Rebecca Manno, MD, MHS: ACR SOTA Clinical Symposium

This week, Rheumatology Network sat down with Rebecca Manno, MD, MHS, Adjunct Assistant Professor of Medicine at John Hopkins University, to discuss the American College of Rheumatology State of the Art (ACR SOTA) Clinical Symposium, which ran from April 9-11. We discuss the ACR SOTA conferences in general, highlights of the presentations, recent advancements in rheumatology, and the challenges facing the specialty as a whole during the COVID-19 pandemic.

Rheumatology Network: Hi, Dr. Manno, thank you for joining me today.

Rebecca Manno, MD, MHS: My pleasure.

RN: To begin, can you give me a brief overview of the goals of the ACR SOTA conferences in general?

RM: Absolutely. So the timing of SOTA is historically about 6 months or so after the annual meeting. So, sort of the halfway point before the next year's annual meeting. And the objective of SOTA, State of the Art, is really a meeting that is focused on the practicing clinician. And the goal is to really crystallize the pearls and the advances in rheumatology over the past year and to discuss state of the art topics and the hottest data and the newest innovations in the field of rheumatology. SOTA has become a very special place for our trainees, for our fellows in training because when we were doing SOTA in person, it traditionally is a smaller, more intimate meeting compared to the annual meeting. And we have special sessions with the fellows and training subcommittee who does some sessions before the SOTA meeting. And so it's a great opportunity for fellows to get some special one-on-one time with presenters, with faculty, and also some special sessions for each other. So that's what makes SOTA special, even in the virtual environment. But certainly historically that's where it has been a special place.

RN: What were some of the highlights and presentations that you were most excited about during the 2021 conference?

RM: So, there was so many great things that happened. And so of course, SOTA 2021 was all virtual. But even though it was all virtual, there were some of the sessions, many of the talks were prerecorded, but all of the question-and-answer sessions were live. So, there was a great interaction between the virtual audience and the speakers. A special edition that we had this year that I think was really great was the community hubs. And this was something that was introduced at ACR Convergence in 2020. And really was very popular. These community hubs are our smaller sort of breakout sessions that highlight specific topics. And the topics that we chose for SOTA included equity and inclusion in rheumatology. There was a special session for fellows, 1 on COVID. And so, this was a really exciting addition to the SOTA program. All of our speakers were phenomenal at SOTA. This year, we had a really jam-packed program; we had a lot of diverse topics, a lot of hot topics in the area. I think our COVID session was absolutely fantastic and it was a live session. So, it was really the literally up-to-the-minute data on COVID and what rheumatologists need to know. We had a the first ever combined neurology rheumatology session called “Brain on Fire” that talked about CNS vasculitis, as well as autoimmune encephalopathies. And that was a really special session as well. There were some great clinical pearls from Dr. Andy Mammen, in terms of cases difficult cases with myositis. And a great talk on updates in lupus because there's been so many wonderful updates in lupus with new FDA approved therapies by Dr. Saira Sheikh. And those are just a few of the highlights. There was a outstanding vasculitis talk by Dr. Dua because of some very exciting advancements in the field of vasculitis as well. And it was a great mix of rheumatology, hearing from rheumatologists who are experts in the field, but also some of our colleagues in the subspecialties that we share patients with such as gastroenterology, pulmonary, cardiology, and neurology.

RN: What is the 1 thing that you would have liked practicing rheumatologists to have taken away from the meeting?

RM: There's definitely not 1 thing. Definitely not 1 thing. I think at the end, it gets back to the spirit of SOTA which is the goal is to have concrete recommendations that the practicing clinician can actually take back to their everyday practice and make a change. And that may be the some of the newer therapies for lupus that they can actually be implementing right now, that may be an increased awareness of myocarditis as a complication of immune checkpoint inhibitors. So, I wish I could say that there was 1 thing, but I think any clinical pearl that is a medication with a dose of frequency and appropriate indication, how to monitor your patients, or how to diagnose your patients, any of those are a great asset to take back to your clinic that you can use in real time. And that's what we emphasize for our speakers, we ask them to really have points that our audience can take back to their clinic. And I think that they exceeded our expectations in that way as well.

RN: What, in your opinion, are some of the challenges facing the specialty as a whole right now?

RM: Yeah, I wish I could say it was unique to rheumatology, but COVID COVID COVID. So COVID, obviously, in the height of COVID, the management in terms of keeping our patients safe if they did get COVID, how to manage their rheumatic disease and/or their medications. As the COVID story has evolved, now, we are so happy to have vaccines. And right now, it's a challenge. It's counseling our patients and making sure that they're vaccinated and protected from COVID. But COVID has also left us with challenges in terms of patient access to care. And all of the downstream effects that COVID has had in healthcare that is not just limited to rheumatology, but the mental health effects that it has had on our patients in terms of stressors, depression, anxiety. So, not only physical health, mental health, and this goes for patients, but also goes for physicians as well. COVID has been a challenging time, of course, for our patients and us as a healthcare profession wanting to keep our patients healthy. B ut it's challenging for physicians too. And so physicians are suffering from COVID burnout, stressors with some of the new regulations and how to manage clinical care. And this time, it's been tough for physicians as well. So, I think the impact of COVID on rheumatology is not unique in and healthcare and many other specialties and certainly all sorts of care providers are struggling with the same issues. We're not immune to it and rheumatology either.

RN: What do you think was the biggest advancement or perhaps a few of the biggest advancements in rheumatology in the last year?

RM: Oh, boy. That is pretty impossible to answer. But I think I think if I if I had to pick some exciting things, if I had to pick 2 things, I would say FDA approval of 2 drugs for lupus, which is very exciting: voclosporin and belimumab. Although belimumab was FDA approved for lupus, it has a new indication for lupus nephritis. So, the fact that we are having great positive trials in lupus is very exciting. I think the second thing that is very exciting are some of the data from ANCA-associated vasculitis from avacopan. And specifically, the hope that we can use less corticosteroids in the treatment of our patients with ANCA-associated vasculitis. That is a very, very exciting prospect.

RN: Is there anything else that you'd like to our audience to know about the conference before we wrap up?

RM: Yeah. So, I think it just gets back to the spirit of SOTA, which is, once again, specifically for with the goal of state of the art, but clinically applicable messages. But also, the spirit of SOTA is to have fun. So, it's supposed to be a fun conference. And it is it is certainly something we miss about the in-person experience and being able to have that one-on-one time. I think in our virtual environment, really, in SOTA 2021 we did a great job of trying to recreate that in the virtual environment the best that we can with the live question-and-answer sessions in the community hub really help. But these meetings should be informative, educational, help us to be better rheumatologists in our practice, but also to be fun, and to spend time with our colleagues and each other. And until that's safe to do in person, the virtual environment will do. It's still a great option for people who may not be able to attend meetings in person in the future anyway. But having fun is a really important part of SOTA too. And, and we hope to keep that as an important objective moving forward as well.

RN: Dr. Manno, thank you so much for joining me today. I really appreciate it.

RM: My pleasure. Thanks for the invitation.