The American College of Rheumatology (ACR) Annual Meeting 2013 was the must-attend event for anyone involved in research or delivery of rheumatologic care and services, and BMC Musculoskeletal Disorders was lucky enough to attend. The beautiful setting of San Diego stimulated thousands of rheumatologists and rheumatology health professionals from around the world to discuss the latest science, research and treatment in rheumatology.
The conference covered every aspect of rheumatology from basic research to clinical practice and intensive care, but it was clear that treatment choices in rheumatoid arthritis were a major theme. Developing and marketing new therapies for rheumatoid arthritis is only the first step towards improving treatment and outcomes. Using new therapeutic agents in the most appropriate and effective ways emerged as the key step. “Rheumatologists have got used to having new drugs every year”, said Daniel Aletha of Medical University of Vienna, “and now the question of how to best to use them becomes more and more important”.
Combinations, debates and connections
Combination therapy was another hot topic that can lead to confusion. Clinicians are familiar with traditional agents such as methotrexate and with newer biologic agents, including adalimumab, a TNF inhibitor. Combining the two therapeutic classes offers synergistic activity that can be more effective than either agent on its own, but the question raised at ACR was: what doses of methotrexate is most effective? The CONCERTO trial, comparing different fixed doses of methotrexate used with adalimumab, seemed to have provided some initial answers. The ultimate result, Aletha said, is that half the standard dose of methotrexate is needed in combination with a TNF inhibitor, compared to the use of methotrexate in monotherapy.
Following these points, an intriguing debate pitted conventional rheumatoid arthritis therapy against biologics. So, which is the better treatment choice? James O’Dell from University of Nebraska argued that combination therapy provides clinical outcomes that equal anything biologic agents can produce, and that there are clearly patients who do better on biologic therapy than on conventional agents. On the other side, Ronald van Vollenhoven from Karolinska Institute in Stockholm countered that biologics are more effective than conventional therapy and they are more effective when used in combination with methotrexate. Comparison of biologics and conventional therapy in Norway and Finland found the two provided similar outcomes, but biologics cost roughly twice as much as conventional therapy, O’Dell said. According to van Vollenhoven, cost of treatment is a valid concern, but all things being equal, biologics are the most effective agents available for rheumatoid arthritis today. At the end of this fascinating debate, both participants agreed that there is no answer to the original question that would cover all scenarios.
A complex connection between obesity and rheumatic diseases such as osteoarthritis, rheumatoid arthritis, and lupus, was discussed, and Marian Hannan, Associate Professor at Harvard Medical School, provided an update on the latest understanding of how each disease affects the other. A lot of ongoing research is attempting to explain the mechanics of this interrelationship. And while none of it has produced a satisfactory explanation yet, researchers are beginning to understand that it is not just the medications that rheumatology patients take that affect their body composition. It may also be the underlying inflammation pathway to the disease that affects how fat infiltrates muscle. The tried and true message of obese people needing to focus on a healthy diet and being more active continues to be a major point, but it is a complicated picture and there are probably other interventions that will affect body composition that we are just starting to learn about, Hannan concluded.
How can publishers help?
According to editors of the ACR’s two journals (Arthritis Care & Research and Arthritis & Rheumatism), good reviewers make good authors. More to the point, a good manuscript reviewer not only helps to improve the quality of the articles published in the ACR’s journals, but the reviewer also improves its own manuscript writing in the process. During this interesting session, editors from Arthritis Care & Research and Arthritis & Rheumatism, Marian Hannan and Joan Bathon respectively, provided tips and key points for conducting excellent research manuscript reviews and, in turn, help authors produce better manuscripts for peer review.
The 21st century approach to reviewing research papers differs from the 20th century approach in that reviewers are more to the point and much more helpful in making comments about the contents of manuscripts submitted to the journals, said Hannan. Modern reviews should also incorporate newer technologies available in the 21st century, she added. Not just technologies for accessing the information authors send in electronically, but also newer statistical and laboratory techniques: “Authors need to incorporate these newer techniques and make them understandable to the general readership and, if necessary, educate readers about these new technologies”.
The aim of the session was to refine and improve researcher’s skills in reviewing for medical journals and to help potential authors improve their manuscripts by seeing how articles are reviewed. Can BMC Musculoskeletal Disorders be of help? Well, all of our reviewers comments are freely available to read from each published article’s “pre-publication history”, so if you are curious to know how other researchers critique manuscripts, that might be a good place to start.