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A number of selected abstracts will be presented.
ACR Musculoskeletal Ultrasound Course for Rheumatologists & ACR Musculoskeletal Ultrasound Course for Rheumatologists–Advanced
Friday, Oct. 19: 6:45 a.m.–5:30 p.m.;
Saturday, Oct. 20: 6:30 a.m.–5:45 p.m.; Advanced—Saturday, Oct. 20: 7:15 a.m.–5:45 p.m.
This year’s pre-course for ultrasound in rheumatology will include a separate advanced track for those who have already become competent in the basics. Following the example set by Europe, the ultrasound leadership from the ACR plans to provide more sophisticated and informative lectures and hands-on sessions. RhMSUS-accomplished sonographers and others with enough experience will be eligible to attend this one-day course on Saturday.
The beginner ultrasound course will remain a two-day introductory curriculum of didactic and hands-on sessions taught by leading rheumatology sonographer. This course will provide extensive examples of basic rheumatologic pathology seen on ultrasound—while teaching students basic scanning techniques and normal imaging patterns.
ACR Practice Management: Putting the Pieces Together—Winning Strategies for Rheumatology Practices
Saturday, Oct. 20: 7 a.m.–4:15 p.m.
The Moving Targets: Practice Models and Alignment Strategies—The world is changing. Private practice; accountable care organizations (ACOs); value-based payments; sell to, join or partner with a system; medical homes; and Medicare/payer care models: What should you do to survive or—better yet—thrive? This session will review the many models and suggest strategies to consider. There are no right answers, just a lot of questions. Many ideas will be offered for your practice. More than one option exists for the solo provider, as well as for the group.
Building Real-Time Analytics for Practice Improvement—Data and more data. What is needed? Is it all just TMI—too much information? We will sort out the key performance indicators (KPIs) from a business perspective and—to a degree, clinically—to help achieve practice improvement. Such items as costs to see patients, cycle time, turnover rate, denial rates, compliance with standards and more will be addressed. This session will look at what systems to use and how best to generate, analyze and use the data.
Payer Contracting Process: Negotiating and Managing Like a Pro—It’s not just the dollars. A solid relationship with the payer can and will go a long way to help you achieve good numbers and reduced hassles for staff and providers. Part 1 is negotiating. This session will address what to and what not to do. The second part will discuss how to best monitor and manage correct payment amounts and address authorization and other issues.
ACR Review Course: Perioperative Management of Rheumatic Disease Patients
Saturday, Oct. 20: 8:45–9:30 a.m.
Despite the widespread use of DMARDs and biologics for patients with RA, joint damage and utilization of arthroplasty remain high. For patients with ankylosing spondylitis (AS) and systemic lupus erythematosus (SLE), use rates for THA and TKA have increased. Complication rates for patients with RA, SLE and SpA have increased, so the demand is high for rheumatologists familiar with perioperative assessment and management of multi-organ disease, immunosuppressant medications and the unique mechanical challenges of patients with arthritis affecting the cervical spine and multiple joints. Patients with RA are at risk of prosthetic joint infection and hip dislocation; patients with AS with limited chest wall expansion are at unique risk for respiratory complications. Patients with SLE are at risk for VTE, even those without antiphospholipid antibodies, as well as acute kidney injury, major cardiac events and death, but it is not known whether active SLE and specific SLE characteristics or prior organ damage are placing patients with SLE at higher risk. These issues and more will be discussed in this review course.
ACR BRC: Epigenetics in Immune-Mediated Disease: Referencing Talk–Cross Talk Between Immunometabolism & Epigenetics in Autoimmunity
Saturday, Oct. 20: 9:10–9:45 a.m.
Metabolic pathways control the development of the immune system by epigenetic mechanisms using substrates from diet and biosynthesis to modify DNA and histones. S-adenosylmethionine (SAM) is an essential methyl donor that originates from adenosine triphosphate (ATP) and methionine. Importantly, the DNA of patients with autoimmune diseases, such as SLE, is hypomethylated, reflecting dysfunction in the SAM cycle.
Mitochondria are the dominant source of ATP, and they provide acetyl-CoA for histone acetylation and flavin adenine dinucleotide for histone demethylation. The depletion of ATP in lupus T cells may affect adenosine monophosphate activated protein kinase, which phosphorylates histones and inhibits the mechanistic target of rapamycin (mTOR).
In turn, mTOR modifies epigenetic pathways through methylation, demethylation and histone phosphorylation, and its hyperactivity underlies pro-inflammatory T cell development in SLE.
This presentation will pinpoint metabolic checkpoints that control epigenetic pathways and serve as targets for treatment in autoimmune disorders, such as lupus.
ANNUAL MEETING PREVIEW
Sunday, Oct. 21
Meet the Professor: Pulmonary Manifestations of Rheumatic Disease
7:45–9:15 a.m.
Lung disease is one of the leading causes of morbidity and mortality in patients with rheumatic diseases. In RA, patients can develop fibrosis of the lungs, a condition with a mortality rate nearly as bad as idiopathic pulmonary fibrosis. In scleroderma, a large percentage of patients will develop lung disease with varying clinical disease severity, and in myositis, patients can develop life-threatening, progressive disease. Given that not all patients, however, will get severe or progressive disease, understanding the identifiable risk factors demographically, physiologically and radiographically will help the clinician identify those patients at highest risk for disease and progression and, thus, guide screening and treatment decisions.
This session will present practical, clinically relevant cases to help the practitioner assess and treat this most challenging group of patients, while also discussing emerging diagnostic and treatment options as we move into the future.
ACR: RA: Beyond Treat to Target
8:30–10 a.m.
Advances in therapy, along with use of the treat-to-target strategy, have greatly improved outcomes of patients with RA over the past two decades. Indeed, some patients appear to develop remission on therapy. Other patients continue to have pain, but no evidence of synovitis. These situations raise such questions as how we define remission and whether maintenance therapy can be tapered. Advances in understanding of disease pathogenesis, which have led to efforts to prevent the onset of RA, have been made in parallel.
In this session, three topics will illuminate frontier issues in RA therapy. Kevin D. Deane, MD, PhD, will review the critical role of anti-citrullinated peptide antibodies in RA pathogenesis and the rationale for studies of treating individuals potentially at risk for developing RA. Daniel Aletaha, MD, MS, will review strategies for assessing remission in RA, focusing on understanding quality of life and pain manifestations along with laboratory and imaging results. Vivian P. Bykerk, MD, FRCPC, will discuss strategies for reducing or discontinuing DMARD or biologic therapy in RA patients who have achieved a sustained clinical remission.
ACR: Biologic Classification of JIA
8:30–10 a.m.
Juvenile idiopathic arthritis (JIA) treatment is historically directed by clinical subtype. Considering the current evidence for mechanisms of disease, RA and JIA may share classification systems and, thus, treatment approaches. During this session, conference attendees will gain a better understanding of:
