The 4th annual European League Against Rheumatism congress in Lisbon: a personal perspective

The editors of this successful journal, Peter Lipsky and Sir Ravinder Maini, have again asked me to write a personal report, not a summary, of my views of the 4th annual European League Against Rheumatism (EULAR) Congress of Rheumatology, and indeed, to be as acid and provocative as I wish. The annual EULAR congresses are now firmly established as the European meeting of the year, combining education with science and politics. It is attended not only by Europeans, but also by delegates from North and South America, Asia, Africa and Australia, and is therefore truly international. The new respectability is a consequence of the election of outstanding officers to the leading posts in the organization of EULAR.

This time I was not an invited speaker or chairman, and I arranged my own trip and paid the registration fee out of my own pocket. I stayed in a modern four-star, air-conditioned hotel close to a metro station and used the free pass that came with the registration. This caused some expenses in time and convenience but provided for ample contacts with the locals. It was unfortunate that I did not speak their language. The registration fee of €800 (onsite registration was €1000) included a year's subscription to The Annals of Rheumatic Diseases, a good journal that now has an impact factor of 3.6. Even taking this into account, the surplus money made by the organization must be handsome. This helps keep EULAR strong, which is a good thing, although I would rather have seen the money coming from other sources than my pension.

When the decision was made to hold this congress in Lisbon, someone said that it was 6 years ago, nobody had anticipated the attendance of more than 8600 delegates. The largest hall had a capacity of a little over 2000 seats. Most sessions were well or very well attended. It was fortunate for the organizers that some registered delegates spent time in cooler environments outside the center. The architecture of this conference center does not deserve praise for simplicity or convenience nor, importantly, for being disabled friendly.

I was put off by the smoking, not least among the friendly and helpful conference staff. Smoking is a well-recognized risk factor for acquiring rheumatoid arthritis and for accelerating damage in affected individuals. In the program inviting one to EULAR 2004 in Berlin, in Europe's largest congress center, one can read that smoking 'is only allowed in designated areas'. That is a definite step back from Stockholm in 2002. EULAR needs a strict no smoking policy now!

The 'ask me' staff was in general very friendly and abundant, but not very informed. If you had not found the right page (page 101) in the 125-page program you could get very frustrated and be late for your executive committee or editorial board meeting. I was unable to find the Annals of Rheumatic Disease board meeting in room 1.08 until running into the unbelievably efficient, competent and friendly executive secretary of EULAR, Fred Wyss, in the entrance hall. This detail would do well with some improvement for Berlin in 2004.

The opening ceremony will be remembered for confusion and for the negligence of the Minister of Health, who never showed up. The president, Professor Kalden, had the pleasure of delivering the usual prizes (or were there more?) to young and older individuals of merit. We were also treated to some nice local guitar music and Fado song. The venue and hot weather, however, impeded the mingling that usually characterizes the EULAR congress opening receptions. I did not attend the Gala Dinner (€120 per person) but was told that the offerings of the table and the entertainment did not quite match the historic setting in which it took place.

After such negative preludes, it is a pleasure to acknowledge the scientific committee and its chairman Maxime Dougados for a well composed and varied smörgårdsbord of excellent parallel sessions. The 190 invited speakers were not often reruns from other meetings, but rather contained a number of new names. The clinical sessions were in the majority. I listened to state of the art presentations on osteoarthritis and scleroderma, where mostly published work was presented in a palatable way. I also listened to a session on treatment of rheumatoid arthritis that started with a report where the only result presented in the abstract published in the abstract book stated 'The database will be locked in early June and assessed immediately thereafter'. Obviously industry and the coauthors of this abstract had convinced the scientific committee that this study should be given a prominent exposure, regardless of what the immediate analysis might contain. This is remarkable and is scientifically unsound.

It was interesting to listen to presentations by Iain McInnes on very preliminary experiences in targeting IL-15 and by Sir Ravinder Maini on the significant but perhaps not overwhelming effects of IL-6 inhibition in rheumatoid arthritis. It was also interesting to listen to a convincingly negative trial report of infliximab in patients with Sjögren's syndrome delivered by Xavier Mariette.

The basic sessions I attended were of a high quality and gave rise to interesting discussions, and the attendance was good. As already mentioned, most sessions were well attended and some were even crowded or impossible to enter. A new and laudable feature was the sessions organized by the standing committees on the final day of the congress, dealing with European cooperative initiatives relating to topics such as ankylosing spondylitis, scleroderma, autoantibodies, cytokines, and genomics.

The stage was thus set for creation of interesting poster sessions, featuring the better half of the submitted abstracts. In Stockholm last year the three poster sessions featuring some 350 posters were each a very positive experience, as I wrote previously [1]. The three locations in the conference center selected by the organizers for poster presentations this year, however, were extremely unsatisfactory. They were located in peripheral areas of the center where temperatures of more than 40°C were prevalent and where the humidity reached saturation. The poster sessions were scheduled from 12.30 to 2.00 p.m., a time also reserved for lunch. Under these circumstances it was no surprise that only the odd presenter was actually present at the poster, and I do not blame them.

There was a corresponding paucity of viewers, so the promising development in Stockholm last year was turned into a disastrous failure. Poster presenters come to the congress after months of preparation. It may be their first exposure to international expertise and to stimulating experience bridging generations. This is hard to say, but I must: EULAR gives a wrong signal to the active young investigators, to the hope of the future. The poster sessions should be the meat and spice of a good congress, but they were spoilt by providing such a substandard environment. Had I been in charge of EULAR I would try to limit the damage to the presenters in Lisbon not only by issuing an apology, but also by offering the senior presenter a substantial rebate on next year's registration. I believe that EULAR could afford it and that this would convey a clear message that poster presentations are an important and vital part of the congress.

The scientific program of the congress started on Wednesday at 2 p.m. and ended at 12.30 p.m. on Saturday. The program featured 10–12 parallel sessions of 90–150 min each plus the daily poster sessions of 90 min. The total time allotted to science every full day amounted to 7 hours including the lunchtime poster sessions.

In addition, attendees could choose between 22 official satellite symposia, sponsored and arranged by industry and held in the main venue. The satellites were not concurrent with any parts of the scientific program, but they occupied 3 hours of time of the first 3 days. They could feature products of the companies or topics they judge to be of interest and thereby to create goodwill and promote sales. This could be a very positive thing for both parties. The chairmen and speakers were selected for eminence as opinion leaders as well as for pedagogic and scholarly skills. Many names were also included in the scientific program of the congress, perhaps addressing the same topic as in the satellite symposia. Glossy handouts with PowerPoint reproductions and references were often provided.

These symposia are popular among congress organizers because they are important sources of income, both through the direct fee to the organization and by covering costs for speakers of the congress proper. They may also motivate industry to support delegates of their choice to attend the congress. The symposia are regarded by the companies as major efficient marketing events, provided the congress itself is attractive enough. They are also often later published as supplements, and can be cited in marketing material.

EULAR allowed six 90 min slots on 3 days for satellites, whereas American College of Rheumatology (ACR) sanctions only two such slots; one of these is a late afternoon and the other is immediately after the end of the meeting. ACR is thus more restrictive than EULAR. Other societies are more permissive and allow luncheon satellites, and others allocate 2 days before or after the congress to satellites. The income from the satellites no doubt increases the economic strength of EULAR, and allows EULAR to attract a large and good faculty of invited speakers.

Interaction with industry is an important component of our professional life and I am not known for shunning work with or for industry. In fact I have at present signed consultant's contracts with two companies. But I would have preferred that the satellites were moved away from the two main congress days. The additional 3 hours should then, in part, be used for additional poster viewing. Perhaps it would reduce the income for EULAR, perhaps not. But it would increase the chances for success in attracting not only numbers of abstracts, but a quality of abstracts in competition with ACR, of that I am sure.

It was easier to register and to submit abstracts than at previous EULAR congresses. It was less easy to make hotel bookings through the organization. Lisbon has many hotels and I had no problem finding one on the Web. It was also easy to get information on the program and to print abstracts before the meeting. I was only under-whelmed by the map in the congress brochure. One should have prepared a list of recommended hotels and provided a readable map indicating their location and ways of getting from them to the congress venue. I hope the reason for neglect in this sense was not anticipation that the majority of delegates arrangements go through sponsoring companies and therefore are not in need of such information.

No other rheumatology congress except ACR's annual meeting can claim to compete with EULAR but, notwithstanding, the national congresses in the European countries continue to thrive and also to grow. It may be an important message to EULAR that the proportion of sponsored delegates at these national meetings is much smaller than at EULAR. The other meetings are therefore less vulnerable to variations in industry support and, importantly, their more human size and moderate cost make them attractive to both academic and practicing colleagues.

Maxime Dougados (and his team) lived up to the expectations when he took over the chair of the scientific committee. A new congress is being organized in Berlin next year in an identical format but with a better venue and a new scientific committee. The EULAR congress in Stockholm in 2002 marked a distinct step forward with regard to overall scientific quality, and in particular a much larger amount of young rheumatologists and trainees were presenting their work. Lisbon in 2003 was not a step forward, but the shortcomings that I pointed out, as requested, will in part be overcome next year. Lisbon stays in our memory as a charming, slightly exotic place of history. EULAR remains strong. It has the power to make an input in many fields of research and practice. Its standing committees are expanding their work with less bureaucracy than we see in organizations under the command of the European Union. But this should not detract from the risks of commercialism and from overt corruption.