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Summer 2019 (Volume 29, Number 2)

RheumJeopardy! at the 2019 CRA ASM

By Philip A. Baer, MDCM, FRCPC, FACR

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Building bridges was the 2019 CRA Annual Scientific Meeting (ASM) theme, which RheumJeopardy supported through gamification, bringing together more than 200 participants on the Friday afternoon of the ASM at the Fairmont Queen Elizabeth in Montreal. Once again, the participants were divided into East and West teams, with the boundary zigzagging through the Greater Toronto area. Both my office in Scarborough and my home in North York put me in the East camp, but I displayed my East-West socks to the audience to show neutrality. Our Chair was Dr. Rosie Scuccimarri, last year’s winning East team captain, running the show after a tough night oncall. She wore a dizzying array of Eastern team sports sweaters in 2018. This time, she showed her neutrality by starting off in a mid-Canada Winnipeg Jets jersey, but by the end showed her true colours with a Montreal Canadiens top. We had new captains this year: Valérie Leclair from the Jewish General Hospital in Montreal for the East, and Jennifer Reynolds from St. Paul’s Hospital for the West.

Thanks to Mark Atkinson and his superb audio-visual (AV) team, we had absolutely no technical glitches this year. Everyone in the audience could participate using the PollEverywhere app. Through spelling errors, I accidentally invented a new disease “dermatomyosotis,” and found out I had D-J dyslexia when I misspelled the famous Dr. Van der Heijde’s name. Glaringly obvious when you use size 60 font on your slides! Others do make errors too: One question this year showed an X-ray image of the spine in ankylosing spondylitis, which had been mislabelled as showing osteoarthritis (OA) of the knee in a 2016 print issue of the American College of Rheumatology (ACR) publication “The Rheumatologist.”

Categories this year were familiar: Rheum Potpourri, Rheum Art, Old Drugs New Tricks, OA, Sight Diagnosis and Numbers. As the 2018 version was low scoring, we played only Double Jeopardy this year, with point values ranging from 200 to 1,000. Themes common to several questions included autoinflammatory syndromes, pediatric rheumatology, diseases/mutations that protect against other diseases, and rheumatology drugs which have been repurposed to treat non-rheumatic diseases.

After Rosie showed photos of her knockout punch against David Robinson from the 2018 match, I reviewed Jeopardy news from 2018, including rumours that Alex Trebek might retire. This was the basis of our sample question on his possible replacements. The answer was Laura Coates, an American legal commentator, not to be confused with rheumatology’s Laura Coates of TICOPA and minimal disease activity fame.

Then it was on to the real game, which was fast-paced and high scoring. Knowing already that sickle-cell trait protects against malaria, and human leukocyte antigen (HLA)-B27 protects against human immunodeficiency virus (HIV), this year’s questions revealed that Familial Mediterranean Fever (FMF) protects against bubonic plague, and that a gene which protects against frostbite predisposes carriers to developing OA.

Once again, we found out that antimalarials are the proverbial Swiss army knives of rheumatology. Not only do they prevent and treat malaria, and treat rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and a host of other rheumatic diseases, but our answers revealed they might work against Zika virus and also protect against HIV (using a vaginal implant developed at the University of Waterloo). Do antimalarials work as OA therapies? The answer to that question may be revealed in a future RheumJeopardy (for those who can’t wait, consult the results of the HERO study online).

As usual, I tried to highlight Canadian research. We found out that the team defining RA flares for OMERACT, led by Dr. Vivian Bykerk, did not include swollen joints in their flare definition, using only patient-related outcomes (PROs). We also found out that Drs. Janet Pope and Dafna Gladman may be prolific researchers, but they were not lumped into the category of “hyperprolific” authors, who average publishing a scientific paper every 5 days, according to a recent article in Nature. Two rheumatologists did make that list: the European pairing of Dr. Maxime Dougados and the aforementioned Dr. van der Heijde.

Questions which stumped both teams included the antinuclear antibody (ANA) titre used as an entry criterion in the new ACR-European League Against Rheumatism (EULAR) SLE classification criteria (Answer 31:80), and one which revolved around calculating the total daily dose of naproxen and ibuprofen a patient was consuming when they mistakenly mixed Advil 12 hour, Advil Arthritis, Motrimax and Aleve together.

We covered 15 of 30 questions on the game board by the time Final Jeopardy rolled around. The category was famous Canadian pediatric rheumatologists. The question centred on a patient with a syndrome of rashes, joint pain, red eyes and migraines, who went undiagnosed until his daughter was born and presented with a similar clinical picture. He researched the cause using Dr. Google, and eventually called Dr. Ron Laxer (the correct person to choose in Final Jeopardy), who confirmed a diagnosis of Muckle Wells syndrome, a form of cryopyrin-associated periodic syndrome (CAPS) mediated by a defective pyrin inflammasome. All of this was captured on CBC radio by Dr. Brian Goldman as part of his White Coat, Black Art series. Dr. Laxer was in the meeting room to bask in the glory, and both teams chose his name correctly.

The final score was East 13,200 and West 10,400. We may be back for a rematch in Victoria at CRA ASM 2020. Thank you to all those who participated.

Dr. Philip Baer, host of RheumJeopardy! 2019, pictured with Dr. Valérie Leclair (Team Captain of the East), Dr. Jennifer Reynolds (Team Captain of the West), and Dr. Rosie Scuccimarri (Chair of this year's event).

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

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