Abstract Body

Hippocrates stated, "Life is short but art is long". Contemporary physicians can diagnose disease conditions portrayed in old paintings.

More than 500 years ago, Dutch painters such as Jan van Eyck and Frans Hals painted excellent portraits showing people with Heberden’s nodules that were only described by William Heberden the Elder in 1802. In 1793, a Dutch physician, Eduard Sandifort, described osteoarthritis of the hip, whereas John Haygarth described in 1805 the polyarticular nature of osteoarthritis (OA). Until then, all forms of arthritis were regarded as manifestations of gout.

This is just one example of what doctors can learn from painters: artists are good observers and by studying the human body very carefully they painted diseases that were not even described in the medical literature. Furthermore, some patients with severe diseases were excellent artists and I propose that Art therapy may work as a good pain killer,

In my presentation, I will try to convince you that Learning Medicine through Art is a great joy. Moreover, I will try to convince you that training the eye may improve your skills to diagnose various diseases. Or as William Osler phrased it: "There is no more a difficult art to acquire than the art of observation".

Abstract Body

Patients with ASIA present with complaints such as fatigue, cognitive impairment, arthralgias, myalgias, pyrexia, dry eyes, and dry mouth. During the last decennium, it has been postulated that these symptoms in patients with foreign body implants are due to a chronic inflammatory process and an adjuvant effect of the implanted biomaterial. Ultimately, these inflammatory reactions result in (an increase of) allergies, autoimmune diseases, immune deficiency, and/or lymphomas. Pre-existent allergic disease has been found to be an important risk factor for the development of ASIA after foreign body implantation. Explantation of the foreign body results in the majority of patients in an amelioration of the symptoms.

The best-studied example of foreign body implantation that may result in ASIA is silicone-breast implantation (SBI). Previously, we calculated from the literature that explantation of the SBI improved silicone-related complaints in 75 % of the patients (469 of 622). In patients with autoimmune diseases, however, additional (immunosuppressive) therapy is needed. There is some evidence that explantation with total capsulectomy may result in better results than explantation without capsulectomy, although good prospective studies are lacking. Recently, thousands of patients have been described demonstrating that SBI explantation results in an amelioration of ASIA symptoms. Several possibilities which could clarify why patients improve after explantation have been postulated. Firstly, the inflammatory response could be reduced after explantation, supporting a causal role for SBI in the pathogenesis of ASIA. Secondly, explantation of the implants may remove a nociceptive stimulus, which may be a causative factor for many complaints as well. Recently, studies have been published that not only suggest recovery of symptoms but also improvement of objective measures after explantation, suggesting that SBI indeed causes ASIA. Options for the reconstruction of the explanted breast such as autologous tissue and/or the use of saline- or hydrocellulose-filled breast implants will be discussed.

Abstract Body

Anti-neutrophil cytoplasm autoantibodies (ANCA)-associated vasculitides (AAVs) are a group of heterogeneous diseases characterized by blood vessel inflammation resulting in organ destruction and death. Although various treatment strategies have resulted in marked improvement in vasculitis-specific outcomes, many patients with AAV continue to suffer from complications related to the prolonged use of glucocorticoids (GC) such as infections, metabolic abnormalities, and increased cardiovascular morbidity. Previously, we observed that activation of the complement pathway plays a pivotal role in disease development in an animal model of AAV. Further studies demonstrated that in human AAV the complement pathway is also implicated in the augmentation of the damage caused by AAV. Different complement inhibitors have been recently developed for use in humans. It has been already shown that specifically targeting the complement C5a receptor pathway may lead to improved outcomes in patients with AAV. Phase I, II, and III findings with emphasis on the efficacy, and safety of Avacopan, a new oral competitive inhibitor that interferes with the binding of C5a to C5aR1 (CD88) will be reviewed. Results from these studies are encouraging, may lead to major changes in the treatment approach for AAV, and give rise to future studies utilizing complement inhibitors in AAV patients, and potentially in other immune-mediated diseases.In 2021, Avacopan was approved in Japan and in the USA as an adjunctive treatment in adults for severe active ANCA-associated vasculitis (specifically MPA and GPA). It is expected that approval in other countries will follow soon. At present, complement inhibition is also investigated for the treatment of complement component 3 glomerulopathy, severe COVID-19 infections, hidradenitis suppurativa, lupus nephritis and IgA nephropathy.