients had a relapse during a mean follow-up of 21.4 months. In

21% of relapses, both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were

normal, suggesting the need for better biomarkers indicating imminent relapse. Robinson et al.

(pp.1702–1707) reported observational data about the quality of care concerning gout in a national

Australian general practice population (about 1.5 million patients). Data were retrieved from

electronic records over a 5 year period. They concluded that gout was poorly managed in Australian

primary care with only 57% of patients with a diagnosis of gout receiving allopurinol. Only 55% of

patients with gout had their serum urate tested at any time during the study period and a serum

urate level of <0.36 mmol/l at any time during the study period was documented in 22.4% of all

patients. A randomised, double-blind, placebo-controlled trial with a 2-period, 2-way crossover

design in 197 patients with fibromyalgia was reported by Arnold et al. (pp.1237–44). The Authors

could show that pregabalin at a mean dosage of 376 and 382mg/d statistically significantly improved

pain by fibromyalgia (compared to placebo) and other symptoms, even in patients already taking

antidepressant medication for comorbid depression.

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MISCELLANEOUS

PAGE 9

Alessia is consultant

rheumatologist and

PhD candidate at the

Rheumatology Unit,

University of

Perugia, Italy. Her

research focuses on

the role of T and B

lymphocytes in the

pathogenesis of

connective tissue

diseases.

In the field of autoantibodies, Kirino Y et al (Nat Rev Rheumatol 2015;11(5):401-414) highlighted the genetic

differences between seropositive and seronegative rheumatic diseases thanks to genome wide association

studies (GWAS). Such differences may account for different clinical pictures, prognosis and eventually different

response to therapeutic compounds. Toes RE et al (Curr Opin Rheumatol 2015;27(3):262-7) provided an

update on antibodies against posttranslationally modified proteins other than those citrullinated in RA. Authors

pointed out that besides a diagnostic role, these autoantibodies may be crucial to identify different clinical

pictures and therefore be employed to identify specific subgroup of RA patients for prognostic stratification and

therapeutic purposes. The novelties, challenges and future perspectives in RA therapy have been reviewed by

Smolen JS et al (Nat Rev Rheumatol 2015;11(5):276-89) and by Ferrari M et al. (Nat Rev Rheumatol

2015;11(6):328-37). In addition Lahaye C et al reviewed currently available data concerning the management

of biologic therapy in elderly patients with RA. The lack of consistent results from randomized controlled trials

regarding mechanisms of actions other that TNF blockade and long term follow-up contribute to the reluctance

in using such compounds in the elderly. However, the benefit of steroid and NSAID-sparing potential of

biologics should be also condìsidered in the therapeutic decision. Blockade of interleukin-17A has already

shown promising results for the treatment of psoriatic arthritis. In a recent study McInnes et al. (Lancet 2015

doi:10.1016/S0140-6736(15)61134-5) now report on the efficacy and safety of subcutaneous (s.c.)

secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis. In this

phase 3 double blind placebo controlled trial (called FUTURE 2) 397 patients with active psoriatic arthritis were

randomly allocated (1:1:1:1) to receive s.c. secukinumab 300 mg, 150 mg, or 75 mg once a week from

baseline and then every 4 weeks from week 4. A significantly higher proportion of patients achieved an ACR20

response (the primary endpoint) at week 24 with secukinumab 300, 150 and 75 mg versus placebo (54%, 51%

and 29% versus 15%). Regarding safety, the most common adverse events were upper respiratory tract

infections upper respiratory tract infections in less than 10 % of patients, which did not substantially differ

between the groups. Hence, s.c. secukinumab appears to be effective and safe, which makes this antibody an

interesting future treatment option for patients with psoriatic arthritis. In light of the burden of cardiovascular

risk in rheumatic disease, a nationwide study performed by Kerola AM et al (Clin Exp Rheumatol

2015;33(3):391-8) in early RA patients from 2000 to 2008 surprisingly reported no increased CV mortality in

such patient cohort. The analysis of over 10000 RA patients revealed that patients with recent-onset RA who

receive consistent RA medication have no increased risk for CV mortality compared to the general population,

at least in the early years of the disease. Methotrexate appears to be associated with lower CV mortality while

the use of corticosteroids is associated with higher CV mortality. Concerning connective tissue diseases,

Young A et al performed a systematic review on therapeutic management in systemic sclerosis from 2011 to

2014 (Curr Opin Rheumatol 2015;27(3):241-8) underlying the advances that have been achieved in recent

years and the need of additional randomized controlled trials to build solid evidence for newly identified

therapeutic strategies. Khanna presented twenty-two points to consider for clinical trials in systemic sclerosis,

based on EULAR standards (Rheumatology 2015;54(1):144-51). Uniform trial design and selection of outcome

SEPTEMBER15

MISCELLANEOUS

Alessia Alunno, MD & Jan Leipe, MD

Jan has completed

specialist training in

rheumatology and

general internal

medicine and is

currently an attending

physician at University

of Munich, Germany.

His major research

interests include early

RA and the role of T

cells in the

pathogenesis of

autoimmune arthritis.


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MISCELLANEOUS

PAGE 10SEPTEMBER15

MISCELLANEOUS

(Continued)

measures are needed. The most important points to consider (PTCs) are that trials should be randomized, blinded and controlled;

placebo-controlled trials are favored; ethical aspects need to be considered. It is also necessary uniform patient selection; validated

outcomes and predetermined analyses are required; concomitant diseases and medications might be considered; adverse events must

be carefully described. Goobie GC reviewed available literature regarding malignancies in systemic lupus erythematosus (SLE) and

reported that disease-specific features (autoantibodies), upregulated inflammatory mediators and underlying viral disease may account

for the different burden of solid and hematological tumors in SLE patients. A systematic review of 6 randomised controlled trials by Tian

et al. (J Rheumatol 2015;42(8):1392-1400) investigated the efficacy of immunosuppressive regimens (AZA, CYC, MMF and

prednisolone) for maintenance therapy of proliferative lupus nephritis. Outcome was defined as prevention of end-stage renal disease.

Although the evidence was not conclusive (i.e. statistically not significant), trends suggested prednisolone is inferior to CYC and AZA

whereas MMF could be superior to both. A direct comparison MMF to prednisolone was not available. The authors suggested longer

trial times (up to 10 years) for maintenance treatment and more uniform ways of reporting study results. Finally, Brito-Zeron P provided

an overview on epidemiology, classification and management of women whose pregnancies are affected by autoimmune congenital

heart block (Nat Rev Rheumatol 2015;11(5):301-12). A new study published by Zhang et al. (Nat Med 2015;21(8):895-905) assessed

the microbiome in patients with rheumatoid arthritis (RA) in comparison to healthy individuals. Sequencing and a metagenome-wide

association study of fecal, dental and salivary samples of RA patients and controls revealed an altered microbiome of RA patients. This

alteration not only distinguished them from healthy controls, but also correlated with clinical measures and could be used to stratify

individuals on the basis of their response to therapy. In particular, Haemophilus spp. were depleted in individuals with RA and

negatively correlated with levels of serum autoantibodies, whereas Lactobacillus salivarius was over-represented in individuals with RA

at all three sites and was present in increased amounts in cases of very active RA. This study suggests that analysis of microbiome

composition might be useful for prognosis of RA in the future. van Kempen TS et al attempted at clarifying similarities and differences

between autoimmune and autoinflammatory disease from a pathogenic point of view (Nat Rev Rheumatol 2015 Aug;11(8):483-92).

Such analysis would allow to identify therapeutic target that may be effective either in both groups of disorders or selectively for one of

them. Salvarani C et al (Semin Arthritis Rheum 2015;45(1):55-9) retrospectively evaluated a cohort of patients with primary central

nervous system vasculitis referring to the Mayo Clinic to assess the efficacy of mycophenolate mofetil (MMF) compared to other

therapeutic strategies. They observed that although no differences could be detected concerning relapses or therapy discontinuation,

patients treated with MMF display less severe long term disability compared to patients treated with other compounds. In Behçet’s

syndrome, oral ulcers, a hallmark of the disease, are often resistant to conventional treatment. In a recent phase 2 double blind placebo

controlled trial, Hatemi et al. investigated the effect of apremilast, an oral phosphodiesterase-4 inhibitor, in 111 patients with Behçet’s

syndrome who had ≥ 2 oral ulcers (N Engl J Med 2015;372(16):1510-8). Patients received 30 mg of apremilast twice daily or placebo

for 12 weeks followed by a 12-week extension phase with aswitch of the placebo group to apremilast. The mean number of ulcers per

patient (primary endpoint) at week 12 was significantly reduced by apremilast compared to placebo (0.5 vs. 2.1). The mean decline in

pain from oral ulcers from baseline to week 12 (secondary endpoint) was greater with apremilast than with placebo (−44.7 vs. −16.0

mm). The adverse events nausea, vomiting, and diarrhea were more common in the apremilast versus the placebo group (22 vs 10, 9

vs 1, and 12 vs 2). Together, apremilast appears to be effective in treating oral ulcers, however, larger studies are needed to assess

the efficacy on other manifestations of Behçet’s syndrome and safety in these patients.


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EDUCATION

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This open congress has the aim to discuss both practical and theoretical issues aroundrunning registers and longitudinal observational drug studies, generating output andunderstanding their results. The meeting will provide an opportunity for networking anddevelopment of international collaborative studies, which would be especially importantfor early-career investigators.

It will furthermore explore issues throughout the lifespan of studies, from first thoughtsaround establishing a register, practicalities such as funding, bio-banking andinformatics, through methods of data collection, opportunities for harmonizing practice,analysis methodology, to the interpretation and dissemination of results.

Next EULAR RODS Meeting will take place in Prague 7-8 December 2015

Register now to save your place! Reduced registration fee until 11 November 2015

http://www.eular.org/epidemiology_registers_observational_drug_studies_meeting.cfm

For the 2015 preliminary programme visit:http://eular.org/myUploadData/files/RODS_2015_preliminary%20programme%20v2.pdf

SEPTEMBER15

THE 2ND EULAR REGISTERS AND OBSERVATIONAL

DRUG STUDIES (RODS)


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EDUCATION

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THE EULAR ON LINE COURSES

All EULAR courses, as electronic ways of continuous medical education in rheumatology, are

managed by a scientific course committee responsible for the structure and content of the courses

and for ensuring regular quality control and advancement. Teams of expert authors are regularly

reviewing and updating the courses to keep up with the newest developments in the field. All courses

are offered at EUR 100 per participant.

REGISTRATION IS OPEN UNTIL 1 NOVEMBER 2015

SEPTEMBER15

Course Duration Link to course content

10th EULAR On-line Course on

Rheumatic Diseases 2 years

http://www.eular.org/myUploadData/files/Online_full

_module_planner.pdf

7th EULAR On-line Course on

Connective Tissue Diseases (CTD) 9 months

http://www.eular.org/myUploadData/files/CTD%20w

eb%20overview%20modules_2012%20(2).pdf

5th EULAR On-line Course on Systemic

Sclerosis (SSc) 9 months

http://www.eular.org/myUploadData/files/SSc%20w

eb%20overview%20modules_2012.pdf

4th EULAR On-line Introductory

Ultrasound Course 7 months

http://www.eular.org/myUploadData/files/Online_M

SUS_content.pdf

2nd EULAR / PReS On-line Course in

Paediatric Rheumatology 9 months

http://www.eular.org/edu_online_course_paediatric.

cfm

1st EULAR On-line Course for Health

Professionals 9 months

http://www.eular.org/myUploadData/files/HP%20we

b%20overview%20modules_2015.pdf

The EULAR On-line Courses on Rheumatic Diseases,

CTDs, SSc and US are also available as APP

THE REPORT OF A PARTICIPANT:

“I concluded the EULAR On-line Course in October 2013. I had initially thought of completing it sooner, but time restrains, clinical duties

and training requirements kept meddling in the way. The course has several modules, and despite the fact you can study and do them

one at a time, a final evaluation at a specific date is mandatory. So, despite a continuous study possibility, it is convenient not to drag it

too long so all modules are "fresh" for the final evaluation. Since I had my Rheumatology training final exam in October 2013, which also

included a theoretical exam, this course would offer a good opportunity to help me consolidate my knowledge.

The course is well organized and most modules are very well written, usually by prominent people in the respective field, and they are

easy to read and study. Most modules are up-to-date and include information from very recent studies/papers. This combination

provided to be effective in terms of getting relevant, updated information in a structured manner. After each module you had a

questionnaire, which worked as a preparation for the final evaluation and also a form of self-assessment. I found this useful, albeit I must

say it is a bit counterproductive that you cannot simply choose the order of what you want to study. In my view, people would have to

complete all modules before applying for the final evaluation, but the order should be irrelevant. In fact, since I was also studying for my

final exam in Rheumatology, this created some conflict with my plans of studying certain areas/chapters at a specific time. Other

downside is that not all topics in Rheumatology are covered by the Online Course. Please do mind it is a very comprehensive and

extensive course, but it does not cover all topics in all fields (and I required that for my Rheumatology final training exam).

The final evaluation of the Online Course was neither easy or too hard, but fair. The time was short I must say, but enough to complete

the task at hand. Overall the course is very good and it was quite useful to me, not only helping to structure my knowledge but also

providing well written, updated and comprehensive study texts. I think all Rheumatology trainees should do it at some point in their

training. In fact, I would also consider it useful for Rheumatology specialists who wish to refresh their knowledge.” (João Madruga Dias)


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SEPTEMBER15

EDUCATION

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1st EULAR Immunology Course

Join us and travel to the top in immunology! Join us for the first EULAR immunology course designed for young rheumatologists and rheumatology researchers working in the field of immunology. This course will offer a great opportunity to gain basic and in-depth knowledge about specific immunological hot topics. Mentoring by experts in the field will teach you how to build a realistic research plan and how to apply for funding. Network with faculty and other participants to build European collaborations which could be used to apply for EU-funding. Faculty: Patrick Blanco, John Isaacs, Rik Lories, Polly Matzinger, Xavier Mariette Date: 1-2 April 2016 Location: Nova Medical School, Lisbon, Portugal Scientific organizers: Christian Beyer, João Dias, Caroline Ospelt, Christophe Richez, Diane van der Woude Application form and additional information (including available EULAR bursaries) will be available on the EULAR website soon.

Application form and additional information (including available EULARbursaries) will be available on the EULAR website soon.


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SOCIAL MEDIA AND EDUCATION

PAGE 14

The 12th October 2015 will be the World Arthritis Day and this year’s theme is ‘It’s in your

hands, take action’. The aim is to raise awareness of rheumatic and musculoskeletal

diseases (RMDs) and to encourage people with RMDs, their carers, families and the general

public to seize every opportunity to take action and make a difference to the quality of life of

people with RMDs.

Get involved in this initiative by sharing a photo of your hand in a High 5 pose on

Twitter or Instagram and use the hashtag #WADHigh5.

The next EULAR Annual European Congress of Rheumatology will take place between the 8

and 11 June 2016 in London. Send your abstract, share your original research and take the

chance to join the largest rheumatology congress in the amazing city of London! Every year

EULAR awards a number of travel bursaries to the first/presenting author of an abstract

accepted for oral or poster presentation at the annual EULAR congress.

The on-line abstract submission and bursary application opens on 1 October 2015

To submit your abstract visit: http://www.congress.eular.org/abstract_submission.cfm

To apply for a bursary visit: http://www.congress.eular.org/travel_bursaries.cfm

EULAR CONGRESS ABSTRACT SUBMISSION OPEN

WORLD ARTHRITIS DAY 2015

SEPTEMBER15

EWRR ABSTRACT SUBMISSION OPEN

The next European Workshop for Rheumatology Research will take place between the 25

and 27 February 2016 in York, UK. EULAR awards 42 travel bursaries to the first/presenting

author of an abstract accepted for oral or poster presentation at the meeting.

The on-line abstract submission and bursary application is now open

To submit your abstract visit: http://www.ewrr.org/abstract-appl-2016.html

To apply for a bursary visit: http://www.eular.org/edu_course_ewrr.cfm

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