1:20 PM
Welcome and Introductions
1:30 PM
Opening Lecture
Chronic Inflammation and Effects on Cancer and the Immune System
Michael Karin, PhD • University of California, San Diego; La Jolla, CA
At the conclusion of this session participants should be able to:
- Examine the range of epidemiological, genetic and pharmacologic evidence linking chronic inflammation to cancer and its potential relevance to pediatric rheumatology
- Describe the proposed molecular mechanisms whereby inflammation promotes cancer
- Investigate new approaches to prevention and therapy of inflammation-associated cancer
SESSION I: Juvenile Idiopathic Arthritis – Pathogenesis
Needs Assessment:
Common forms of autoimmune arthritis are thought to have a complex genetic etiology with important but variable environmental contributions. While major advances have been made in identifying susceptibility genes for rheumatoid arthritis, efforts for JIA have lagged behind for several reasons, including a lack of adequate sample sizes and the heterogeneous phenotypes subsumed by the JIA classification. Although treatment options and outcomes have improved greatly over the last decade, it is likely that major breakthroughs will require a better understanding of etiology and pathogenesis. Recent advances in cellular and molecular immunology, including recognition of the important role that regulatory T cells (TREG) play in maintaining tolerance and controlling autoimmunity, have fueled studies in JIA. Although it remains unclear whether TREG numbers and/or function are altered in JIA, there may be an opportunity using cell-based and biological approaches to restore tolerance by enhancing TREG function, and thus, provide therapeutic benefit for children with JIA.
2:30 PM
Regulatory T Cells and Immune Tolerance in the Pathogenesis of Oligo/Polyarticular Juvenile Idiopathic Arthritis: Opportunities for Treatment
Berent Prakken, MD, PhD • University Medical Center, Utrecht; Utrecht, The Netherlands
At the conclusion of this session participants should be able to:
- Discuss fundamental components and regulation of the immune response, including the role of TREG in maintaining tolerance
- Discuss evidence for immunological abnormalities in oligoarticular and polyarticular JIA, including TREG function/dysfunction
- Discuss the potential for TREG based cellular therapies in JIA, including approaches that might be used
3:00 PM
Break
4:00 PM
Plenary Abstract Presentations
6:00 PM
Opening Reception and Poster Presentations
7:00 AM
Breakfast and Poster Displays
SESSION II: Lupus
Needs Assessment:
SLE is the prototypical autoimmune disease. While current treatments have significantly improved life expectancy over the past 25 years, the therapies are highly toxic and suppress broad aspects of the immune response. Recently, new therapeutic agents have become available which block specific immunomodulatory pathways. There is a growing interest in using more highly targeted therapies to improve efficacy and decrease short- and long-term medication effects. In addition, recent research findings highlighting the role of the innate immune system suggest new therapeutic targets.
8:30 AM
Targeted Therapies in Lupus
John J. Looney, MD • University of Rochester; Rochester, NY
At the conclusion of this session participants should be able to:
- Explain the rationale for B cell depletion and BLyS-specific inhibition in treating SLE
- Describe the role of tolerance in SLE
- Discuss the role of rituximab and belimimab in treating SLE based on the current evidence base
9:15 AM
Role of Innate Immunity in Lupus
Mariana J. Kaplan, MD • University of Michigan; Ann Arbor, MI
At the conclusion of this session participants should be able to:
- Discuss the central role of alpha-interferon in the pathogenesis of SLE and the rationale for alpha-interferon inhibition as lupus therapy
- Discuss the role of innate immune system cells, including neutrophils, in the pathogenesis of SLE
- Discuss how innate immunity contributes to premature vascular damage in SLE
SESSION III: Innovations in Education
Needs Assessment:
Academic rheumatologists and allied health practitioners are responsible for developing the next generation of pediatric rheumatology care providers. New technologies, strategies and techniques to facilitate learning are evolving rapidly and a new understanding of how students learn and how they can best take advantage of technology is developing in tandem. Staying abreast of ongoing advances in the field of medical education is of importance to the pediatric rheumatology community.
10:30 AM
E-learning Innovations and Pediatric Rheumatology
Taunton R. Southwood, MD, FRCP • Birmingham Children's Hospital; Birmingham, England
At the conclusion of this session participants should be able to:
- Discuss the impact of computer-delivered education and interactive formative assessment on the principles of associative, cognitive and situational learning
- Recognize unique learning opportunities in pediatric rheumatology that computer-delivered education can provide
- Select from a wide range of reusable learning objects and available e-learning tools to facilitate the acquisition of knowledge and skills relevant to pediatric rheumatology
11:15 AM
Cognitive Reasoning and Meta Cognition
Geoffrey Norman, PhD • McMaster University; Hamilton, Ontario, Canada
At the conclusion of this session participants should be able to:
- Communicate the relevance of basic sciences to pediatric rheumatology optimizing knowledge transfer to clinical practice
- Integrate new approaches to teaching clinical decision-making
- Explain how assessment steers learning
12:00 - 1:30 PM
Lunch
12:20 – 1:20 PM
Lunch Sessions
Introduction to Musculoskeletal Ultrasound in Pediatric Rheumatology
Ralf Thiele, MD • University of Rochester Medical Center; Rocheller, NY
Johannes Roth, MD • Children's Hospital of Eastern Ontario; Ohawa, Ontario, Canada
Informal Round Table Discussions
- Early Career Development and Mentoring
- Exercise Testing and Training in Pediatrics
- Rehabilitation Medicine for the Pediatric Rheumatology Practitioner
- Pediatric Rheumatology Education: What to Teach and How?
- Pregnancy in the Young Adult With Rheumatic Disease
- Difficult Cases in Lupus
- Difficult Cases in Dermatomyositis
- Exercise Regimens for Pediatric Rheumatic Diseases
- Foot Problems and Gait Analysis in Children
- Aiming for Excellence in Office Practice
- Psychosocial Issues in the Adolescent Patient With Rheumatic Disease
- Difficult Cases in JIA
- Difficult Cases in Scleroderma
- Difficult Cases in Vasculitis
- Utilizing NP's and PA's in the Pediatric Rheumatology
SESSION IV: Vasculitis
Needs Assessment:
Pediatric rheumatologists have been increasingly asked to participate in the diagnosis and therapy of traditional and newly emerging inflammatory disorders that may or may not fall into the Chapel Hill classification of vasculitis. Because of the rarity of these disorders, the accumulated knowledge base for these diseases rests on a combination of small case series, registry studies and data gleaned from larger adult series. Over the past decade there have been new discoveries as to the genetic basis of these diseases and new observational and clinical trial data in adults that informs providers about the biological basis of disease and their therapy. This session will contain focused content on Wegener’s Granulomatosis (a systemic vasculitis) and the emerging category of disorders that fall under the umbrella of CNS inflammatory disease.
1:30 PM
Wegener's Granulomatosis: How Does Biology Inform Therapy and Vice Versa?
Carol Langford, MD • Cleveland Clinic Foundation; Cleveland, OH
At the conclusion of this session participants should be able to:
- Describe the role of ANCA in diagnosis and as a measure of disease activity in Wegener's granulomatosis and what is known about how this may be linked with pathogenesis.
- Discuss treatment options for Wegener's granulomatosis that utilize conventional immunosuppressive agents and the evidence for these regimens.
- Identify biologic agents that have been investigated in Wegener's granulomatosis and what role they play in the current treatment approach to this disease.
2:15 PM
CNS Inflammatory Disease: An Expanding Spectrum
Susanne Benseler, MD, PhD • The Hospital for Sick Children; Toronto, Ontario, Canada
At the conclusion of this session participants should be able to:
- Discuss the range of inflammatory and auto-inflammatory diseases that pediatric rheumatologists should include in their differential diagnoses of children with central nervous system complaints/symptoms
- Distinguish between infectious, post-infectious and inflammatory causes of disease
- Identify types of diagnostic tests that should be used at the time of initiating therapy, in evaluating treatment options and those tests that can be used to measure therapeutic response
3:00 PM
Break
3:15 PM
Plenary Abstract Presentations
Evening Session: 6:00 – 7:00 PM
Needs Assessment:
The Pediatric Rheumatology Objective Structured Clinical Examination (PROSCE) is a tool that fellows and residents can use to guide them in their discussions with parents and children diagnosed with rheumatic disease. Relatively easy to implement in the academic clinical setting, it will assist in the evaluation of core competencies such as professionalism, communication, practice-based learning, knowledge and clinical care. More than just an introduction, this session will review valuable data accumulated from actual PROSCE assessments with sample scenarios and evaluation materials for attendees.
Pediatric Rheumatology Objective Structured Clinical Examination
David Sherry, MD • Children's Hospital of Pennsylvania, University of Pennsylvania; Philadelphia, PA
At the conclusion of this session participants should be able to:
- Identify the core competencies tested via different PROSCE scenarios
- Define the different roles needed in carrying out a PROSCE
7:00 AM
Breakfast and Poster Displays
8:30 AM
Plenary Abstract Presentations
10:00 AM
Break
SESSION V: Impact of Inflammation on Health
Needs Assessment:
Many health problems evident in adult life have their onset, or are precipitated by events that occur, in childhood. Childhood rheumatic diseases in which inflammation plays a primary pathologic role represent an important example. These diseases provide us with an important opportunity to expand our knowledge of the well known role of inflammation on future health outcomes. In this regard, cardiovascular outcomes are important. The role of inflammation in their development is well known, particularly in relation to coronary artery disease. An understanding of the evolution of this problem has implications for childhood rheumatic diseases and their management. It is clear that children with rheumatic diseases do not engage in the required amount of moderate daily physical activity and are becoming increasingly obese. The additional effects of obesity in association with inflammation have far reaching health outcomes, especially in cardiovascular disease. This session will explore the impact of inflammation on health by focusing on the associations between inflammation, obesity, cardiovascular disease and other health outcomes.
10:30 AM
CV Outcomes in Rheumatic Disease
Stacy P. Ardoin, MD • Ohio State University; Cleveland, OH
At the conclusion of this session participants should be able to:
- Explain the pathologic basis and the specific role of inflammation in the evolution of cardiovascular events in rheumatic diseases
- Identify various cardiovascular outcomes occurring in rheumatic diseases
- Develop strategies for intervention that might reduce the risk of these events
11:15 AM
Obesity, Inflammation and Metabolic Syndrome
Sarah de Ferranti, MD, MPH • Children's Hospital of Boston, Harvard University School of Medicine; Boston, MA
At the conclusion of this session participants should be able to:
- Recognize the extent of obesity and its implications for children with rheumatic disease
- Describe the association between obesity and inflammation and its consequences
- Implement early interventions and strategies to prevent the associated long-term complications
12:00 PM
Lunch
12:20 – 1:20 PM
Lunch Sessions
Introduction to Musculoskeletal Ultrasound in Pediatric Rheumatology
Informal Round Table Discussions:
- Early Career Development and Mentoring
- Exercise Testing and Training in Pediatrics
- Rehabilitation Medicine for the Pediatric Rheumatology Practitioner
- Pregnancy in the Young Adult With Rheumatic Disease
- Difficult Cases in Lupus
- Difficult Cases in Dermatomyositis
- Pediatric Rheumatology Education: Assessing Learning and Teaching
- Exercise Regimens for Pediatric Rheumatic Diseases
- Foot Problems and Gait Analysis in Children
- Aiming for Excellence in Office Practice
- Psychosocial Issues in the Adolescent Patient With Rheumatic Disease
- Difficult Cases in JIA
- Difficult Cases in Scleroderma
- Difficult Cases in Vasculitis
- Utilizing NP's and PA's in the Pediatric Rheumatology
- Practical Points in Promoting Weight Control in Pediatric Patients
SESSION VI: Juvenile Idiopathic Arthritis – Clinical Aspects
Needs Assessment:
There has been a rapid expansion in the range of drug therapy and multidisciplinary team options available for the management of juvenile idiopathic arthritis. Of particular importance is the timeline of targeting treatment approaches:
- How early in the disease course should biologics be used?
- When does transition begin?
- What is the impact of treatment timing on the roles of team members?
- How are the family and the patient involved in the clinical decision-making which accompanies these processes?
This session will concentrate on two aspects of these advances—the role of self management in the transition process and drug therapy timing.
1:30 PM
Self Management and Transition in JIA
Jennifer Stinson, RN, PhD, CPNP • The Hospital for Sick Children; Toronto, Ontario, Canada
At the conclusion of this session participants should be able to:
- Compare and contrast similarities and differences between self management and transitional care
- Identify perceived self-management and transitional care needs of children and youth with JIA
- Describe the evidence base for self management and transitional care interventions in improving health outcomes in youth with JIA
2:15 PM
Advances in JIA Treatment: Lessons Learned From Clinical Trials
Carol A. Wallace, MD • Children’s Hospital and Regional Medical Center; Seattle, WA
At the conclusion of this session participants should be able to:
- Summarize results from recent important clinical trials in JIA
- Detail new biologic therapies and treatment approaches in JIA
- Discuss how clinical trials in JIA will change treatment
3:00 PM
Break
3:15 PM
Keynote
Imaging Inflammation in Arthritis – More Than Meets the Eye?
Iain B. McInnes, MD • University of Glasgow; Glasgow, Scotland
At the conclusion of this session participants should be able to:
- Recognize the potential of nanoparticles to image inflammation in the pediatric rheumatic diseases
- Differentiate between untargeted and targeted imaging to define cellular recruitment, vascular activation or leakage
- Determine the timeline of development for new biologic imaging techniques
6:00 PM
Awards Dinner
7:00 AM
Breakfast and Poster Displays
Session VII: Exercise in Chronic Inflammatory Diseases
Needs Assessment:
Aerobic and muscular fitness are frequently impaired in children and youth with chronic inflammatory disease, most likely due to a combination of factors, including the disease process, effects of medications and inadequate physical activity. There is now general agreement among rheumatology health professionals that regular moderate physical activity is safe and necessary for this population living with rheumatic disease. However, questions still remain about the interaction of specific exercise mode, intensity and duration on inflammatory markers and the optimal exercise prospection to improve health outcomes. Health professionals also need to learn and to incorporate effective strategies to increase healthy physical activity behaviors in children and youth with chronic inflammatory disease.
8:30 AM
Exercise Training and Testing in Pediatric Rheumatic Diseases
Tim Takken, MSc, PhD • Wilhelmina Children’s Hospital, University Medical Center Utrecht; Utrecht, The Netherlands
At the conclusion of this session participants should be able to:
- Identify valid and reliable methods of testing exercise capacity in children with chronic inflammatory disease
- Describe the most common impairments in aerobic and anaerobic exercise capacity in children with rheumatic disease
- Identify the minimum requirements for exercise intensity, duration and frequency to induce positive changes in fitness
- Discuss the benefits and risks of exercise training on aerobic capacity and muscular function in children with rheumatic disease
9:15 AM
Physical Activity Promotion for Obesity Prevention in Youth
Russell R. Pate, PhD • University of South Carolina; Columbia, SC
At the conclusion of this session participants should be able to:
- Summarize current physical activity guidelines for youth
- Explain the impact of physical activity on prevention of childhood obesity
- Identify effective strategies for intervening to increase physical activity in youth
SESSION VIII: Cutting Edge Biologic and Cellular Therapies
Needs Assessment:
Treatment for arthritis has undergone a revolution in recent years as a result of new therapies that target specific inflammatory mediators. Despite the advances these therapies provide, there is still no cure and there are patients who do not adequately respond. Thus, there is continued interest in finding novel approaches to treatment. Two general approaches actively being explored are
- targeting inflammatory mediators
- using regulatory cells to actively suppress disease.
Understanding the most promising of these approaches is of interest to practitioners.
10:30 AM
Translational Aspects of Cytokine Biology
Iain B. McInnes, MD • University of Glasgow; Glasgow, Scotland
At the conclusion of this session participants should be able to:
- Explain the role of cytokines in inflammation
- Discuss promising new cytokine/chemokine targets that are likely to be entering clinical use in the near future
11:15 AM
Mesenchymal Stem Cells Overview
Arnold I. Caplan, PhD • Case Western Reserve University; Cleveland, OH
At the conclusion of this session participants should be able to:
- Summarize the biology of mesenchymal stem cells in the formation of bone, cartilage, tendon and various connective tissues
- Discuss the role of mesenchymal stem cells in the development of rheumatic diseases
- Discuss the potential therapeutic use of mesenchymal stem cells in the clinical setting
runs every 30 minutes between the airport and South Beach. The fare is $2.35 for a one-way trip.
