Istanbul: Between Hüzün and Modern PMR Rheumatology

While reading Orhan Pamuk’s book and immersing myself in the athmosphere of hüzün, I arrive at the Point Hotel Barbaros, a thoroughly modern hotel in one of Istanbul’s modern districts.

This year, Istanbul hosted the LVV-PMR Conference, where I had the privilege of being the only Hungarian participant and poster presenter. The conference is one of the most important international scientific forums dedicated to research and clinical care in large-vessel vasculitis (LVV), particularly giant cell arteritis (GCA) and Takayasu arteritis (TAK), as well as polymyalgia rheumatica (PMR).

My previous participation in this conference series dates back to 2018, when I attended what was then still known as the PMR/GCA Conference at the world-renowned Mayo Clinic in Rochester, Minnesota, USA. I refer readers to my previous blog post for more details.

Looking back at the history of this conference series warms my heart. As a member of the working group, I have had the opportunity on several occasions to witness the extraordinary enthusiasm that characterises these meetings. Much credit goes to the leadership for the society’s growth: it now brings together nearly 200 colleagues.

The conference series began in the late 1990s as a more narrowly focused international scientific meeting devoted specifically to PMR and GCA. The very first meeting took place in Prato, Tuscany, Italy, in 1999, organised by the Mayo Clinic in collaboration with local Italian experts, including Professor Carlo Salvarani.

Over the years, the meeting has evolved considerably. Alongside traditional clinical topics, increasing attention has been devoted to innovative imaging techniques, including ultrasound, MRI and PET/CT, and their role in diagnosis. The conference’s scope has also expanded to include Takayasu arteritis. Today, the meeting serves as a global bridge, bringing together European and American specialists with researchers from the Asia-Pacific region.

One of the most important milestones in the history of the conference series was the 2016 meeting in Southend-on-Sea, England, hosted by Professor Bhaskar Dasgupta. This meeting marked a genuine diagnostic breakthrough. The local working group presented a risk-stratification scoring system developed and validated to support the rapid assessment of patients with suspected GCA. This approach became an important component of the Fast-Track Clinic model, which has since transformed the diagnostic pathway for this potentially sight-threatening disease.

The 2018 conference at the Mayo Clinic, hosted by Professor Eric Matteson, was another particularly significant milestone, both scientifically and in terms of international professional collaboration. It also provided an important forum for discussions involving the American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (EULAR). These international efforts contributed to the development of clinical recommendations that have substantially influenced the management of GCA and PMR. Important advances included a greater emphasis on shared decision-making and treatment targets agreed upon with patients, helping to improve the likelihood of achieving remission. Diagnostic progress has also been remarkable: modern vascular ultrasound has increasingly assumed a central role in the assessment of GCA and PMR and, in appropriate clinical settings, may reduce the need for invasive temporal artery biopsy. Therapeutically, the introduction of steroid-sparing biological agents, particularly interleukin-6 receptor (IL-6R) inhibitors, has represented a major advance in the treatment of GCA.

The most recent meetings were held in Innsbruck, Austria, in 2024 and in Istanbul, Turkey, in 2026. The opening lecture began with a retrospective overview of the conference series, highlighting the latest advances in genetics, pathophysiology and biological therapies. I will return to these scientific developments in my upcoming blog post.

And as I made my way towards the Bosphorus along the broad, elegant Barbaros Boulevard, a familiar melody came to my mind: the iconic Hungarian song "Istanbul" by the band Hungária:

“Istanbul! Oh-oh-oh! Istanbul!

Oh, Istanbul, I long to be with you …

… perhaps one day we shall meet,

On the shores of the Bosphorus.”