What an amazing All Star Season. In the end, Cortisone cut down the nets as the most important and transformational article ever written in the field of rheumatology.

To see how your bracket did, head over to the RheumMadness Tourneytopia website.

Below is a detailed analysis of the entire tournament.  We’d also like to highlight all the amazing people who collaborated to make this tournament the best one yet – see below.

Final Match-up: Cortisone defeats Etanercept for RA (4-3)

This was almost a huge upset – Cortisone barely beat Etanercept for RA in a 4-3 nail-biter according to Blue Ribbon Panel (BRP) votes. Here is what the BRP had to say about this year’s winner:

• “A championship for the ages! Both teams made spectacular, innovative plays (ie new mechanisms of action), took care of the ball (patient care) hit their free throws down the stretch (persistently effective). But cortisone has touched more lives across a broader array of diseases for a longer time, so it cuts down the nets for me.”
• “Nobel Prize aside…it was cortisone that changed all our thinking in rheumatology. Every drug developed since cortisone was an effort to mimic its benefits and minimize the cortisone toxicity.”
• “Etanercept led the way for biologics, but let’s not forgot who started it all. The fact that so many of our current efforts are targeted toward minimizing steroids just highlights their importance in our field. A flashy Noble prize doesn’t hurt as well.”
• “While everyone in rheumatology has a love / hate relationship with glucocorticoids, no other discovery has advanced therapeutics in our field to a greater degree.”

Despite Cortisone being the heavy favorite, Etanercept for RA made it close. Here is what the BRP had to say in favor of Etanercept for RA:

• “It goes without saying that this final was a very difficult matchup. There’s no doubt regarding the force that ‘cortisone’ has brought to the rheumatology world, and we all knew from the beginning it was a favorite in the tournament as it has been in previous years. However, every one loves an underdog story, and perhaps ‘Etanercept for RA’ was the one needed to dethrone ‘cortisone’.Etanercept for RA’ changed the treatment landscape for RA, very much triggering the biologic renaissance in rheumatology. No easy task, and to make such a revolutionary impact demands the respect it rightfully deserves.”
• “TNF inhibitors ushered in the era of durable responses for patients with RA, with e a remarkable safety profile. Rheumatology has never been the same.”

Did they get it right? Here’s a breakdown of all participant picks for the winner of RheumMadness 2023: The All Star Season. Basically, once you made it past cortisone, it was anyone’s game!

Participant Winners

This year, we received 142 bracket submissions from participants in 13 different countries. Here’s a breakdown of who submitted a bracket for RheumMadness 2023:

• Attending: 44%
• Fellow: 26%
• Resident: 13%
• Medical Student: 5%
• APP: 3%
• Patient/interested citizen: 3%
• Other health care professional: 1%
• Chose not to answer: 5%

Prizes are awarded for participants who submitted a bracket in three categories: 1) Attending / APP, (2) Fellow, and (3) Resident / Medical Student. Members of the RheumMadness Leadership team are not eligible to receive these prizes. This year, the prizes go to:

• Attending / APP: RobShmerling (41 points, link shows their bracket)
• Fellow: lveder8 (40 points, link shows their bracket)
• Resident / Medical Student: Gmaldonado (39 points, link shows their bracket)

Thank you so much to everyone who played!

Time to Say Thank You

This was our biggest season ever, which means we have so many people to thank. First, thank you to the Rheumatology Research Foundation for supporting this project with the Clinician Scholar Educator (CSE) Award.

We would also like to thank the leaders of NephMadness for allowing us to borrow their amazing educational model to create RheumMadness.

Thanks to the Scouting Report Authors

The real all stars of RheumMadness are the scouting report authors who create reviews of each team in the tournament. This year, the scouting reports were written by 123 collaborators from 19 fellowship programs and 2 private practice groups, including 76 fellows, 40 faculty, 4 residents, and 3 medical students. What an amazing collaboration! Thank you to all those who wrote the scouting reports for each team, as follows:

• Etanercept for RA, by the Ohio State Fellowship Program
• Etanercept + MTX, by the University of Chicago Fellowship Program
• Infliximab for RA, but the University of California San Diego Fellowship Program
• TEAR Triple Rx, by the UT Southwestern Fellowship Program
• BeSt Trial, by the Medical University of South Carolina Fellowship Program
• TICORA Trial, by the Arthritis & Rheumatism Associates Practice, Washington DC
• Clonal Selection, by the Vanderbilt University Medical Center Fellowship Program
• MSU & NLRP3, by the Geisinger Medical Center Fellowship Program
• Abs before SLE, by the Massachusetts General Hospital Fellowship Program
• CCP & Enolase, by the University of South Florida Fellowship Program
• Pathogenic ANCA, by the University of North Carolina Fellowship Program
• CYC for PAN, by the Allegheny Health Network Fellowship Program
• CYC in Scleroderma, by the Louisiana State University Shreveport Fellowship
• ULT During Flare, by the Medical College of Wisconsin Fellowship Program
• RAVE Trial, by the Wake Forest Fellowship Program
• HCQ Withdrawal, by Bryn Mawr Medical Specialists Association Practice
• ALMS Trial, by the University of Alabama and Birmingham Fellowship Program
• LUMINA, by the Northwestern University Fellowship Program
• HAQ, by the RheumMadness Leadership Team
• Cortisone, by the University of Colorado Fellowship Program
• Origin of RA, by the Duke University Fellowship Program
• Origin of sJIA, by the Montefiore Pediatric Fellowship Program

Thanks to The Rheumatologist

Thank you to the editorial staff of The Rheumatologist for their amazing support of RheumMadness over the last 3 years, including this article highlighting the 2023 tournament:

RheumMadness 2023: the All-Star Season

Thanks to theMednet.Org

We would also like to thank theMednet.org for collaborating with us to create even more content for this year’s RheumMadness tournament. theMednet.org is a physician only site providing a space for physicians to tackle difficult clinical questions and see how colleagues are practicing. theMednet is featuring select Q&A relevant to articles in our 2023 tournament, providing a space for further discussion and polling around clinical application. They offer free CME and MOC credit for reviewing this material. Register here for a free account with full access to the theMednet site. After registering, click here to find RheumMadness content on theMednet, with Q&A about the following topics:

1. How do you approach follow up of young patients with isolated +ANA, but no current clinical signs or symptoms of SLE?
2. Do you use IL-1 inhibitors to prevent flares of gout or CPPD in patients who experience flares despite prophylaxis with colchicine, NSAIDs, and/or low-dose prednisone?
3. Do you ever consider discontinuing hydroxychloroquine in patients with SLE in longstanding remission except in cases of overt toxicity?
4. Are there certain patients in whom you would avoid initiation of ULT during an acute gout flare?
5. Do you use conventional DMARDs aside from methotrexate to prevent anti-drug antibody development for patients on infliximab?
6. Is there a role for monitoring serum ANCAs to assess ANCA associated vasculitis disease activity?

Thanks to the 2023 Blue Ribbon Panel

Next, we’d like to thank our amazing Blue Ribbon Panel (BRP). This panel worked hard to review each article and scouting report, and they didn’t mind taking the heat for all those upsets in the early rounds. Thank you so much to our panelists!

Thanks to the 2023 RheumMadness Leadership Team

Finally, we’d like to thank all the members of the RheumMadness Leadership Team for the 2023 tournament.

Finally, thank YOU for playing.  We can’t wait to do this again next year!

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The IgG4 (fourth round) of RheumMadness is complete!

To see how your bracket is doing, head over to the RheumMadness Tourneytopia website.

Results for reach matchup in the second round are reviewed below, including how the  Blue Ribbon Panel (BRP) voted compared to participant picks.

Match-up 1: Etanercept for RA defeats Abs Before SLE (6-1)

The winner of the TNF Takedown didn’t need any Ab workouts to move on to the next round, with Etanercept for RA defeating Abs Before SLE in a 6-1 blowout per the BRP.

Here’s what the BRP had to say in support of Etanercept for RA:

• “Etanercept for RA punches its ticket to the Championship game by transforming the lives of so many patients, and making Rheumatology so rewarding to practice.”
• “Etanercept for RA paved way for age of biologic therapy in rheumatology. Abs before SLE provides important clues about SLE pathogenesis but hasn’t led to major breakthrough about disease causality that has led to direct therapeutic advancement.”

The lone supporter of Abs Before SLE said this: “Seminal study that defines the beauty of autoantibodies.”

Participants were much more split than the BRP, though Etanercept for RA did receive the most participant picks to win this round.  Here’s the breakdown of which team participants thought would win this round:

• Etanercept for RA: 20%
• Abs Before SLE: 18%
• TICORA: 15%
• TEAR Triple Rx: 10%
• Infliximab for RA: 9%
• Etanercept + MTX: 8%
• Pathogenic ANCA: 6%
• MSU & NLRP3: 5%
• BeSt: 4%
• Clonal Selection: 4%
• CCP & Enolase: 1%

Match-up 2: Cortisone defeats RAVE (7-0)

Cortisone continues behaving just the way it does in the immune system: defeating everything. It won this round in a blowout, defeating RAVE 7-0. Here’s what the BRP had to say about this match-up:

• “Cortisone started it all. We hate and love them (note that I mention hate first), but who says an All-Star can’t be polarizing?”
• “Cortisone’s all-star duo of transforming treatment and clarifying the biochemical mechanism of RA were too much for even the impressive RAVE squad.”
• “RAVE was a great study but it’s applicable only to a small subset of patients within the field. Cortisone is for everyone.”
• “The OG med.”

Did they get it right? The VAST majority of participants picked cortisone as well.  Here’s the breakdown of participant picks for this round:

• Cortisone: 51%
• RAVE: 17%
• LUMINA: 8%
• HAQ: 6%
• ULT During Flare: 5%
• HCQ Withdrawal: 4%
• ALMS Trial: 4%
• CYC in Scleroderma: 2%
• Origin of RA: 2%
• Origin of sJIA: 1%
• CYC for PAN: 1%

What’s next?

We will release the results of the Interleukin-2 (the championship) on Monday, April 3.

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The Entheseal 8 (third round) of RheumMadness is complete!  After a tournament full of upsets, this round seemed to go smoothly for the favorites. To see how your bracket is doing, head over to the RheumMadness Tourneytopia website.

Results for reach matchup in the second round are reviewed below, including how the  Blue Ribbon Panel (BRP) voted compared to participant picks.

Match-up 1: Etanercept for RA defeats TICORA (5-1)

TICORA missed the target in this one, losing to Etanercept for RA in a 5-1 vote from the BRP. Here’s why the panel picked Etanercept for RA:

• “Introduction of successful biologic therapy into RA with just gorgeous dose response curves was groundbreaking. T2T strategy of TICORA is nice but was already also being studied in other concurrent trials in RA like the BEST trial.”
• “Etanercept was the original quantum shift in ‘modern’ era rheumatology.”

Did the panel get it right? YES. According to participant picks, the BRP nailed this one. Here’s a breakdown of all participant picks for the winner of this round:

• Etanercept for RA: 25%
• TICORA: 20%
• TEAR Triple Rx: 20%
• Etanercept + MTX: 13%
• Infliximab for RA: 12%
• BeSt: 8%

Match-up 2: Abs Before SLE defeats Clonal Selection (5-2)

Abs Before SLE pulled out the win in this match-up, defeating Clonal Selection 5-2 in BRP votes. Here’s why:

• “Both studies are giving us lots of clues about pathophysiology that we still have yet to decipher. But Abs before SLE provides more practical information to fuel discovery and perhaps at the moment more relevant to rheumatology – or at least at the moment is a more famous paper in rheumatology.”
• “Coach Burnet of Forbidden Clones wrote the transformational playbook about antibody formation that was later exploited by Coach Arbuckle’s Abs Before SLE team. So Abs should advance.”

The majority of participants also picked Abs Before SLE in this match-up.  Here’s a breakdown of all participant picks for the winner of this round:

• Abs Before SLE: 46%
• MSU & NLRP3: 20%
• Clonal Selection: 15%
• Pathogenic ANCA: 11%
• CCP & Enolase: 8%

Match-up 3: RAVE defeats CYC for PAN (6-1)

Rituximab tied cyclophosphamide in RAVE, and the BRP felt that was enough for the win in RheumMadness, with RAVE defeating CYC for PAN 6-1. Here’s what they had to say:

• “RAVE was an elegant trial and finally allowed us to have a less toxic treatment option for ANCA+ disease.”
• “Cyclophosphamide is on the decline in rheumatology, and for AAV rituximab is increasingly standard of care thanks to this trial. Both trials impressively conducted with very little preliminary data to support efficacy.”

In contrast, the lone supporter of CYC for PAN said this: “RAVE and CYC for PAN were equally important for patients, but the Fauci/Wolff study was just more transformational and groundbreaking.”

What did participants think? The overwhelming majority picked RAVE.  Here’s a full breakdown of participant picks for this match-up:

• RAVE: 46%
• HCQ Withdrawal: 18%
• ALMS Trial: 11%
• ULT During Flare: 11%
• CYC for PAN: 8%
• CYC in Scleroderma: 6%

Match-up 4: Cortisone defeats HAQ (6-1)

Cortisone entered the tournament as a heavy favorite, and it continued its dominant run in this matchup, defeating HAQ 6-1. Here’s what the BRP had to say:

• “Research papers come in all shapes and sizes, but not too many lead to Nobel prizes.”
• “The granddaddy”. Can’t imagine a rheum without steroids in their back pocket!!

In contrast, the lone supporter of HAQ said this: “You can’t play the game today without both cortisone and PROs like HAQ. But only one will survive well into the future. Clinicians and clinical researchers will always need the HAQ. It may bust brackets, but HAQ gets my vote.”

The majority of participants also picked cortisone to win this round. Here’s a full rundown of participant picks:

• Cortisone: 65%
• LUMINA: 17%
• HAQ: 11%
• Origin of RA: 6%
• Origin of sJIA: 1%

What’s up next?

Results for the next 2 rounds will be released on the following dates:

• Round 4: Saturday, April 1 (the IgG Four)
• Round 5: Monday, April 3 (the Interleukin Two, aka the championship!)

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The second round of RheumMadness was full of upsets and a few surprising blowouts. To see how your bracket is doing, head over to the RheumMadness Tourneytopia website.

Results for reach matchup in the second round are reviewed below, including how the  Blue Ribbon Panel (BRP) voted compared to participant picks. Huge thanks to our amazing panel for their thoughtful consideration.

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Match-up 1: Etanercept for RA defeats Infliximab for RA (5-2)

This was the match-up everyone wanted to see. Infliximab was the first anti-TNF molecule ever studied for RA, and etanercept was the first anti-TNF agent approved by the FDA for the treatment of RA. In the end, etanercept took the win 5 to 2.

In support of Etanercept for RA, the BRP said, “TNFi vs TNFi. Both seminal studies but ETN shot to popularity in use due to convenience.”

In contrast, a BRP member who voted for infliximab had this to say: “The transformational aspect as first human biologic TNF but also showing disease modification which was critical.”

Did they get it right? According to participant picks, 39% picked Etanercept for RA and 37% picked Infliximab for RA (the remainder picked Etanercept + MTX which lost in Round 1). So in the end, most participants agreed with the panel, but JUST BARELY!

Match-up 2: TICORA defeats TEAR Triple Rx (5-1)

This was, at least according to participants, another huge upset. According to the Blue Ribbon Panel (BRP), TICORA had no trouble defeating TEAR Triple Rx, even with Dr. Worthing abstaining from the vote again. TEAR Triple Rx only mustered one vote.

BRP comments in support of TICORA: “T2T was the game changer that changed how we approached all future studies.”

However, participants did NOT agree, with 43% of all participant brackets picking TEAR Triple Rx in this round versus 35% who supported TICORA. The remaining 22% picked BeSt, which lost in round 1.

So who got it right? The panel or the participants? Use #RheumMadness to tell us what you think.

Match-up 3: Clonal Selection destroys MSU & NLRP3 (7-0)

Wow. This was another huge upset. According to the BRP, the mechanism madness region was a blowout, with Clonal Selection receiving every single BRP vote. Here’s what the BRP had to say:

• “This team has some of the best fundamentals of the whole tournament. Well earned Nobel for a doctor Burnet. But the inflammasome was critical.”
• “Fundamental theoretical paper.”

Yet again, the majority of participants did NOT agree, with only 44% picking Clonal Selection and 56% picking MSU & NLRP3!

We are sure no one will have any strong opinions about this on social media 🙂

Match-up 4: Abs Before SLE defeats Pathogenic ANCA (7-0)

Another blowout, this time in the Ab workout region, with Abs Before SLE receiving all 7 BRP votes. Sounds like myeloperoxidase, considered by some to be the Most Villainous Protein (MVP) of the tournament, didn’t come ready to play this round.  Here’s what the BRP had to say:

• “Both scouting reports are stuffed full of outstanding hoops references and transformational, novel data. But Abs Before SLE pulled away down the stretch by influencing the care of millions more people with preclinical positive test results.”
• “Higher conceptual impact in rheumatology.”
• “The concept of antibody formation leading to disease led to the search for other “pathogenic” antibodies in other diseases.”

This time, participants agreed, with 67% picking Abs Before SLE versus just 16% picking Pathogenic ANCA. Interestingly, those who chose CCP & Enolase remained faithful to their team, with 17% picking it to win the entire region. Oh well, nice try!

Match-up 5: CYC for PAN defeats ULT During Flare (5-2)

Now this was an interesting upset. CYC for PAN defeated ULT During Flare in BRP votes, 5-2, however the majority of participants disagreed.

Here’s why the BRP chose CYC for PAN:

• “John Stuart Mill and the utilitarian philosophers step into the arena with this classic test of saving the lives of a few vs improving the lives of many. CYC for PAN wins in double overtime when Coach Fauci dramatically leaves a man under the hoop to cherry pick 17 times while ULT sticks with its deliberate, controlled study all game.”
• “Use of cyclophosphamide has greater impact across many diseases in rheumatology.”

In contrast, one member of the BRP who voted for ULT During Flare said this: “If there is one thing we continually have to teach and reteach non rheumatologists, it is this.”

The majority of participants disagreed with the BRP, with 46% picking ULT During Flare, and just 25% picking CYC for PAN. The remaining 29% picked CYC for Scleroderma, suggesting their fanbase is more loyal than CYC for PAN.

Match-up 6: RAVE defeats ALMS Trial (6-1)

The Jump Ball region was certainly not a toss-up. RAVE dominated the ALMS Trial in BRP votes, 6-1.

Comments from the panel in support of RAVE: “RAVE more strongly disrupted standard of care, and the scouting report was just too good for RAVE.”

In contrast, the lone BRP who voted for ALMS had this to say: “Best matchup yet! RAVE may have one of the best names in the tourney, but it I think it loses in a squeaker to ALMS, who showed up to practice and ultimately gave patients an oral option for life-changing treatment,”

The majority of participants agreed with the BRP, with 61% picking RAVE to win this region. Interestingly, only 14% of participants picked the ALMS Trial to win this region, compared with 25% of participants who stayed true to HCQ Withdrawal despite its early exit in round 1. The bottom line? Rheumatologists sure love their rituximab and hydroxychloroquine!

Match-up 7: HAQ defeats LUMINA (5-2)

Another region, another upset, this time in The Whole Patient Region. Here, the BRP picked HAQ over LUMINA, 5-2. Comments from the panel in support of HAQ:

• “Foundational for patient reported outcomes.”
• “Post-game interview said it all. 40 years hence, every one of my patients completes a HAQ. Teams in other regions are trembling — except RA Revamp!”

Participants disagreed, with 54% picking LUMINA and 46% picking HAQ. To us, it sounds like everyone is passionate about caring for The Whole Patient, with strong support for both teams!

Match-up 8: Cortisone defeats Origin of RA (5-2)

Finally, in the Origin Story region, Cortisone defeated Origin of RA 5-2, and the vast majority of participants agreed.  The main surprise of this region was that cortisone didn’t all 7 votes!

According to the BRP in support of cortisone:

• “Cortisone wins this rare, heartbreaking (because early) matchup of two powerhouses. We now know that cortisone would be effective for both primary asthenic gout and ordinary gout even if Dr. Landré-Beauvais hadn’t distinguished the two.”
• “The mainstay of our treatment paradigms and the story of its discovery is amazing. Talk about a shift in how rheumatology was approached!”
• “Glucocorticoids are the currency of rheumatology.”

The overwhelming majority of participants agreed, with 86% picking Cortisone, 11% picking Origin of RA, and 3% remaining true to Origin of sJIA.

What’s up next?

Results for the next 3 rounds will be released on the following dates:

• Round 3: Tuesday, March 28 (the Entheseal Eight)
• Round 4: Saturday, April 1 (the IgG Four)
• Round 5: Monday, April 3 (the Interleukin Two, aka the championship!)