Report from the 26th Annual Congress of the Croatian Society for Rheumatology with International Participation

Sažetak

Za što bolju svakodnevnu kliničku praksu, otkako je medicine, važno je dijeljenje iskustava, spoznaja i saznanja. Navedeno je posebno bitno u slučaju rijetkih bolesti kao što su i idiopatske upalne miopatije odnosno imunosno posredovane miopatije, glavna tema ovogodišnjeg, 26. po redu, godišnjeg kongresa Hrvatskoga reumatološkog društva s međunarodnim sudjelovanjem.

Text and figures kindly obtained from the journal Medix (year XXX, Nr. 162/163), courtesy of Mr. Bralić./ Tekst i slike preuzeti iz časopisa Medix (god. XXX, broj 162/163) uz dopuštenje urednika gospodina Bralića.

The wonderful, scenic region of Istria once again hosted a Congress that now traditionally takes place in October with the participation of rheumatologists, clinical immunologists and doctors of related specialties from Croatia and other European countries.

The opening ceremony of the Congress was preceded by interactive workshops. B. Karanović, MD (UHC Zagreb) held a workshop on the diagnostics and treatment of adults with primary immunodeficiencies for the second year in a row, and this year a capillaroscopy workshop was also held under the mentorship of Assoc. Prof. M. Radić, MD, PhD (UHC Split) and Prim. M. Barešić, MD (UHC Zagreb). Some of the new, but well-attended, workshops were “RadionicANA” (in English: Workshop ANA) on the interpretation of antinuclear antibody (ANA) findings in everyday clinical work (A. Barić, MD et al., UHC Sisters of Mercy Zagreb) and “Intraartikularne infiltracijske tehnike u kliničkoj praksi” (in English: Intra-articular infiltration techniques in clinical practice) under the mentorship of A. Šegota, PhD (UHC Rijeka) et al.

On the evening of the first day, Srđan Novak, MD, PhD from UHC Rijeka, the newly elected President of the Croatian Society for Rheumatology, officially opened the Congress, which was followed by an honorary lecture in memory of Primarius Drago Čop, MD. This year, Prof. Branka Marinović, MD, PhD (Department of Dermatology and Venereology, UHC Zagreb) had the honour of giving this lecture. During her presentations, she introduced us to new findings on the diagnosis and treatment of skin manifestations of lupus, that has the leading role in the sphere of systemic inflammatory diseases that are in the centre of interest of rheumatologists. The first day of the Congress came to an end with a lecture on 70 years of Reumatizam, the official journal of the Croatian Society for Rheumatology. The past and present of the aforementioned journal were the topics presented by the prior editor-in-chief, Prof. Simeon Grazio, MD, PhD (UHC Sisters of Mercy Zagreb), and plans for the future were relayed by Assistant Professor Ivan Padjen (UHC Zagreb), the new editor-in-chief of the Reumatizam journal.

Idiopathic inflammatory myopathies

The main topic of this year’s Congress were idiopathic inflammatory myopathies (IIM), which, according to some authors, are more frequently known as immune-mediated myopathies (IMM) due to the sometimes histologically absent inflammatory infiltrate.

IIMs are a heterogeneous group of autoimmune diseases of the skeletal muscles, and less commonly of the myocardium, which are systemic in nature because they also affect other organs or organ systems such as the skin or lungs (1,2). This group consists of conditions such as polymyositis, dermatomyositis, amyopathic dermatomyositis, inclusion body myositis, immune-mediated necrotizing myopathy (IMNM; it can be associated with anti-HMGCR or anti-SRP antibodies), antisynthetase syndrome, and myositis overlap syndrome. Myositis is the name for a group of rare conditions with incidence rates ranging from 0.2 to 2 cases per 100,000 person-years and a prevalence from 2 to 25 per 100,000 people. Due to raising awareness about this group of rare conditions and their earlier diagnosis, mortality rates in patients suffering from these conditions is lower than before. However, morbidity is still high, especially due to cardiovascular and respiratory complications and the fact that these conditions are often part of a paraneoplastic phenomenon, which means that they include signs and symptoms characteristic of malignancy. Although cancer-associated myositis (CAM) is defined as malignancy occurring within 3 years of IIM diagnosis, according to data from literature, the risk of malignant disease is higher compared to the general population even after 10 years following disease onset.

The aforementioned findings, as well as numerous other data, were presented to us during the morning of October 25th by our colleagues from various Croatian centres under the watchful eye of three moderators: Assoc. Prof. Mislav Radić, MD, PhD (UHC Split), Assoc. Prof. Frane Grubišić, MD, PhD (UHC Sisters of Mercy Zagreb) and Prim. Marko Barešić, MD. Moreover, Prof. Jasminka Milas-Ahić, MD, PhD (UHC Osijek) spoke about the pathophysiology of IIM, while Prof. Joško Mitrović, MD, PhD (UH Dubrava) chose to cover the topic of the clinical features and differential diagnosis of these conditions. In the diagnosis of IIM, there are several useful diagnostic techniques, such as muscle biopsy, which was a topic presented by Prof. Daniela Marasović Krstulović, MD, PhD (UHC Split), Assoc. Prof. Miroslav Mayer, MD, PhD (UHC Zagreb) and Prim. Leo Pažanin, MD (Ljudevit Jurak University Department of Pathology and Citology, UHC Sisters of Mercy Zagreb), and electromyoneurography (EMNG), which was a topic mentioned in the lecture given by Prof. Ervina Bilić, MD, PhD (Department of Neurology, UHC Zagreb). As it was mentioned before, in addition to muscle pathology, these conditions also affect other organ systems, and one of the more common and severe clinical manifestations is interstitial lung disease, which was a topic discussed by Prim. Ana Hećimović, MD, PhD (Department of Lung Diseases, UHC Zagreb). Prof. Srđan Novak (UHC Rijeka) presented the well-known facts as well as new findings in pharmacotherapy, and Prof. Nadica Laktašić Žerjavić, MD, PhD (UHC Zagreb) talked about a very important part of treatment when it comes to patients suffering from these diseases, which is rehabilitation. During the final part, the main topics, experiences and data related to clinical practice were shared by the representatives of author groups from three university hospital centres. The lecturers were Krešimir Rukavina, MD (UHC Zagreb) with the topic of “Profil protutijela u bolesnika s idiopatskim upalnim miopatijama i povezanost s malignim bolestima – iskustva tercijarnog centra” (in English: Antibody profile in patients with idiopathic inflammatory myopathies and their correlation with malignancies – a tertiary centre experience), Prof. Daniela Marasović Krstulović, MD, PhD (UHC Split) with the topic of “Kardiološke manifestacije u idiopatskim upalnim miopatijama – iskustva tercijarnog centra” (in English: Cardiac manifestations in idiopathic inflammatory myopathies – experiences of a tertiary centre) and Filip Mirić, MD (UHC Rijeka) with the topic of “Klinička obilježja pacijenata s antisintetaznim sindromom – iskustva jednog centra” (in English: Clinical features of patients with antisynthetase syndrome – experience of the single centre).

After lunch, in the afternoon, our resident and specialist colleagues under 40 years of age had the opportunity to present their works as part of the “Mlada reumatologija” section (in English: Young Rheumatology), which was moderated by Assistant Professor Ivan Padjen (UHC Zagreb), Ivona Božić, MD, PhD (UHC Split) and Filip Mirić, MD (UHC Split). The reference to the main topic was provided by the lecturers on behalf of a group of authors: Antica Mihaliček, MD from the UH Dubrava, who spoke about the experiences with interstitial lung disease in patients with IIM who were treated at the said hospital, Valentina Juraga, MD from the UHC Sisters of Mercy Zagreb, with the topic of clinical and laboratory characteristics of patients with IIM treated at that centre in the past three years, Ivan Vlak, MD with a cumulative overview of the experiences from the UHC Split related to the follow-up and treatment patients with IIM, and Mirna Lucić, MD from the UHC Osijek who presented the case of a patient with oropharyngeal dysphagia as part of statin-induced myopathy. We also had the chance to hear about other topics from other presenter such as Lucija Prtenjača, MD from the UHC Zagreb, who covered the topic of the follow-up and treatment of patients with Behçet’s syndrome, and Nika Nikolac. MD from the UHC Rijeka who presented the use of hyperspectral imaging diagnostics (TIVITA) in the assessment of microcirculation in patients with Raynaud’s phenomenon as a new and potential diagnostic method in the diagnosis of people with this phenomenon. We must also proudly note that two foreign lecturers also participated in this section, Paul Studenic, MD (Medical University of Vienna, Karolinska Institutet) with the topic of Innovative approaches to patient care upon collaborative research and Jelena Čolić, MD (Institute of Rheumatology, Serbia) with the topic of The association of global hemostasis markers with the risk of new digital ulcer onset – circulating extracellular vesicles as a predictive marker of interstitial lung disease progression in systemic sclerosis: a prospective cohort study. The first working day of the Congress was brought to a close by our long-time collaborators from the Rheumatology International journal, Prof. Armen Yuri Gasparyan, MD, PhD and Assist. Prof. Olena Zimba, who organized the workshop named Peer review updates, peer review credits and social media platforms, which was moderated by Prof. Simeon Grazio, MD, PhD.

International experts in the field of rheumatology introduced us to topics of the second day of the Congress, and the moderators in the first section were the following experts: Prof. Daniela Marasović Krstulović, MD, PhD, Prof. Jasminka Milas-Ahić, MD, PhD and Prof. Srđan Novak, MD, PhD. Prof. Gyorgy Nagy, MD, PhD (Semmelweiss University, Hungary) gave a lecture on an everyday and very important topic: are glucocorticoids still necessary in the treatment of patients with rheumatoid arthritis and systemic lupus erythematosus, considering how many other immunosuppressive and immunomodulatory drugs are available today? An equally interesting lecture on skin manifestations of dermatomyositis and their importance in clinical practice was held by Sandra Meislau, MD, President of the Estonian Rheumatology Society. The series of lectures by foreign participants was completed by Prof. Savino Sciascia, MD from the University of Turin, who presented the topic of modern findings related to the antiphospholipid syndrome. In the afternoon, the oral presentations were moderated by Prof. Jasminka Milas-Ahić, MD, PhD (on behalf of Prof. Jasenka Markeljević, MD, PhD, who was absent) and Prof. Simeon Grazio, MD, PhD. In those presentations, the regional experts spoke about the challenges in the treatment of severe cases of dermatomyositis (Tatjana Zekić, MD, UHC Rijeka), the evaluation of the screening algorithm for interstitial lung diseases as part of systemic connective tissue diseases (Kristina Frketić Marović, MD et al., Zadar GH), the potential use of the D-dimer test as an indicator of inflammation in patients with rheumatoid arthritis (Samir Mehmedagić, MD et al., Clinical Centre of the University of Sarajevo), the frequency of other HLA loci in patients with axial spondyloarthritis (Adelmo Šegota, PhD et al., UHC Rijeka), experiences in the UHC Zagreb related to the use of anifrolumab in the treatment of SLE patients (Marija Šćepović–Ljucović, MD et al., UHC Zagreb), experiences in the UHC Rijeka related to the combined use of rituximab and tofacitinib in the treatment of dermatomyositis with positive anti-MDA5 antibodies (Filip Mirić, MD et al., UHC Rijeka), persistence and reasons for discontinuation of therapy with IL-17 or TNF-alpha inhibitors in patients with psoriatic arthritis treated at the UHC Sisters of Mercy Zagreb (Stipe Ćavar, MD on behalf of Hana Skala Kavanagh, MD et al., UHC Sisters of Mercy Zagreb) and the association of C1q with SLE activity and kidney involvement in SLE (Robert Marčec, MD et al., UHC Zagreb).

On Saturday, just like in the previous years, a poster session was held, in which our numerous young colleagues from the Republic of Croatia, as well as our colleagues from the neighbouring countries, got the opportunity to present their scientific works, the experiences of their centres with certain diseases or methods of therapy, and interesting medical cases from the profession in a dynamic and riveting atmosphere. The first poster presentation was moderated by Prof. Branimir Anić, MD, PhD and Assist. Prof. Marina Ikić Matijašević, MD, PhD and the moderators for the second poster presentations were Prof. Nadica Laktašić Žerjavić, MD, PhD and Assist. Prof. Ana Gudelj Gračanin, MD, PhD.

The interesting and complex clinical cases were quite a wakeup call for the Congress participants on Sunday morning, and they were presented in a way that was wholeheartedly accepted at our Congress after several years of use. With the help of Assoc. Prof. Dijana Perković, MD, PhD (UHC Split) and Assoc. Prof. Miroslav Mayer, MD, PhD (UHC Zagreb), who served as moderators, our colleagues Tea Ahel, MD and Katarina Borić, MD, PhD, Ana Šimac, MD and Assist. Prof. Marija Bakula, MD, PhD, Vinka Vukosav, MD and Lea Šalamon, MD, PhD and Ines Doko Vajdić, MD, PhD and Assist. Prof. Iva Žagar, MD, PhD gave us the answers to the questions of which challenges to expect in patients with macrophage activation syndrome, which complications to expect in patients with antisynthetase syndrome and how to treat them, which complications to expect in the use of TNF-a blockers in patients with uveitis, and which complications can occur in patients with ankylosing spondylitis if it is not diagnosed in a timely manner.

The working part of the Congress was completed with short oral presentations, moderated by Assist. Prof. Iva Žagar, MD, PhD and Prof. Joško Mitrović, MD, PhD, on a number of interesting topics: tocilizumab-induced hypofibrinogenemia in children with JIA (Branka Zadro, MD et al., Children’s Hospital Zagreb), the role of Gd-IgA1, HMGB1, RAGE and PCDH1 in the pathogenesis of IgA vasculitis (Martina Held, MD et al., UHC Zagreb), long-term monitoring results of patients with IgA vasculitis associated with nephritis (Mario Šestan, MD et al., UHC Zagreb), methotrexate intolerance scoring (Marija Šenjug Perica, MD et al., Paediatric Department, Srebrnjak Children’s Hospital, Zagreb), experiences in UHC Dubrava with IIM patients (Stela Hrkač, MD et al., UH Dubrava), the importance of HBOT in the treatment of patients with systemic sclerosis (Klara Svalina, MD et al., Polyclinic for hyperbaric and occupational medicine OXY, the Zagreb branch), the effectiveness of TECAR therapy in patients with axial spondyloarthritis (Prof. Simeon Grazio, MD, PhD on behalf of Hana Skala Kavanagh, MD (who was absent) et al., UHC Sisters of Mercy Zagreb), the importance of anti-TIF-1-gamma antibodies in patients with dermatomyositis (Filip Mirić, MD et al., UHC Rijeka).

At the closing ceremony of the Congress, the best works were announced, and this year’s laureates were: Kristina Frketić Marović, MD et al., Evaluation of a screening algorithm for interstitial lung diseases associated with systemic autoimmune rheumatic diseases: a single center cross-sectional study, for the best oral presentation, Lucija Prtenjača, MD et al., Clinical manifestations and treatment of patients with Behçet’s syndrome: a single centre experience (UHC Zagreb), for the best paper in the Young Rheumatology section, and Danijela Kolarić Matešić, MD et al., Felty’s syndrome, systemic lupus erythematosus or cytomegalovirus infection: report of a patient, for the best poster.

After the award ceremony, it was time to pack our bags and head home with the sense of new knowledge, nice memories, optimism, and eager anticipation for the next 27^th Annual Congress of the Croatian Society for Rheumatology with International Participation, which will be held in October 2025 in the ancient and celebrated city of Dubrovnik.

Krešimir Rukavina, dr. med.;

prof. dr. sc. Srđan Novak, dr. med.;

prof. dr. sc. Simeon Grazio, dr. med.

Krešimir Rukavina, Srđan Novak, Simeon Grazio

Photo 1. The Congress was opened by the new President of the Croatian Society for Rheumatology, Prof. Srđan Novak, MD, PhD.

Photo 2. An honorary lecture in memory of Prim. Drago Čop, MD, Cutaneous lupus erythematosus: new findings in 2024, held by Prof. Branka Marinović, MD, PhD.

Photo 3. Prof. Srđan Novak, MD, PhD with Prof. Simeon Grazio, MD, PhD (in the middle) and Assist. Prof. Ivan Padjen (first on the left), prior and current editors-in-chief of the Rheumatism journal.

Photo 4. Main topic moderators (from left to right): Assoc. Prof. Mislav Radić, MD, PhD, Prim. Marko Barešić, MD, Assoc. Prof. Frane Grubišić, MD, PhD.

Photo 5. Prof. Armen Yuri Gasparyan and the participants of the Peer review updates, peer review credits and social media platforms workshop.

Photo 6. Lecturers and moderators of the Section of lectures given by invited lecturers (from left to right): Prof. Srđan Novak, MD, PhD, Prof. Daniela Marasović Krstulović, MD, PhD, Prof. Sandra Meisalu, MD, PhD, Prof. Jasminka Milas-Ahić, MD, PhD, and Prof. Gyorgy Nagy, MD, PhD.

Photo 7. The always well-attended poster presentation.

Photo 8. Pictured in the photo on the monitor: Kristina Frketić Marović, MD, Marija Zubčić, nurse, President of the Croatian Association of Nurses, Technicians and Physiotherapists in Rheumatology and Immunology, and Assist. Prof. Željka Kardum, MD, PhD. The award was presented to the winner by the members of the Committee and the President of the Croatian Society for Rheumatology (standing, left to right), Prof. Simeon Grazio, MD, PhD, Prof. Jasminka Milas-Ahić, MD, PhD, Prof. Srđan Novak, MD, PhD and Prof. Joško Mitrović, MD, PhD.

Photo 9. Lucija Prtenjača, MD won an award for the best paper in the Young Rheumatology section, and the award was presented to the winner by Prof. Srđan Novak, MD, PhD, and Assist. Prof. Ivan Padjen.

Photo 10. Danijela Kolarić Matešić, MD (second on the left) won an award for the best poster, and the award was presented to the winner by Prof. Ana Gudelj Gračanin, MD, PhD, Prof. Branimir Anić, MD, PhD and Prof. Srđan Novak, MD, PhD.

Photo 11. The 2024 Managing Board of the Croatian Society for Rheumatology (left to right): Krešimir Rukavina, MD (Secretary), Prof. Joško Mitrović, MD, PhD, Prof. Branimir Anić, MD, PhD, Prof. Jasminka Milas-Ahić, MD, PhD, (First Vice-President), Prof. Simeon Grazio, MD, PhD, Prof. Srđan Novak (President), Prof. Daniela Marasović Krstulović (Second Vice-President), Prof. Dijana Perković, MD, PhD, Prof. Miroslav Mayer, MD, PhD, Prof. Nadica Laktašić Žerjavić, MD, PhD, Prof. Frane Grubišić, MD, PhD, Assist. Prof. Ivan Padjen.