Home > meeting report > Meeting report (part 1): Biological treatment of rheumatic diseases with special focus on T cell modulation

Meeting report (part 1): Biological treatment of rheumatic diseases with special focus on T cell modulation

Meeting report (part 1): Biological treatment of rheumatic diseases with special focus on T cell modulation
Venue: Karolinska Institute, Department of Rheumatology, Stockholm, Sweden.
Date: 22-23 November, 2011.
Participants: approx. 30 rheumatologists from 9 different European countries (Sweden, United Kingdom, the Netherlands, Belgium, France, Germany, Czech Republic, Austria, Spain)

Invited by BMS, a major pharmaceutical company that co-sponsored this meeting, rheumatologists from 9 countries throughout Europe gathered for a 2-day visit at the EULAR Center of Excellence in the department of Rheumatology at the Karolinksa Institute (KI) in Sweden last week. Being a participant in this interesting and well-organised meeting I wrote down some notes during the lectures that were given, and I thought to share them here. Feel free to comment.

Day 1 (Tuseday November 22nd, 2011)
Despite foggy weather conditions in the Netherlands we managed to arrive in Stockholm the evening before the meeting started, and we stayed in the Berns Solanger hotel in the centre of Stockholm, a very nice ans special location. On Tuesday the meeting was kicked-off by some brief introductions to the magnitude, location and organisation of the rheumatology care in Stockholm and direct surroundings were 2 of the 9 million inhabitants of Sweden live. The introduction talks were given by Cecilia Carlens, head of Dept of Rheumatology at KI, and Magnus Andersson Sandqvist who was the friendly chairman during the 2-day visit.

The Karolinska Institute delivers the core of rheumatology care in Sweden, and all more advanced rheumatological cases are treated either in Solna, Stockholm at the Institute or in a second more southern situated location Huddinge which is of equal dimensions. The major part of this meeting was held in the Center for Molecular Medicine research buidling which is located less then 100 yards from the Department of Rheumatology (on the photo snapshot) just on the opposite side of the street (i.e. untill the currently being built new Karolinska Hospital opens in 2015, which will be slightly further away but also on walking distance). Quite remarkable figures and facts stated in the introduction talks were that over 25% of the 10,000 outpatient-clinic patients that are being taken care of are on biological treatment, which is so far quite unrestricted in Sweden, but may quite vary per region in Sweden. However it is fair to say that the nurses in the daycare unit at the Department of Rheumatology in the Karolinska Institute (about 20 intravenous treatments per day) are by far the most experienced ones in Sweden and probably in the whole of Europe as far as intravenous treatment with biological agents in rheumatic diseases concerns. Combining this with the excellent Swedisch Registry system -that includes all 9 million inhabitants of the country and which started in 1995 for rheumatology- offers a great source of information on efficacy and safety of these (expensive but powerful) drugs that are so widely used in rheumatology clinical practice worldwide. Furthermore it was stated that at the moment 12 different clinical trials are ongoing at KI and about 10 million euro research funds are available on annual base to perform clinical and laboratory research. In the Stockhom area there are about 10 private (outpatient-only) clinics in the field of rheumatology (the only ones in Sweden) and their number may rise sharply when the new Karolinska Insititute Hospital is opened (the strategy of the new hospital focuses on smaller dimensions then the current hospital which most probably will cause a shift from the very crowded outpatient clinics at KI to a number of private clinics for the less severe cases that do not require hospitalisation).

Following this introduction professor Lars Klareskog (photo) summarised current and recent rheumatology research work at the Karolinska Institute. The main objective of this research work is to find out more about genetic and environmental factors and to determine which factors are relevant in the pre-diagnostic phase of rheumatoid arthritis rather then when the disease is already established. Questions that may arise from this focus and that are “hot” nowadays are e.g. whether people can actually be vaccnated to prevent development of rheumatoid arthritis. In search for environmental factors that may contribute to the development of rheumatoid arthritis (on top of the genetic constitution) 90% of all known rheumatoid arthritis patients and 82% (!) of asked normal healthy subjects as controls completed an extensive questionnaire provided to them by the KI. This enabled nuemrous case-control studies with (sex, age, etcetc) matched individuals. From this tremendous effort at least for the development of ACPA (anti-citrullinic-peptide-antibody) positive rheumatoid arthritis smoking came forward as a very strong risk factor. Actually at KI it is stated that “21% of all rheumatoid artritis (RA) cases -and 33% of ACPA positive RA cases- would not have occurred if nobody had smoked” (!). (Citation weblink: “Smoking is a major preventable risk factor for rheumatoid arthritis”) This precentage even rises to 53% in those patients that have a double HLA-DRB1 shared epitopes risk genotype. In other words, smoking ads a significant relative risk for developing RA both with or without the presence of genetic risk factors (single or double shared epitope). Also smoking was found to be of negative influence for succesful treatment of rheumatoid artritis.

However in ACPA negative rheumatoid arthritis none of the environmental or genetic associations found for ACPA positive rheumatoid artritis were found, which leaves question marks and still a lot to find out about the environmental factors and mechanisms involved in developing ACPA negative polyartritis. A more general, and in recent years already widely felt conclusion is that the same clinical phenotypes (e.g. symmetrical polyartritis) can be the result of distinct pathophysiological mechanisms. This explains why artritis in mice can be very well treated (we know how we caused them to develop artritis) and artritis in mankind is still not fully elucidated (we do not know exactly which are all the contributing factors that cause rheumatoid artritis to develop). Additional research at KI was done on lung biopsy specimens of smokers which actually stained positive for cittrulated peptides and may or may not be contributing to the developemnet of ACPA antibodies that appear in the development of ACPA positive RA.

The meeting continued with a very interesting state-of-the-art lecture on safety of biologic treatment in rheumatic diseases, given by Johan Askling, associate professor rheumatology. A report on this and more of the meeting in part 2 (expected).

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  1. Aone
    25 November 2011 at 20:50

    Interessante samenvatting van je verblijf in Zweden. Toch maar wat strenger optreden tegen al die café’s die het rookverbod negeren. Benieuwd naar deel 2!

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