Arthritis Consumer Experts is again reporting from American College of Rheumatology Annual Meeting where patient advocates, rheumatologists, researchers, and arthritis health professionals are sharing their knowledge and experience around the prevention, diagnosis and treatment of arthritis.
Here are highlights from Day 2 of ACR Convergence 2024:
How cancer treatments could offer new hope for treatment of autoimmune disease
Immunotherapies, such as chimeric antigen receptor T-cell (CAR-T) therapies, have revolutionized cancer care and are now being explored as potential treatments for autoimmune diseases, including lupus, systemic sclerosis (SSc), and idiopathic inflammatory myositis (IIM).
At ACR Convergence 2024, experts Marco Ruella, MD, Assistant Professor of Medicine in the Division of Hematology/Oncology and the Center for Cellular Immunotherapies, and Scientific Director of the Lymphoma Program at the Hospital of the University of Pennsylvania, and Laura Cappelli, MD, Associate Professor of Medicine and Oncology at the Johns Hopkins University School of Medicine, discussed immune-related adverse events associated with these therapies and their implications for rheumatology. The session provided insights into CAR-T’s mechanisms, safety, and potential in autoimmune care, offering hope for patients with severe autoimmune diseases while addressing the challenges of long-term monitoring and resistance.
Dr. Ruella highlighted the unique toxicities of CAR-T therapy: “Immunotherapies are certainly one of the most exciting treatments developed for cancer, as they provide the opportunity for complete remission for patients with cancers otherwise characterized by an extremely poor prognosis,” said Dr. Ruella. “Many patients have survived longer, but these therapies are also associated with new toxicities, which are not common or absent with standard chemotherapy and small molecule-based cancer therapies.”
While these adverse effects pose challenges in oncology, early data suggests CAR-T therapies may have a more favorable safety profile in autoimmune disease patients. For example, a small study showed significant symptom relief in 15 patients with severe lupus, SSc, or IIM following a single CAR-T infusion.
Dr. Cappelli addressed the overlap between oncology and rheumatology in managing immune-related adverse events and the evolving application of immunotherapies. As these treatments become more prevalent in rheumatology, understanding and managing their side effects will be crucial.
Keynote address spotlights importance of allyship in rheumatology
At American College of Rheumatology (ACR) Convergence 2024, Dwinita Mosby Tyler, PhD, delivered a keynote address – The Transformative Power of Allyship in Rheumatology -emphasizing that meaningful diversity, equity, and inclusion (DEI) efforts start with self-reflection and lead to actionable allyship. Allyship, she noted, is an active process of building connections and driving systemic change to create equitable and inclusive environments.
Dr. Tyler, CEO and founder of The Equity Project, introduced the concept of “mirror work,” a practice of reflecting on how personal actions and biases affect others, as the foundation of DEI efforts. From there, allies must move beyond passive support to actively challenging inequities and fostering belonging. She identified five mental models influencing how people perceive DEI, stressing the importance of understanding others’ viewpoints, even when they oppose DEI principles.
Dr. Tyler emphasized that allyship requires compassion and a commitment to reducing feelings of “outsiderness” for everyone. Her philosophy avoids divisive labels and focuses on collaboration and shared growth.
Other (ACR leaders also underscored the importance of DEI and interdisciplinary collaboration in rheumatology. ACR President Deborah Dyett Desir, MD, highlighted initiatives addressing education, advocacy, and global outreach, all aimed at improving care for people with arthritis while fostering equity and inclusion in the profession.
Go Deeper
What makes one person healthier than another? Many people think first about things like smoking and exercise; however, economic and social conditions have a greater influence on the health of individuals and communities. Some examples include race/racism, gender, housing, income, employment, and disability. These are known as the social determinants of health and are typically the root cause of health inequalities because they impact where and how a person lives, their work, their access to resources (e.g. groceries, healthcare, day care) and the level of stress in their daily life.
Health inequalities are called health inequities when they are unjust. Race is an important social determinant of health because it is closely tied to other factors such as income, employment, education, housing, and experiences accessing healthcare resources. In other words, systemic racism can impact many areas of a person’s life and thus their health. In addition, life-long experiences of racism and discrimination can affect a person’s health by causing them high levels of stress in their daily life.
To learn more, Arthritis Consumer Experts has developed specific programming focussed on health inequities in arthritis and healthcare at large:
- Inequities in Arthritis Care in Canada: The Black, Indigenous & Person of Colour (BIPOC) Experience – Infographic and video
Reducing steroid in treatment for people living with arthritis: Experts discuss challenges and progress
Steroids have been a cornerstone of arthritis treatment for decades, but their long-term use is linked to significant toxicity. At ACR Convergence 2024, experts looked at efforts to reduce steroid dependency, leveraging emerging therapies to improve patient outcomes.
John Stone, MD, MPH, of Harvard Medical School, presented advances in treating ANCA-associated vasculitis. He emphasized the role of new therapies like avacopan, approved in 2021, which reduces steroid toxicity and offers an alternative to high-dose steroid regimens. “We’re making progress, but eliminating steroids entirely will take time,” Dr. Stone said, pointing to ongoing vasculitis trials that include measures for steroid toxicity reduction.
Michelle Petri, MD, MPH, from Johns Hopkins University, addressed systemic lupus erythematosus (SLE). She noted that prednisone contributes to 80% of permanent organ damage in SLE patients. The 2023 EULAR guidelines recommend keeping prednisone doses at 5 mg or less and using immunosuppressives or biologics earlier.
Beth Wallace, MD, MS, of the University of Michigan, discussed rheumatoid arthritis (RA). While biologics have reduced steroid reliance, many patients still face challenges tapering off.
When people with RA flare, rheumatologists currently have no alternative to help them in the short term other than steroids, she noted. So, the long-term goal must focus on recognizing RA early, getting patients on disease-modifying treatment quickly, and treating-to-target aggressively.
“That is something we’re going to have to continue to work toward from both the clinical side and the translational side,” Dr. Wallace said. “On the clinical side, we need to focus on treatment protocols that get people’s RA under control well enough that they don’t need steroids for flares. On the translational side, we need to develop treatment modalities that act quickly enough that we don’t need to rely on steroids until [those treatments] start working.”
Dr. Wallace also identified the need for faster-acting treatments and aggressive early intervention to minimize flare-ups without steroids.
Cultural Humility: A path to better care for children living with arthritis
At ACR Convergence 2024, a panel discussion titled Cultural Humility for the Pediatric Rheumatologist explored how understanding and addressing cultural and socioeconomic differences can improve care for children with arthritis and the importance of listening to patients and considering their unique needs.
Panelists offered actionable strategies to promote equitable, patient-centered care for children with arthritis, including Jillian Rose-Smith, PhD, Vice President and Chief Health Equity Officer of the Hospital for Special Surgery who introduced the concept of cultural humility, urging healthcare providers to reflect on their biases and engage in open, lifelong learning. She emphasized that co-creating care plans with patients, based on their lives and values, can lead to better outcomes. She added: “Cultural humility asks us to consider how treatments fit into patients’ lives beyond the clinic.”
The session also featured Adaobi Ugochukwu, MD, a first-year pediatric resident at Children’s National Hospital, who has lived lupus since she was 9 years old. Dr. Ugochukwu shared her journey as both a patient and a physician, emphasizing how access to care and resources impacts outcomes.
Shiloh Kantz, Executive Director of the Oklahoma Policy Institute discussed her family’s struggles after Oklahoma lost its only pediatric rheumatologists, forcing an eight-hour round-trip to Texas for care. She highlighted the importance of community efforts to break down barriers and improve access to quality care.
Go Deeper
In this episode of ACE’s Arthritis at Home program, Ms. Natasha Trehan, Dr. Michelle Batthish and Dr. Stephanie Garner discuss what is the definition of an emerging adult with rheumatic disease and highlights the challenges that may arise in the transition from pediatric rheumatology care to adult rheumatology care.
Additional learning resources