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For a few days in November, Atlanta, the home of Coca-Cola, Delta Airlines, Jimmy Carter and the birthplace of Martin Luther King, welcomed c.16,000 adult and paediatric rheumatologists and health professionals from all over the world to the 2019 ACR/ARP meeting. Here are some of President Liz Price's reflections.

The meeting was enormous, with over 450 sessions, nearly 3000 posters and over 150 exhibitors including 40 pharma stands, not to mention the wellness area, which hosted daily visits by therapy dogs to help you relax.

Much of the talk was upbeat, as rheumatology was the most popular and, by default, most competitive specialty for medical graduates last year in the US. Many of the posters and sessions highlighted new advances in the treatment of psoriatic arthritis, in particular the IL23 and IL17 axis inhibitors. There was similar excitement about the growth in JAK inhibitors, both in terms of variety and indication and the news that nintedanib slows loss of lung function in scleroderma-associated ILD.

Our North American colleagues presented their very comprehensive, evidence-based guidelines for the diagnosis, treatment and management of patients with systemic vasculitis, and NYU rheumatologist Dr Jill Buyon delivered a true masterclass in managing lupus and pregnancy. Their ‘MOC’ sessions are very reminiscent of our own Case-based Conference session using cases to facilitate in-depth discussion of conditions and highlight evidence-based recommendations for diagnosis and management.

Like us, they used voting apps but they took this a stage further and participants could upload their scores to their web-based accreditation to gain certified credits.

There was some dismay about the increasing cost of TNF-inhibitors. The US has not embraced biologics and ongoing use of branded biologics seems to have driven prices ever-upwards. They were cheered by the finding that any physical activity, even golf, helps prevent osteoporosis and that there is some evidence for apremilast in Behçet's.

Similar to the UK, the US is using increasing amounts of rituximab to achieve and maintain remission in ANCA-positive vasculitis and, freed from NICE constraints, are using tociluzimab to maintain remission in GCA out to three years. They are hopeful that metformin may inhibit progression of knee osteoarthritis.

The food – or rather the lack of it – deserves a special mention. Despite the registration being nearly three times that of our own much-loved meeting, there is no food provided and the food outlets on site were of the fast food variety. Queuing to buy a coffee on day two, an an American delegate behind me in the queue confided that she thought the food had been much better at EULAR, which she had attended a few years ago but she had it on good authority that the food at the British meetings was the best...

BSR's Annual Conference returns to Glasgow in 2020. Make sure you're there