Overview of the 2014 Asia Pacific Rheumatology Consortium Annual Meeting (Reprint)

Professor Levy of Yao Hemming Diffuse Connective Tissue Disease Systemic Lupus Erythematosus (SLE) Brazil, Department of Rheumatology and Immunology, Second Affiliated Hospital of Guiyang Traditional Chinese Medicine, gave a systematic report on the treatment of SLE. Currently, the treatment of SLE still relies mainly on glucocorticoids and requires the combination of hydroxychloroquine and immunosuppressants. In patients with lupus nephritis, oral morte-macrolide and intravenous cyclophosphamide have comparable effects in inducing remission, but the former has significantly fewer adverse effects; morte-macrolide may be superior to azathioprine in the maintenance phase of remission. Professor Levy also provided an overview of the diagnosis and treatment of antiphospholipid syndrome (APS), noting that there is a group of patients with APS with typical clinical symptoms and negative serologic indicators that should be addressed in clinical work. Professor Hahn of the University of California summarized the treatment of lupus nephritis. The American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) treatment of lupus nephritis includes induction of remission, maintenance of remission, and prevention of organ damage. For patients with lupus nephritis types III, IV and V, high-dose glucocorticoids (tapered) and immunosuppressive therapy are recommended for 6 months. For those who respond to treatment, morte-macrolide or azathioprine can be continued for at least 3 years and hydroxychloroquine plus angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) can be used to prevent organ damage. The therapeutic effect of hormone shock + rituximab + oral morte-macrolide (instead of daily oral glucocorticoids) in lupus nephritis was also investigated by Prof. Hahn, and this treatment regimen minimizes the adverse effects of hormones. In terms of basic research, Professor Shen Nan from Renji Hospital, Shanghai Jiao Tong University reported that microRNAs (miRNAs) alone or in concert activate abnormal immune and inflammatory pathways, and found that selective miRNA inhibitors have a positive therapeutic effect in mouse models of lupus. Prof. Mok of the University of Hong Kong found that dendritic cell maturation and dysfunction play an important role in the pathogenesis of SLE; hydroxychloroquine blocks intracellular Toll-like receptors and treats SLE by inhibiting type I interferon secretion by dendritic cells; and targeting dendritic cells is a therapeutic option for autoimmune diseases such as SLE. Professor Low (Low) of Scleroderma Singapore summarized the diagnosis, activity evaluation and treatment progress of scleroderma. Currently, the 2013 ACR-EULAR diagnostic classification criteria for scleroderma have a higher sensitivity. The evaluation indicators of disease activity include Medsger Severity Index, European Scleroderma Study Group Activity Index (ESSG-AI), Health Assessment Questionnaire-Disability Index Scale (HAQ-DI), Scleroderma-Health Assessment Questionnaire (Scleroder ma-HAQ), etc.; laboratory indicators reflecting disease activity include enhanced liver function test (ELF) score, Laboratory indicators of disease activity include enhanced liver function test (ELF) score, interferon-inducible chemokine score, baseline serum interleukin (IL)-6 (correlated with skin score), etc.; indicators of skin fibrosis activity include osteopontin, matrix metalloproteinase (MMP)-9, MMP-12, adipo nectin and monocyte chemotactic protein (CCL) 18; CCL18 was associated with interstitial lung lesion activity. In terms of treatment, several randomized controlled studies (RCTs) suggest that methotrexate is effective for skin lesions, and several studies suggest that mortification of methotrexate is effective for skin lesions. Dry syndrome Professor Les sard in the United States completed a genome-wide association study (GWAS) of dry syndrome and found that genes such as IRF5, BLK, STAT4, IL12A, CXCR5 and TNIP1 were associated with dry syndrome. Independent meta-analysis suggested that genes such as TNFAIP3, FCGR2A and IRAK1BP1 were associated with desiccation syndrome. Expanding the GWAS study to a larger population and further investigating the functions of related genes have profound implications for understanding the pathogenesis of dry syndrome. Inflammatory joint disease rheumatoid arthritis (RA) The executive chairman of this year’s conference, Prof. Zhanguo Li of Peking University People’s Hospital, summarized the treatment of refractory RA, pointing out that the current remission rate of RA treatment is not satisfactory. The 2013 EULAR recommendations for the treatment of RA provide a basis for our clinical practice. Professor Chaturvedi from India, on the other hand, pointed out that the combination of three palliative antirheumatic drugs (DMARD) for early RA in patients who failed methotrexate monotherapy was as effective as tumor necrosis factor inhibitors (TNFi). This news is encouraging (especially for Asian countries where biologics feel expensive). Professor Yamamoto of the University of Tokyo, Japan, reported through a meta-analysis on 42 genetic loci associated with RA pathogenesis identified by the GWAS study. His team found that haplotypes of the PADI4 gene were associated with RA and single nucleotide polymorphisms of the CCR6 gene were associated with RA. Professor Takeuchi (Takeu chi) from Japan elaborated the molecular mechanisms of different drugs acting on RA, and found that RA patients who responded well to methotrexate treatment had significantly lower serum levels of IL-6, but not TNF-α, and IL-6 levels were closely associated with bone destruction; serum IL-6, TNF-α, and soluble IL-6 receptors may be predictors of disease In-depth study of these predictive factors can help individualize the treatment of RA. Professor Chou from Taiwan has reported on the biological markers and therapeutic targets of AS, and ESR, C-reactive protein (CRP), MMP3, serum amyloid A protein, IL-6, TNF-α, macrophage colony-stimulating factor (M-CSF), sRANKL and osteoprotegerin (OPG) can reflect the disease activity of AS. Persistent elevated CRP levels and the presence of ligamentous tuberosities at baseline are predictors of AS radiological progression. In patients with refractory disease, the efficacy of rituximab, tolimumab, and abata cept is unclear. Open studies have shown that ustekinumab reduces the activity level of AS. Clinical observations of IL-17 monoclonal antibodies and JAK inhibitors in AS are still awaited. Professor Brown from Australia pointed out that in Asian populations, HLA-B2704-positive individuals have a higher risk of AS than HLA-B2705-positive individuals; in European populations, the IL23R and IL6R genes, which are closely associated with AS, are not significantly associated with AS in Asian populations, which may be related to the low expression of the above gene frequencies in Asian populations. Professor Xu Huji et al. from the Second Military Medical University in Shanghai found through GWAS that the IL23R gene was not significantly associated with AS in the Chinese Han population, while the STAT3 gene was well correlated with AS. Functional studies on the above genes are important to clarify the pathogenesis of the disease. Osteoporosis and osteoarthritis (OA) Professor Islam from Bangladesh discussed that vitamin D and calcium are the most essential drugs for the treatment of osteoporosis. Professor Camacho of the United States noted that the benefits of long-term bisphosphonate therapy for osteoporosis outweigh the risks for patients at high risk of fracture. Prof. Kendler from Canada pointed out that teriparatide promotes new bone tissue formation, improves bone structure, increases bone strength, and reduces fracture incidence, and is the only clinically approved drug to promote bone anabolism. Professor Hunter from Australia reported that the pathological manifestations such as synovial hyperplasia, fibrosis and lymphocytic infiltration support the theory of osteoporosis and osteoarthritis (OA) that OA is an inflammatory joint disease. In the treatment of OA, lifestyle changes such as weight reduction are clearly effective but have not received much attention. In Japan, Professor Taka hashi (Taka, Japan) increased the temperature of articular cartilage and subchondral bone to 40°C by thermal magnetic therapy technique, and type II collagen and proteoglycan in articular cartilage increased significantly, suggesting a beneficial effect on cartilage repair.