October 21 Daily Buzz at ACR 2018

Liz Neporent

October 21, 2018

ACR 2018 is in full swing as its scientific sessions get underway.


CHICAGO — Results from two dozen rheumatology studies presented at the American College of Rheumatology (ACR) 2018 Annual Meeting were released late yesterday. The research topics — ranging from rheumatoid arthritis to lupus to gout — reflect the span of conditions rheumatologists typically diagnose and manage in clinical practice.

Here's What We Were Waiting For

An investigative team from Lancaster University in the United Kingdom scrutinized long-term bone loss at different sites in patients with rheumatoid arthritis. The researchers examined bone densitometry scans from nearly 7000 patients over an 11-year time span, and found that bone density loss was greater in the hips of patients with rheumatoid arthritis than in those without. However, bone density mass in the lumbar vertebrae was higher in patients with rheumatoid arthritis.

Effect size of rheumatoid arthritis on annula change in bone mineral density,(Source: Marwan Bukhari)

The reason for the discrepancy in bone loss at different sites in patients with rheumatoid arthritis is unclear, said Marwan Bukhari, MD, one of the study's lead authors and an honorary lecturer at Lancaster University.

"The most likely explanation may be an activation of cytokines that enhance bone reabsorption preferentially in the cortical bone but not the trabecular bone," he told Medscape Medical News.

The findings are clinically significant because bone loss in the hip is used as a predictor for fracture, said Bukhari. The rapid bone loss in the hip observed in this study suggests a need to reduce the length of time between scans in patients with rheumatoid arthritis, he added.

Unexpected Emotion

A surprisingly emotional opening lecture left both the presenter and many in the audience in tears last night.

The speaker, Jonathan Koch, developed necrosis in his hands and feet after being diagnosed with acute hemophagocytic lymphohistiocytosis. Koch spoke about the physical and emotional aspects of his medical journey, and said that he believes he was born with the heart of a champion and felt he could not give up.

"When I interacted with all the medical professionals, it was important for me to tell them I wanted to fight," he said. "And not just to say it, but for them to believe it."

Koch also wanted his healthcare team at George Washington Hospital in Washington, DC, "to feel the same way about me that I feel about them — which is thankful and grateful that they are there."

Koch speaking about the physical and emotional aspects of his medical journey. (Photo: Darbe Rotach, Medscape)

His words seemed to inspire those in the audience who packed the auditorium at the McCormick Place conference center. Many took to Twitter to express support and praise.

"Powerful testimony from Jonathan Koch at the opening lecture #ACR18...," tweeted user @amlopezo.

"Emmy winning producer Jonathan Koch giving an incredible keynote speech on resilience at #ACR18 opening lecture about surviving his medical illness that caused multiple amputations and required a hand transplant...," another user, @KDAO2011, tweeted.

Marwan Bukhari has disclosed no relevant financial relationships.

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Follow Medscape Rheumatology on Twitter @MedscapeRheum and Liz Neporent @LizzyFit


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