October 23 Daily Buzz at ACR 2018

Liz Neporent

October 23, 2018

More than 15,000 people attended the ACR 2018 annual conference in Chicago this week.

CHIGACO — After more than 450 sessions, the American College of Rheumatology (ACR) 2018 Annual Meeting is winding down. The conference saw the release of more than 3000 scientific abstracts featuring research on the most relevant and cutting-edge information in rheumatology.

One investigation of the METEOR registry — a free, online, international database of daily practice visits to rheumatologists — provided some interesting results. An analysis of more than a decade's worth of registry data from 12 countries uncovered an association between the socioeconomic status of a country and disease activity in its rheumatoid arthritis (RA) patients.

Here's What We Were Waiting For

In countries with less wealth, disease activity was more severe in RA patients, and in higher-income countries, remission was more common. For each increase of 10,000 international dollars in gross domestic product per capita, an additional 4.2% of patients met the criteria for DAS28 remission.

Association between disease activity and GDP per capita (top left), DAS28 remission and GDP per capital (top right), disease activity and bDMARD use (bottom left), and bDMARD use and GDP per captia (bottom right). (Source: Sytske Anne Bergstra)

Even when biologic disease-modifying antirheumatic drugs (bDMARDs) were available in poorer countries, the effect on disease activity was less than expected, said investigator Sytske Anne Bergstra, a postdoctoral researcher at Leiden University Medical Center in the Netherlands.

"It seems like the association between socioeconomic status and disease activity is very complicated," she said, because "it is hard to argue that the availability of biologics makes the difference between good and bad care for RA patients."

Influences other than bDMARDs, such as "general access to medical and nonmedical care, support systems, well-functioning healthcare systems, prescription and reimbursement rules," could contribute to the success of treatment, she told Medscape Medical News.

These findings could help policymakers and rheumatologists improve access to good care and lead to a better understanding of inequities in RA treatment, she added.

An Unexpected Find

Although art and medicine are often viewed as being at opposite ends of a spectrum, they intersected here, thanks to the work of Denver-based artist Alece Birnbach.

The ACR hired Birnbach to create an expansive mural in a busy hallway of the McCormick Center to illustrate what rheumatologists think healthcare will look like in 2030. She painted, brushed, and penned drawings of the answers to questions she asked of bypassers, and noted one theme that came up again and again.

Birnbach illustrates what rheumatologists think healthcare will look like in 2030. (Source: Darbe Rotach, Medscape)

"They're telling me that demand will outweigh the supply," she told Medscape Medical News. "Rheumatologists are feeling challenged that, already, there aren't enough of them to meet patient needs."

Interested in learning more about this project? A full story on the artist, with pictures of her incredible work, is forthcoming and will be part of the ACR coverage by Medscape Medical News. And check us out on Twitter, Instagram and Facebook.

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


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