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29th Apr

2018

American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting

by Gabrielle McFarlane

15th February 2018

This report is submitted in fulfilment of the requirements for Travel Scholarship from Australian Rheumatology Health Professionals Association – ARHPA

I am very pleased to have the opportunity to attend this international conference, and extremely grateful to ARHPA for favourably assessing my application for financial assistance.

The ACR/ARHP Annual meeting is the largest rheumatology conference in the world with over 16,000 delegates attending. In 2017 it was held on November 3-7, in the San Diego Convention centre. The session program was packed with accredited clinical practice and science, basic science and research presentations and workshops. A huge poster hall displayed a collective of work from around the world, and an industrial ‘discovery centre’ shared contemporary treatment offerings. To help delegates navigate the entire meeting opportunities, every session was segmented into ‘tracks’, available in hard copy booklet and digital App format.  Information helpers and security presence were able to provide immediate assistance and support as required from each day opening – 7am through closing 7pm.

The quality, interest factor and relevance of information opportunities at this conference was extremely high and I sort to attend a variety of sessions. I planned my journey through the tracker, with some highlights listed below.

My inaugural session was Orientation for first timers. I met one of the Clinical Nurse Specialist lead meeting organisers, who texted me in on an introduction with the Clinical Nurse Specialist Paediatric organising lead. My journey had begun with purpose and direction and from that first meeting I rapidly became linked and connected with nurses. Of particular note was my introduction to the ARHP network lunch, established to provide a location for network opportunities. Tables were allocated to various professions with the intention that you turn up find your table and introduce yourself. 

This forum was amazing – not only did I meet paediatric nurses from around the world, but we connected on an App and were able to meet up multiple times over the following days as well. The connection enabled and prompted valuable clinical conversation such as a discussion about the use of biosimilar medication around the US, and an introduction and  offer to join the Pediatric Rheumatology Nursing (PRN) Network listserve coordinated through John Hopkins All Children’s Hospital Florida. The listserve currently has 200 paediatric rheumatology nurses connected from around the world via email.

 A repeat presentation from EULAR 2017 Making Connections Count

  • Don’t delay – Connect today is a campaign launched at EULAR annual conference in June 2017 in Spain.
  • Worldwide delay in the review of patients with rheumatological disease was acknowledged – due to lack of awareness, reducing people’s quality of life and affecting physical abilities.
  • Early diagnosis is key to preventing damage.
  • Window of opportunity identified to start treatment
  • Aggressive therapy and early approach to treatment is recommended MTX + steroids in short term – bDMARDS within 3/12
  • Ideal outcome is disease remission on no drugs, over disease remission on drug therapy

Study Group Juvenile Arthritis Workgroup session – TMJ Arthritis

This session was particularly fascinating  with speakers including a Paediatric Orthopaedic surgeon

  • Alarming incidence of silent subclinical arthritis in TMJ – jaw joint
  • symptomless but seen on MRI
  • Intra articular steroid injections effect is limited
  • Surgical intervention drastic measure in child but has good outcomes in the small cohort

Poster Hall presentation-Paediatric Musculoskeletal Matters

PMMONLINE.COM Launch  – a paediatric rheumatology education platform for health professionals.

Another highlight was meeting Paediatric Rheumatology Nurse Ruth Wylie from Great North University Hospital in Newcastle UK. I had met Ruth’s Medical team lead academic Professor Helen Foster, at a recent visit to Australia. Professor Foster is highly regarded around the world for work in paediatric rheumatology health care. She has published multiple practice evidence based papers and work practice guidelines including Pgals a world first paediatric musculoskeletal assessment tool for medical staff. Ruth has worked extensively with Prof Helen Foster- as a Clinical Nurse Specialist – in this flagship paediatric rheumatology service.

With quality bench marking opportunities on which to base our relatively new service here in Queensland, I was able to spend precious time with Ruth across the four days. I particularly enjoyed exchanging health care ideas and feeling reassured our nurses role and service delivery in Queensland would align with current and in some cases exceed clinical practice around the world. An example is our current transition of care service development for adolescents with our unique position to have an adult health facility located next door and a shared Rheumatologist position on both sites.

There was a professional and personal buzz about attending an international academic information technology launch, and being introduced among the delegates, from Australia!   I was particularly proud. I have also been invited to attend a two week intensive clinical placement with Ruth to work side by side with her. I feel grateful and excited at the thought and will seriously consider logistics over the next few years to gain this valuable experience and return with effective practice ideas to Queensland. 

Since returning from ACR

Pmmonline.com is a feature in our nurse development program and commitment to promote the site at every opportunity

Our service is prioritising – preparation to transition, implementing a clinical process before transfer, and collaborating with community agencies to develop and implement a transition education program.

Keynote address Clinical Practice session Exercise as medicine – we all need to say the same thing  and Alex Mroszczyk-McDonald

The main message is GET MOVING

‘If there was one drug in the world that could provide the most benefit to reduce severity of a broad range of disease, that could benefit the majority of people from around the world, and would be the most cost effective – it would be EXERCISE’ – Dr Teresa J Brady

Sedentary behaviour in human population is increasingly evident, with significantly high proportion of the general community reported as inactive.

The cohort of patients with arthritis generally;

  • education is comprised
  • limited work opportunities
  • often psychological distress to patient and family is evident
  • experience poor general health
  • Social complexity on back of disease chronicity

Patients fear exercise due to pain, and uncertainty about it being ok to participate

They need to hear from their Doctor it is ok to exercise;

  • Doctors should assess patients participation in exercise as if a vital sign – prescribe, refer and follow up
  • Assess how much for how long and how many days per week

The benchmark is150 minutes moderate/75 minutes vigorous per week  (ideal is 30 minutes x 5 day)

  • Opportunity for the multidisciplinary team to contribute to exercise planning
  • Each patient could leave consult with a brief plan, some motivation and follow up

Since returning from ACR

Exercise assessment tool and Paed JIA plan in development

Exercise discussion to be added to our New diagnosis starter pack checklist

Pharmaceutical company network

Representation from a variety of pharmaceutical companies promoting their products was extensive. Stands offered everything from pens and ribbons to coffee and slushes. The biggest displays were Adalibumab Humira, and Tofacitanib. I met with Rheumatology health professionals from Sydney Adelaide and Melbourne, at a pharmaceutical company hosted lunch as well as further developed relationships with our state sale representative and her colleagues. A recent issue with medication access for a significant cohort of patients has been efficiently dealt with by this pharmaceutical company and I feel important collaborative outcomes have been secured for our patients based on good communication, and good will with suppliers.

In conclusion I was exposed to a richness of information and experience unobtainable locally, I have improved my knowledge base and bring contemporary ideas and conversation to my work place to change or improve practice. I also had the opportunity to take experience and skills from my work place, my state and my country to this international meeting, which I shared at the many opportunities of interaction moving through and participating in the program. I felt valued and respected in this forum.

I have returned home with a renewed passion to establish better and improved practice for patient care, to improve health workers education through access to consistent guidelines and evidence based standards, (promotion of PMMonline .com is a good start) and to conduct relevant research to share with peers and colleagues.

I am lit up about Rheumatological disorders in children, I’m empathetic and passionate to help improve their quality of life and lesson disease burden on families. In my everyday work there are many opportunities to be effective.

I would like to acknowledge again my sincere thanks to the ARHPA for financial assistance to attend the 2017 ACR/ARHP, and look forward to planning and attending other important meetings in the future.

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