Needs & Objectives

2018 TRS Annual Scientific & Business Meeting

February 23 – 24, 2018
Franklin Marriott Cool Springs
Franklin, Tennessee

Educational Needs

Chaos surrounds the definition of vitamin D “inadequacy” optimal status despite a plethora of basic science and clinical trials evaluating the effect of vitamin D. Current inadequacies of clinical trials designed to define low vitamin D status will be considered. The challenges surrounding measurement of 25(OH)D, the necessity of utilizing standardized 25(OH)D assays and the futility of attempting to perform meta-analyses using non-standardized 25(OH)D measurement will be considered. A reasonable approach to vitamin D status based upon highly sun exposed individuals and appreciating assay variability will be discussed.

Recent epigenetic studies reveal the pathogenic role of micro-ribonucleic acids (microRNAs) and their targets in the inflammatory process in rheumatoid arthritis (RA). Rheumatologists need competency in novel biomarkers of rheumatoid arthritis in order to provide their patients with best possible treatment and outcomes.

The new direct oral anticoagulants (DOAC) used in the treatment of Antiphospholipid syndrome (APS) are direct anti-Xa inhibitors. These agents do not interact with dietary constituents and alcohol, have few reported drug interactions, and monitoring of their anticoagulant intensity is not routinely required due to their predictable anticoagulant effects. However, DOACs should be used with caution in APS patients and rheumatologists need to be aware of the possible safety issues.

Fragility fractures engender major healthcare cost, reduce independence/quality and life and increase mortality risk. Despite availability of multiple therapies to reduce risk for future fracture, few patients are treated even following hip fracture. Clearly, approaches of the past aimed at reducing fragility fracture risk, primarily by diagnosing osteoporosis and initiating bone-active medications, have failed. As such, a different approach is required; such a change in focus is proposed. Briefly, the dysmobility syndrome concept recognizes fragility fracture as the clinical outcome of consequence and appreciates that osteoporosis is only part of the syndrome leading to “osteoporosis-related” fracture. Other components of this syndrome include sarcopenia, obesity, diabetes, osteoarthritis, and potentially multiple other factors that increase risk for falls with attendant increased fracture risk. In summary, the dysmobility syndrome concept moves the field, and also importantly, older adults at risk for fragility fracture, beyond a singular focus on bone to more appropriately focus on an overall approach to fracture risk reduction.

Transitioning patients with childhood-onset rheumatic diseases that persist into adulthood can be complex and challenging. Understanding the important differences in the classification, pathogenesis, and complications of juvenile idiopathic arthritis when compared to adult onset inflammatory arthritis is important for ensuring high quality care for this vulnerable group of patients throughout all phases of their lives. Well-developed resources exist and are useful to facilitate the transition of patients from the pediatric to adult systems of care, with tools that pediatricians and adult providers alike should be aware of and incorporate into their practice when useful.

Educational Objectives

At the conclusion of the TRS 2018 Annual Scientific & Business Meeting, attendees will be able to:

  1. Explain the controversy surrounding the definition of vitamin D status and understand the reason(s) for this.
  2. Appreciate the challenges/limitations of 25(OH)D measurement and a reasonable approach to defining “optimal” vitamin D status.
  3. Review the different antiphospholipid antibodies.
  4. Evaluate the non-thrombotic manifestations seen by Rheumatologists.
  5. Describe the controversy of DOACs for APS.
  6. Evaluate the definition of “osteoporosis” and consider whether this definition should be expanded.
  7. Appreciate the importance of sarcopenia and other co-morbidities as contributors of the syndrome of “osteoporosis-related” fracture.
  8. Evaluate the price patients pay for reliance on steroids.
  9. Review recent data on non immunosuppressive immunomoddulators, not just hydroxychloroquine, but also vitamin D.
  10. Evaluate Phase 2 trial results for both lupus nephritis and non-renal lupus—the future is exciting!
  11. Explain how small RNAs such as microRNAs modify cellular function.
  12. Identify what microbial small RNAs are altered in patients with rheumatoid arthritis.
  13. Explain differences in the classification and complications of juvenile idiopathic arthritis compared to adult onset inflammatory arthritis.
  14. Recognize available resources that can be used to facilitate the care of teens and young adults from pediatric to adult systems.