Winter 2015 (Volume 25, Number 4)

Tales of the City: ACR 2015

By Philip A. Baer, MDCM, FRCPC, FACR

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“The glory that was Rome is of another day /
I've been terribly alone and forgotten in Manhattan /
I'm going home to my city by the Bay /
I left my heart in San Francisco.”
– Tony Bennett, "I Left My Heart In San Francisco" (lyrics, Cory/Cross), I Left My Heart in San Francisco, 1962.

I have heard this song many times, but not all the lyrics were familiar. How very appropriate it turns out to be for rheumatology in 2015, with European League Against Rheumatism (EULAR) meeting in Rome and the American College of Rheumatology (ACR) in San Francisco.

“Getting there is half the fun,” they say, but modern travel is not familiar with the adage. I booked my hotel within 15 minutes of the ACR website opening for reservations in June, and managed to snag my first choice. A prior check of Trivago, TripAdvisor, and Expedia had confirmed that the ACR hotel rates were a great deal compared to the standard online offers. Flights worked out well, with numerous seat sales, and I even managed to upgrade to business class for the outbound leg.

Air Canada likes the collapse in oil prices, but the negative impact on the Canadian:US exchange rate that resulted made the rest of the trip pricier by the day. Air Canada also likes last minute aircraft changes; my return flight was altered three times. One day before departure, I received a mysterious email from Air Canada refunding my fee for a preferred seat. No indication of which flight it was for, but prior experience told me this was not good. By then, I had also tried to check-in online for the flight to San Francisco, and been rejected three times. A call to Air Canada confirmed what I had already deduced: I had been randomly selected for special security screening, which meant I would have to check in at the airport. We also worked out that my coveted aisle seat had disappeared; I now had a “preferred” middle seat instead, proffered at no cost, hence the fee refund.

Up early to get to Pearson airport. I breezed through US customs, avoiding the dreaded “holding pen”, but security screening was another story. I expected the rotating X-ray scanner treatment, but not having to unpack my entire carry-on for inspection and swabbing. Every electronic device had to be turned on, every power cord checked and every bag strap examined in a fashion akin to a surgeon “running the bowel”. Fortunately I had charged everything the night before. Everyone was very polite, and I even reached the lounge for a few minutes.

Meeting so many colleagues travelling on the same flight was a pleasure, especially some I only seem to meet in these situations once or twice a year. Leaving slightly late raised my pulse, as I had only about an hour between landing and my first meeting, and I loathe being late.

I planned to work en route, including on this article, after enjoying some on-board entertainment. Problems again: My touch screen was singularly unresponsive. I heard the flight attendants muttering about problems with the entertainment system; however, they resolved my issue by bringing me a large alcohol swab. Cleaning the screen restored it to normal function—one wonders how much dirt there must have been on it before. The crew could not fix the next issue: The in-seat power outlets were all dead. This was a known issue, apparently, but not something worth Air Canada’s while to fix if it meant taking the plane out of service. Also not something anyone mentioned to us; my seatmate had purchased inflight WiFi for five hours, before finding out she did not have enough juice in her computer to actually use it.

Despite everything, the actual flight arrived on time and I narrowly made my first meeting. The weather was fine for exploring the city, and walking to and from the conference centre daily. I frequently found myself near the iconic Transamerica pyramid, which had special meaning for me as a long-time medical consultant at Transamerica Life Canada. Interestingly, the adjacent “Flatiron” style building was the original Transamerica head office, now housing the Church of Scientology. With the sale of Transamerica Life Canada to the Canada Pension Plan Investment Board, the company name is now the not-yet-infused-with meaning ivari, and my efforts there might contribute a small amount to the maintenance of all of our government pension benefits.

The old...

and the new TransAmerica buildings.

Outside the conference itself, I enjoyed multiple breakfast, lunch, coffee, and dinner meetings while struggling to avoid overeating. The CRA Council and CRAJ Board meetings were particularly interesting and productive.

I presented one poster on minimal disease activity and patient-related outcomes in psoriatic arthritis (PsA; abstract 676), and was very surprised when we ended up as an impromptu stop on the spondyloarthropathy (SpA) poster tour. That poster also found me meeting a number of other 1-L “Philip’s” attending the conference. Dr. Philip Mease had a PsA poster around the corner, Dr. Philip Helliwell stopped by, and Dr. Filip van den Bosch led the poster tour which visited our poster. Nice to see so many agreeing Philip really should be spelled with one L, not two. For fans of Ogden Nash, I did not see any 1L, 2L or 3L lamas/llamas/lllamas at ACR.

I was a free agent the rest of the time. Of course, I attended the ACR Knowledge Bowl in preparation for my role creating questions for and moderating RheumJeopardy at the CRA ASM in Lake Louise. The repeat winners were the University of Iowa Hawkeyes, defeating teams from Massachusetts General Hospital and the University of Texas at Galveston by a wide margin in a very fact-focused competition.

I also found intriguing presentations on my interests du jour, including biosimilars, JAK and IL-17 inhibitors, smoking cessation in rheumatic diseases, bispecific antibody drugs, and non-radiographic axial SpA. The Great Debate on low-dose steroid therapy in rheumatoid arthritis (RA) ended up a draw between Dr. Ruderman and Dr. Boers, and was quite entertaining. I now know the difference between non-alcoholic fatty liver disease (NAFLD), non-alcoholic fatty liver (NAFL), and non-alcoholic steatohepatitis (NASH) when discussing fatty liver. Dr. Bevra Hahn’s update on aspects of systemic lupus erythematosus (SLE), including arthritis, bone disease, pregnancy, and nephritis was also very educational.

ACR 2015 broke attendance records with over 16,800 registrants. Canadian content was as strong as ever; the best coverage of the conference is provided by Dr. Andy Thompson and his team of intrepid reporters at rheumreports.com. In addition to great medical coverage, I also learned that Yerba Buena was San Francisco’s original name (meaning “Good Herb;” while nothing to do with marijuana, the odour of that controversial herb was highly prevalent on the streets around the Moscone Centre), and that St. John’s and San Francisco have many things in common.

Canadian scientific content I noted with particular interest included the results of the Stand Up and Be Counted survey of rheumatology manpower in Canada (abstract 1269), delays in rheumatology consultation and treatment (abstract 1031), tumour necrosis factor (TNF) inhibition of radiographic progression in ankylosing spondylitis (AS) (abstract 975), some of the papers on underuse of triple therapy (abstracts 1044, 2106, 2107), and papers on the improving survival of RA patients (abstracts 1999 and 3240). Dr. Glen Hazlewood probably set a record with three podium presentations within a single session (abstracts 1041, 1043, and 1044).

The progress in rheumatology continues to amaze, driven by a new generation of clinician scientists and basic researchers. As that other famous song about San Francisco says:

“In the streets of San Francisco […] / People in motion.
There's a whole generation / With a new explanation.”

We all ♥ San Francisco.

ACR 2015 was a nice break from the daily office routine, though just as or more tiring in its own way. In 2016, for the first time in years, I will not be physically attending the ORA, EULAR, or ACR meetings. I hope to be a virtual presence at the CRAJ Board meeting at ACR through teleconferencing, assuming Air Canada gets me home on time from my overlapping event next November. So I am issuing another call for prospective authors who want to cover EULAR and/or ACR 2016 for CRAJ in my place: Please contact me to express your interest.

Philip A. Baer, MDCM, FRCPC, FACR
Editor-in-chief, CRAJ
Scarborough, Ontario