From the academically intoxicating late breakers to the options, remembering a rheumatology great and even the cinnamon scrolls, ACR Convergence delivered in spades.
As I make my way back from this year’s ACR Convergence, I can’t help but reflect – was this a normal meeting or something different?
I had plenty of conversations with Australian and generally non-American colleagues who dismissed the idea of attending this year, for a diverse range of reasons.
In the US, Chicago had also been in the news in the weeks leading up to the meeting, and not always positively. As I sat on the long flight to ACR this year I wondered, would this year’s meeting be the usual behemoth that it is famed for being?
In fact, this year’s conference had bigger registration numbers than last year, both overall and for international attendees.
Chicago is also, at heart, one hell of a fantastic city, with character and beauty and great food, art, and nightlife, and the host city would have been compelling for many (although in a different way to next year’s venue, the Disney-adjacent Orlando).
The challenges for the organisers would have been multiple, and it was certainly sad that because of the US government lockdown, government agency employees (like NIH clinicians and FDA employees) were not allowed to be at ACR.
So, prompted by my editor as to what my highlights of the meeting were, here are my top three (and an honourable mention to the deep-dish pizza and hot cinnamon scrolls on the exhibition floor):
3. Options, options, options
Chicago’s McCormick Place is the biggest conference centre that ACR goes to. In fact, ASCO (the oncology equivalent, and one of the few medical conferences bigger than ACR) is always held there, because it is the only venue that can take its capacity.
What this means is that ACR sprawls over what is a very organised conference centre, but one that traverses a major road and dips and dives over several levels.
So when I say that there is enticing breadth at ACR, carefully curated by the ACR’s Annual Meeting Planning Committee at their multi-day retreat, it’s sometimes a physical challenge as well as a mental one.
If you want to catch a talk on a hot topic like AI or CAR-T, you won’t be able to duck next door into one of the rheumatoid arthritis oral abstract sessions, or the health professionals stream detailing out how to navigate dietary guidance, or the debates between heavyweights.
And yet, it’s worth traversing, a veritable smorgasbord of choice, and like any buffet you can taste a bit of anything or just feast on the crab legs. Failing that, you get the take home container that is the on-demand replay to remind you of the flavours of ACR for the year that follows.
The breadth this year was phenomenal, and the depth of content was impressive across basic science, clinical science, the practical and the abstract – not to mention a poster hall back in full dynamic flight. For those who were in Chicago and not shopping, there was no shortage of things to engage with.
2. Late breaking abstracts
Once upon a time, before social media or journal email alerts, the big rheumatology breakthroughs of the day were delivered solely in the crowded plenary halls of major conferences (or so I’m told).
If you wanted to see it happen, you had to be there, and you could feel the mood of the crowd sway and shift in a visceral manifestation of pre-social media groupthink.
With all of our digital connectivity, I’d argue including news sites like ours, that imperative is less notable.
If there is an exception to the blandness of curated presentations already published online, then it is the pressure of the conference plenary hall, and the peak of this fun is the late breaking abstracts at ACR.
In its full glory, there is a heady combination of raw data, an imperative (sometimes desperation) to disseminate news, a crowd waiting in anticipation.
Most of all, there is a sense that everything that is presented is a moment in history, that those present might look back at in decades and think about how they were there when the world first heard the news. It is, in short, academically intoxicating.
This year was particularly rock-and-roll. Sitting there, you could help but think that if any of the six abstracts presented reached its maximum potential, it could be a game changer, yet there were caveats and potential flaws at every turn.
PD-1 agonists which induce remission in the worst RA, a PsA oral therapy that could disrupt the algorithm, a NETosis disperser that could cure SLE in hours, autologous CAR-Treg without lymphodepletion in RA, and a Sjogren’s treatment (and one that brought back saliva for some people, no less).
Mumbles from the crowd and phone cameras that raised in synchrony with the flip of the next slide, Roy Fleischmann was at the questions microphone before anyone else after every clinical trial and the crowd ready to turn with his every interrogation. It was top quality rheumatology drama, which you had to be there to appreciate.
In my mind, the dark horse winner was the new VEXAS, the clonal haematopoiesis of IDH1/2. Could more haematological malignancy links to inflammatory diseases like PMR and GCA be explained by a mutation, and one that we can inhibit to boot?
No photos allowed, because you have to think it’s up for review in Nature or NEJM right now (my speculation), but one has to think that you’ll hear plenty more about that to come.
1. Philip Robinson Global Scholars
The ACR was kind enough to honour Phil with a named program, hopefully for a few more years yet, where young scholars from around the world, but particularly the developing world, get to experience the magic of an ACR meeting.
It is not an honour that is given out frequently, especially to an Australian, and took the fearless advocacy of Jinoos Yazdany and many others (including Rebecca Grainger), but the nature of it is no accident.
About two months before Phil died, we had a drink or two when he was passing through Melbourne, and we looked into the bottom of our glasses and contemplated life.
The heat of the COVID pandemic was fading, and it was inevitable that in amongst contemplating the nuances of life that we would contemplate the future of the COVID-19 Global Rheumatology Alliance which Phil had poured so much of his effort into in the final years of his life.
He told me that the thing that he was most proud of about that initiative, aside from responding to rheumatology’s overwhelming need at that time, was the chances that it gave talented young investigators to grow and prove themselves, no matter where they came from.
It didn’t matter if you were at a top US hospital or from a small hospital in a country without a substantive academic track record, the Global Rheumatology Alliance was set up to create equitable chances, free from prejudice.
Phil once told me that it was his wife, Helen, who pushed him to prioritise creating mentorship opportunities for those who needed them, but he lived that with gusto. He loved bringing people into that sense of community, seeing what they could achieve when they were surrounded by bright minds.
This year, the day before the main program of the conference I walked into a drab room in a conference hotel, but the moment I walked in I could feel that energy.
A small group of young rheumatologists from around the world, the Philip Robinson Global Scholars, were dressed in their business finest, full of nervous energy, excited to be part of this carnival of rheumatology.
Many had struggled to get visas in time, and in fact some had to defer from the year before because of that. Yet for them, it was a red-letter day, when they could physically step into the biggest game in town, exchange ideas, seek connection, and live the spirit that Phil espoused.
David Liew is deputy editor of Rheumatology Republic. He is also the International Adviser for Australia to the American College of Rheumatology.
