15 Random Thoughts and Truisms About EULAR 2017

Here are some things to keep in mind during a busy EULAR meeting in Madrid:

• Your patient is not a mean but a 0 or 1. They either get better or they don't, they get a side effect or not.

• The take home message for most drugs, "Therefore, it is safe and effective," also applies to placebo (but it is usually not as effective as the active comparator)!

• The chance of damage in highly active RA is less than a half a modified Sharp score these days, so don't tell those who reimburse drugs that you need the drug to prevent damage.

• SLE is having a heyday of new molecules being tested. Most patients included in non-renal SLE trials have skin and joint involvement. It's too bad that the response criteria are so strict. You can improve your SLE rash and arthritis dramatically but still be a non-responder (i.e. 2 or more swollen joints is still scored as arthritis and rash present scores on the SLEDAI). Maybe it's time for an ACR20, 50, 70 type response to be studied or a change in disease activity including TJC, SJC and perhaps numerical ratings of rash.

• Newer cytokine inhibitors in PsA, SpA and psoriasis will change our gold standard for skin clearing with major efficacy on joints (IL-17i, IL-12/23i, etc). The problem will be lack of response of IL-17i in inflammatory bowel disease. The effects on uveitis need further study.

• Do your homework: choose what lectures and posters you want to see in advance or you will wander aimlessly like a zombie…but that is how you meet other rheumatologists.

• Find the location of EULAR lunches quickly as you paid for them.

• If you have jet lag, free coffee is plentiful at most large exhibitor booths.

• If you miss something, you can always watch it later (for oral presentations).

• You should plan on getting 2 to 4 clinical pearls on how you will change your practice or other insights to enhance patient care out of the whole meeting, but you need to put some effort into finding them.

• Your major 'take home' should be that your practice is not more than 2 standard deviations different from your colleagues, but if it is, you need to justify why (and hopefully be at the cutting edge of the curve, not the remedial side).

• Don't always believe what you read – there is context to everything and the generalizability to your patients may be lacking. RCTs have rigid treatment demonstrated, in general, in compliant patients with few comorbidities and higher disease activity.

• Rheumatology is big business. Think 20,000 people coming to a city, corporate sponsorship of EULAR to make the meeting happen, and unveiling of data that affects stock prices. Therapeutics in rheumatology cost way more than nearly all other chronic diseases.

• Make time to eat well.

• There is always time to shop.

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