Looking Forward to ACR2014: My Picks From the Program

The American College of Rheumatology (ACR) is hosting its 2014 annual meeting[[{"type":"media","view_mode":"media_crop","fid":"29324","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_4600662016743","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3038","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 106px; height: 105px; float: right; margin: 3px;","title":" ","typeof":"foaf:Image"}}]] in Boston, which has been a center for change and new direction in our country, not only through  the American Revolution but also through the academic institutions it nurtures, from Harvard and Massachusetts General Hospital to MIT. It seems fitting, therefore, to anticipate revolutionary changes from the ACR meeting as well.

Here’s what I’m watching for:

•Further news  about the clinical utility of the protein 14-3-3n and the anti-14-3-3n antibody to precede and independently predict progression to early rheumatoid arthritis. Over the past year this molecule has  progressed from a sideline interest to a commercial test,  featured in last issue of the Journal of Rheumatology At ACR2013 it featured in  3 posters and a podium presentation, and a separate abstract discussed a decrease in the protein level and an increase in the antibody with anti-TNF therapy, predicting remission.

The 14-3-3 protein was noted in other viral arthritidities ( hepatitis C-associated arthritis, EBV- associated arthritis and parvovirus B19 arthritis) but in significantly lower titers, making it  an attractive assay for the presence of rheumatoid arthritis. This year’s meeting will feature over 14 abstracts and podium presentations on this topic, discussing its role in rheumatoid arthritis, lupus, and spondyloarthropathies, including:.

– Change in 14-3-3n Expression in Early RA Patients Treated with DMARDS Corresponds with Change in DAS 28 and Good EULAR Responses (Abstract 1903. Monday, November 17, at 4:45 PM) During the session "Rheumatoid Arthritis - Clinical Aspects IV: Promising Biomarkers," Dirkjan van Schaardenburg MD PhD will discuss how a decrease in 14-3-3n plasma levels correlates with response to therapy and with changes in DAS28.

– Autoantibodies to 14-3-3n are novel biomarkers associated with Inflammation and Radiographic Progression in Ankylosing Spondylitis (Abstract 2985, Wednesday November 19,  at 9:30 AM).  In the session “Spondyloarthropathies and Psoriatic Arthritis VI - Imaging and Biomarkers," Walter P Maksymowych MD will discuss the presence of 14-3-3n autoantibodies in patients with ankylosing spondylitis versus healthy controls.  

– Among numerous  posters on this topic (359, 360, 361, 362, 400, 405, 407, 408, 987, 1975,  2091, and L18), I’m specifically interested in  "Clinical Utility of 14-3-3n in the Evaluation in Inflammatory Arthritis" (Abstract 400), presented by Lance Feller MD during the poster session "Rheumatoid Arthritis - Clinical Aspects:  Novel Biomarkers and Other Measurements of Disease Activity" (Sunday, November 26, starting at 8:30 AM).

• As an avid supporter of the evolution and incorporation of imaging into clinical practice in rheumatology, I hope to see imaging continuing to play a greater role  in classification and diagnosis. Two years ago, I was excited to see the ultrasound signs of shoulder tendonitis and bursitis included in the joint ACR/EULAR classification of polymyalgia rheumatica in 2012. I wonder which conditions will be next.

A general session entitled "Classification Criteria for Gout" (Monday ,November 17, at 1:00 PM) will discuss the role of imaging modalities and will explore new joint ACR and EULAR Gout Classification Criteria.  Will our knowledge of the imaging characteristics of gouty arthritis facilitate more accurate diagnosis of this condition?  

The ACR Musculoskeletal Ultrasound Study Group  (Monday, November 17, at 6:30 PM) will discuss the role of sonography of the tendon and entheseal structures in the diagnosis of crystalline arthropathies and spondyloarthropathies. 

During the session "Sjogren's Syndrome I:  Clinical Perspectives" (Tuesday, November 18, at 4:30 PM) Chiara Baldini MD will present "Longitudinal Examination with Salivary Gland Ultrasonography of Patients with Primary Sjogren's Syndrome:  A Single Center Experience." (Abstract 2931) This study compares sonographic scoring of the parotid and submandibular salivary glands to the conventional scoring system, the ESSDAI (European Sjogren's Syndrome Disease Activity Index).

Will the revolutionary spirit of Boston inspire rheumatologists at these sessions? What other revelations in the program may lead us to unexpected new actions? I’m excited to find out this week – and I will let you know what I learn.