Spring 2023 (Volume 33, Number 1)
ACR Convergence 2022 Review
By Philip A. Baer, MDCM, FRCPC, FACR
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This information is brought to you by the Journal of the Canadian
Rheumatology Association (CRAJ) and is not sponsored by, nor
a part of, the American College of Rheumatology.
The expression “I’d rather be in Philadelphia” is
derived from a fictional epitaph that locally born
entertainer W.C. Fields (1880-1946) proposed for
himself in 1925: “Here lies W.C. Fields. I would rather be
living in Philadelphia.” Contrary to popular belief, this
joke did not ultimately grace his tombstone.
While I would rather have been in Philadelphia for
ACR Convergence 2022, I ended up attending virtually
again. Other than a few select sessions such as the ACR
Business Meeting and Rheumatology Knowledge Bowl,
every session was available simultaneously virtually and
in-person. The audio and video quality on the platform
were generally excellent, and the in-session polling worked
smoothly. PDFs of presenter slides were unfortunately
not usually available at the time the sessions occurred
but were promised for later if and when presenters made
them available. The pre-recorded poster videos were high
quality, and PDFs of the posters were all available from
the start of the meeting. The platform remains open for
review until October 31, 2023, which is a very generous
timeframe.
We live in an “Attention Economy” where key social
media platforms seek to attract and monetize our attention.
Some believe that our attention spans are decreasing
consequently. Society has adapted, with movies and advertisements
getting shorter in recent years. Professional
baseball games remain a work in progress. Medical meetings
have also had to change. I noted that the Dubois SLE
lecture was 30 minutes long this year versus one hour in
the past. The ACR also introduced Ignite Talks, which
were sessions covering 213 key posters each presented
orally in 5 minutes, back-to-back, without a question-and-answer period. The other session format which was
very prominent was the Community Hub type, of which
there were multiple instances covering the gamut of clinical,
research and business aspects of rheumatology. These
generally occurred on Zoom rather than the main meeting
platform.
I enjoyed the Opening Session, featuring ACR President
Dr. Ken Saag and ARP President Barbara Slusher.
Both organizations were highlighted for their trustworthiness
and responsiveness. The Plenary Keynote
was noteworthy, with Dr. Abraham Verghese of “Cutting
for Stone” fame presenting a memorable lecture. He is a
noted author and Professor for the Theory and Practice of
Medicine at Stanford University Medical School. He has
always emphasized the value of physical examination, a
competency highly regarded in rheumatology.
Many Canadians were prominent as presenters and
session chairs as usual. We were also well represented as
ACR/ARP award winners, and all these awardees will be
highlighted in upcoming issues of the CRAJ. One of my
favourite sessions was The Great Debate. The question
was whether disease-modifying anti-rheumatic drugs
(DMARDs) should be used to treat subclinical rheumatoid
arthritis (RA) to prevent full-blown RA. The “no”
side featured an all-Canadian powerhouse duo of Janet
Pope and Hani el-Gabalawy. Their dialogue pretending
to be a doctor and patient discussing the issue, including
both what was said and what was left unspoken by both
sides, was masterful in highlighting the difficulties of getting
a patient to accept such treatment, even if we had
better evidence that it might be helpful. The online poll
was over 90% in favour of the “no” side by the end of the
debate.
COVID-19 scientific studies were of course prominent.
A key study was Abstract 950: Obstetric Outcomes in
Women with Rheumatic Disease and COVID-19 in the
Context of Vaccination Status: Data from the COVID-19
Global Rheumatology Alliance Registry. A greater number
of preterm births (PTB) were noted in unvaccinated
women compared to fully vaccinated women (29.5%
vs. 18.2%). This was presented as a poster, in an Ignite
session, and at an ACR press conference by Dr. Sinead
Maguire, who is currently a clinical fellow at the University
of Toronto, though formally based in Ireland. More
Canadian content!
Posters were only presented virtually, so there was no
poster hall for mingling and networking. Accepted abstracts
totalled 2,240, with 17 presented at plenary sessions,
and 282 as oral presentations.
Other sessions I enjoyed were the Year in Review,
both adult and pediatric rheumatology versions, and the Wrap-Up session, as well as the FDA Update,
Thieves Market and Curbside Consult sessions,
and several of the named lectureships, including
the Hench, Gluck, Daltroy and Klemperer
talks. Dr. Wigley’s Hench lecture on scleroderma
was comprehensive, and cited William Osler
among other clinicians. I learned that pulmonary
hypertension has been redefined to start at a mean
pulmonary artery pressure of 20 rather than the
previous 25 mmHg. As well, his parting advice
that “While I have treatment goals (skin, lung,
GI, kidney improvement)…Remember the patient’s
(pain, pruritus, coping)” hit home. From a
Canadian perspective, we should be proud of the
work done by our own Canadian Scleroderma
Research Group (CSRG) on this topic.
Multiple new, updated, and draft guidelines
and classification criteria were presented at ACR
Convergence. Topics covered included calcium
pyrophosphate crystal deposition (CPPD) disease,
steroid-induced osteoporosis, anti-phospholipid
syndrome, and vaccinations in rheumatic disease.
A novel ACR guideline for exercise, rehabilitation,
diet, and additional integrative interventions
for RA was also highlighted. Consistent exercise
was strongly recommended, while dietary supplements,
chiropractic and electrotherapy were
conditionally not recommended.
I note the IgGenerals team from Massachusetts
General Hospital won the ACR Knowledge Bowl,
the ACR’s counterpart to CRA’s RheumJeopardy. A
very appropriate team name.
As usual, ACR Convergence 2022 was jampacked
with interesting sessions, cutting-edge
science, and innovative presentations. Attendance
statistics showed total attendance was more
than 13,000, total scientific attendees numbered
11,000 plus, with in-person scientific attendees
just under 7,000, and virtual scientific attendees
over 4,300. International attendance showed a
near 50:50 split, while U.S. attendees were about
two-thirds in person. ACR Convergence 2023
will again be presented in hybrid fashion in early
November 2023, with the in-person sessions returning
to San Diego, a familiar venue for ACR
meetings. I will see you there, one way or another.
Philip A. Baer, MDCM, FRCPC, FACR
Editor-in-chief, CRAJ
Scarborough, Ontario
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