Rapporteurs reportMalabar hall(25/11/16)

Dr S. Sham

Year in Review

Best papers in aetiopathogenesis of AIRDs (Dr Sapan pandya)• To avoid sclerostin inhibitors in TNF mediated inflammn. • Noncanonical autophagy and inhibition of autoinflammation• DNAses and role in prevention of autoimmunity• Nucleosomes and assoc.with immunologic abnml.in ssc• Mice model – APLA – how apo er2mediates trophoblastic inflammn.• PR3 on apoptotic cell membranes disrupt immune silencing• ? ia TREG – biomarker in JIA

Year in ReviewBest papers in Vaculitis and gout• Impact of febuxostat in gout with moderate to severe renal impairment• RCT – reduction of flares with arhalofenate• ANCA vasculitis – eular recomm. – RTX over CYC in relapsing patients• ACR/EULAR 2017 classfn criteria for GPA• No added value for ANCA by IIF when high quality specific EIA vailable• Role of calprotectin in predicting disease relapse in pr3 – AAV• PR3 no role in predicting relapses but for severe

manifestations(capillaritis)

PAH in Scleroderma Early diagnosis and management strategies(Dr Prashant Aggarwal)

• Definition, classification• Incidence(7-12%)• Who are more prone?(older age, diffuse, digital ulcers etc.)• Screening – various guidelines – DETECT algorithm• Survival less in comparison to non SSc CTD• Early treatment – improvement in mortality• No evidence for routine anticoagulation• Combination therapy(ETA + PDEI5) - better

Lung Dominant CTD To treat or not to treat Dr Pravin Hissaria

• Why important? – increased mortality• UCTD criteria/Lung dominant CTD criteria• CTD-ILD/UCTD-ILD/ILD – OCCULT CTD – proper clinical examn.• To look for nucleolar, cytoplasmic ANA• IPF – worst prognosis with immunosupression• No definitive guidelines/retrospective studies/to treat as per usual

indication of CTD

Disease modifying therapy in Scleroderma Dr Shefali Khanna Sharma

• Pathogenesis • Endothelial(vascular)/Inflammation/Fibrosis• Disease/stage specific• Skin/GI/SRC/CVS• Raynaud’s – RAPID 1& 2(ET BLOCKER – prevn of new ulcers)• ILD – FAST trial(cyc+ steroids) – stabilization• MMF – SLS II• PAH – Combinationtherapy(ETA+PDEI5 – ET/NO/PGI2)• TGF BETA INHIB. – Metalimumab/Resolimumab• IL- 6 trial – in diffuse SSc• Tyrosine kinase/PPAR gamma/ HSCT(ASSIST/ASTIS)

Bench to bedside Gut microbiome in inflammatory arthritis

Dr Sundeep grover• Enterotype – each of us• Bacteroides – gut• Dysbiosis in gut – SpA• Arthritis – animal models – some(E.Coli) protect and exacerbate• Bact.overgrowth – reactivatn. Of Strep. Induced ReA• GENES – role in determining microbiome• Implication – role of antibiotics/probiotics

Cytokine Hierarchy in AIRDs-Clinical relevance

Dr Anuj Shukla• Why such a complicated subject to be studied?• Justified – starting from TNF alpha – IL 1 – IL 6(tcz, Sirulimumab) –

ANTI GM CSF(Mavarilimumab) – IL 12/23(Ustenikumab) – IL-17• Anti – IFN alpha therapy – phase 3 TULIP trial(Increase Influenza,

Zoster)• Newer classification? – based on predominant cytokine (disease

functional module)

Th-17 cells to IL 23 blockade –the path travelled Dr Anupam Wakhlu

• Th 1, 2, 17• IL 23 – Th 17 – STAT3 – IL 17,21,22• Innate and adaptive immunity – Th 17• IL 12/23 – P 40(Ustenikumab) ; P19 – Guselkumab• 1L 17A – blockade• Secukinumab(SCAPHO) – trials & Ustenikumab(Stelara)

WHAT IS NEW (WIN)

• Novel Oral Anti Coagulants – New opportunities in rheumatology? Dr Varaprasad

• Rivaroxaban, Dabigatran, apixaban• Advantages: Fixed dose, rapid onset of action, less drug interaction,

no monitoring• Disadvantages – Titration, Cost, Reversal challenging, severe bleeding

in renal impairment• Trials in various diseases like APS

Kawasaki Disease : recent trendsDr Surjit singh

• Commonest paediatric vasculitis• May replace RHD• Falacies with diagn.criteria – atypical/incomplete• Spectrum expanding – myocarditis• Lab – whole blood gene expn., gene transcipt signature• ECHO – miss out LCX; CT ANGIO• MP(RAISE)/IVIG/INFLIXIMAB(Single dose 5mg/kg)• Adult ACS – no risk factors – could be KD

Fibromyalgia and neurogenic neuroinflammation Dr Able lawrence

• Pain not only central also peripheral• Alpha wave intrusions in slow wave(delta) non REM sleep – can be a

marker• Small fibre neuropathy – FMS• Aberrant innervation of AV shunts in skin• Hyperexcitabe C fibres/ Mitochondrial dysfunction• Any role for low does metformin?

Free paper session1. Gut microbiome in children with ERA in a developing country

(Prof.Amita.A)

2. Simplified version of ASDAS for Indian patients (Dr Jeet patel) 3. Elevated levels of serum myeloid related protein 8/14 in AS(Dr Latika

gupta)4. Gender difference in PsA and relevance of age of onset of psoriasis (Dr

Taral parikh)5. USG and clinical assessment of peripheral enthesitis in Indian SpA pts (Dr

Saumya Ranjan Tripathi _6. Evidence of inflammation amplifier in reactive arthritis (Dr Sandeep

kumar)

Clinical science session Newer understanding in pathogenesis of gout

Dr Vikas Agarwal

• Genetics – enzymes/uric acid transport proteins• Diet – fructose cycle/SLC2A9(gene environment interaction)• Urate excretion • Dysregulation of immunity – actvn.of inflammasome• Role of neutrophils – NETosis• Resolution of acute attack – IL 10, ACTH, MSH• Targeting cytokines – IL 37 treatment

New and emerging therapies in gout

Dr Uma kumar• Existing Drugs• AGREE trial – low dose colchicine safe• Riloncept/canakinumab – IL1inhibition• Bucillamine – anti oxidant – inhibits actvn.of inflammasome• Lesinurad – URAT1; OAT4 (more effective in combination with

allopurinol/febuxostat)• Arhalofenate (inhibits IL 1 beta; URAT 1/OAT 4• Tranilast – URAT1, GLUT 9• Levatofisopam - ULT

B2B – ‘omics’ in medicineDr Shankar

• Genomics/transcriptomics/proteomics/metabolomics/phenomics• Candidate gene study• Genome wide association study• Whole genome sequencing• Epigenetics

Application of genetic signatures to clinical care of lupus

Dr Durga prasanna misra

• Genetics – apoptosis, innate and adaptive immunity• Type 1 interferons alpha – produced by TLR actvn.• Type 1 Interfernopathies – phenotypes similar to lupus• Interferon signature in lupus – IFN induced genes – IFN signature

metric• Targeted therapy – Sifalimumab/Rontalizumab/Anifrolumab(R) – studies• IFN alpha kinoid – endogenous antibodies against IFN• Proteasome inhibitor

Link between environment and autoimmunity

Dr Bidyut K Das• Env. Factors(UV rays, Vit D in SLE) – Mechanisms/Assoc.sudies• Smoking – citrullination, pro inflammatory• Silica dust – SSc/vasculitis• Drug induced SLE/SSc/AAV• Epigenetic alterations• Intestinal microbiota

MHC 1 opathy – Dr Vineeta shoba

• Type 1 and type 2 MHC ag presn.

• Biosimilar adalimumab symposium