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Latest Episodes:

Pulmonary hypertension and the rheumatologist, part 2: The history Feb 26, 2025

In part 2, we dig into the history of pulmonary hypertension. How did this strange diagnosis first get recognized, what does it have to do with cows with thick necks and urinary catheters in the heart?

Intro 0:11
In this episode 0:17
Recap of part 1 0:26
How was pulmonary hypertension discovered? 2:38
1891 3:51
1901 5:07
1935 7:02
Hilar dance 12:58
Cardiac catheterization: 1929 15:03
When did cardiac catheterization become relevant? 20:10
1965: Aminorex 24:40
World Health Organization: 1975 26:37
1980s: toxic oil syndrome of Spain 28:20
Preview of part 3 33:15
Back to cardiac catheterization 34:08
Briskets disease 35:45
1947 37:56
Pulmonary physiology and prostaglandin therapies (in the next episode) 38:41
Schistosomiasis outbreaks in Egypt 1938 40:26
Chronic thromboembolism 45:03
Thanks for listening 48:16

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Barst RJ. Ann Thorac Med. 2008;doi:10.4103/1817-1737.37832.

Bodo R. J Physiol. 1928;doi:10.1113/jphysiol.1928.sp002447.

Dresdale DT, et al. Am J Med. 1951;doi:10.1016/0002-9343(51)90020-4.

Egypt. Stanford.edu. Published 2015. https://schisto.stanford.edu/pdf/Egypt.pdf.

Hewes JL, et al. Pulm Circ. 2020;doi:10.1177/2045894019892801.

Johnson S, et al. Am J Respir Crit Care Med. 2023;doi:10.1164/rccm.202302-0327SO.

Newman JH. Am J Respir Crit Care Med. 2005;doi:10.1164/rccm.200505-684OE.

Weir EK, et al. Circulation. 1996;doi:10.1161/01.cir.94.9.2216.

Disclosures: Brown reports no relevant financial disclosures.

Pulmonary hypertension and the rheumatologist, part 1: A bit of background Feb 12, 2025

In this series, we dive into what rheumatologists should know about pulmonary hypertension, starting an interview with Joseph Parambil, MD, where we learn about the disease, when to suspect and how to work up!

Intro 0:11
In this episode 0:16
Preview of the four-part series 4:46
Interview with Joseph Parambil, MD 6:27
How did you become interested in pulmonary hypertension? 7:02
Brown and Parambil discuss the histology of pulmonary hypertension. 10:13
Brown and Parambil discuss a case of pulmonary hypertension. 12:26
What is pulmonary hypertension and what does that mean for a rheumatologist? Where is pulmonary hypertension happening? 13:25
Describe the different groups of pulmonary hypertension. 19:51
A note about Dr. Chatterjee 20:25
Brown and Parambil discuss the groups of pulmonary hypertension. 23:35
What should we know about evaluating patients with pulmonary hypertensions? 26:51
Brown and Parambil discuss bendopnea and other signs of pulmonary hypertension. 29:58
What about the heart sound? 33:06
What should we look for in patients who we suspect to have pulmonary hypertension? 36:52
What should we look for in the tricuspid jet? 38:18
Brown and Parambil discuss the use of echocardiograms in pulmonary hypertension. 39:28
Tell us about the threshold of diagnosis. 40:47
What is the difference between the mean pressure and the wedge pressure? 41:41
What about the role of the pulmonary function test? 43:55
Summary 46:41
Do you think the pulmonary hypertension in scleroderma and lupus are different entities? 48:37
Brown and Parambil discuss the connection of autoimmune disease and pulmonary hypertension. 50:49
Coming up in episode 91 51:50
Thanks for listening 52:25

Disclosures: Brown and Parambil report no relevant financial disclosures.

Joseph Parambil, MD, is a staff member in the Respiratory Institute and the director of the HHT Center of Excellence and the Vascular Anomalies Center at the Cleveland Clinic. He is associate professor of medicine at Cleveland Clinic’s Lerner College of Medicine. He is certified by the American Board of Internal Medicine with additional specialty certification in pulmonary medicine and critical care medicine.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

COVID's role in autoimmunity and where we are in the world of long COVID Jan 22, 2025

On this episode, hear the 2024 updates on COVID-19, long COVID and the latest developments in research in rheumatology. Hosted by Dr. Leonard Calabrese.

Intro 0:12
In this episode 0:21
Coming up on Healio Rheuminations 0:56
COVID-19, long COVID and the rheumatologist with Leonard Calabrese, DO 2:19
Questions 3:12
Long COVID 4:46
Calabrese’s bias 10:15
The evidence 13:08
Auto antibodies 14:54
Why does the body develop auto antibodies? 17:47
COVID-19 and epidemiologic association 22:25
New clinical entity 26:40
Therapeutic implications 31:00
In conclusion 32:00
Thanks for listening 33:18

Leonard H. Calabrese, DO, is the chief medical editor, Healio Rheumatology, and professor of medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer chair of clinical immunology at the Cleveland Clinic.

Disclosures: Calabrese reports professional relationships with AbbVie, AstraZeneca, Bristol Myers Squibb, Galvani, Genentech, GlaxoSmithKline, Janssen, Novartis, Regeneron, Sanofi and UCB.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

The Story of the Flu Vaccine (Re-Release) Oct 24, 2024

It's that time of year again, everyone rolling up their sleeves to get a flu shot. This throwback episode dives into the history of the struggles pinning down the causative agent of flu and the journey to the vaccine!

Intro 0:40
In this episode 1:11
The history of the flu: 1892 1:41
What do we know about viruses? 6:29
Rabies and dead virus 11:17
A Sickness in the Serum, Part 2 14:43
1918 16:44
Vaccines and trials 19:13
Pig influenza 23:12
Influenza: a filterable agent we can’t see 27:01
The trials of 1942 33:02
PS: 1918 influenza 38:57
Thanks for listening 47:42

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Hicks DJ, et al. Clin Exp Immunol. 2012;doi:10.1111/j.1365-2249.2012.04592.x.

Rosenau MJ. Experiments Upon Volunteers to Determine the Cause and Mode of Spread of Influenza, Boston, November and December, 1918. https://quod.lib.umich.edu/f/flu/3750flu.0016.573. Published February 1921. Accessed December 6, 2023.

Rosenau MJ, et al. JAMA. 1925;doi:10.1001/jama.1925.02670070040019.

Taubenberger JK, et al. Antivir Ther. 2007;12(4 Pt B):581-91.

Tobin J. The first flu shot. https://heritage.umich.edu/stories/the-first-flu-shot/. Accessed December 6, 2023.

NSAIDs, Part 3: The rise, fall and rise again of COX-2 inhibition Aug 29, 2024

In the third episode of the NSAIDs saga, we focus on COX-2 inhibition! Did the hopes and dreams of selective COX-2 inhibition pan out? What can the rise and fall of VIOXX teach us about physiology?

Intro 0:11
Recap of part 1 & 2 0:28
In this episode 1:44
Cyclooxygenase 2 (COX-2) and the rat experiment 3:12
What do we know about the prostaglandins? And what about COX-2 7:54
What does prostacyclin do? 10:33
The first COX-2 inhibitor: VIOXX 10:56
What is COX-2 doing?: Pfizer and Merck 12:15
Two more NSAID studies: colon cancer, Alzheimer’s disease and COX-2 inhibitors 18:41
VIOXX: Why is myocardial infarction risk occurring? 22:34
Animal models and the Goldilocks theory of thromboxane and prostacyclin 23:49
PRECISION trial 30:25
Rheum + Boards 37:14
Thanks for listening 37:32

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Anderson GD, et al. J Clin Invest. 1996;doi:10.1172/JCI118717.

Funk CD, et al. J Cardiovasc Pharmacol. 2007;doi:10.1097/FJC.0b013e318157f72d.

Hennan JK, et al. Circulation. 2001;doi:10.1161/hc3301.092790.

Krumholz HM, et al. BMJ. 2007;doi:10.1136/bmj.39024.487720.68.

Nissen SE, et al. N Engl J Med. 2016;doi:10.1056/NEJMoa1611593.

Disclosures: Brown reports no relevant financial disclosures.

NSAIDs, Part 2: The Dawn of the Anti-Inflammatories Jun 26, 2024

In this episode, we dive into the story of aspirin and the development of ibuprofen, ending with the experiments that showed the mechanism of how aspirin actually works.

Intro 0:12
Review of part 1 0:28
In this episode 1:04
Blocking prostaglandins and willow leaves 2:26
Edward Stone 3:45
Johann Andreas Buchner 4:16
The chemical structure of salicylic acid and creating the synthetic compound 4:44
Dr. TJ MacLagan: The first trial in 1876 and treating acute rheumatism 5:16
Felix Hoffmann: manipulating salicylic acid and aspirin 8:47
How widespread was the use of aspirin for rheumatoid arthritis? 12:04
1938: problems with aspirin and endoscopies 14:58
1950s: long-term use of aspirin and chronic renal impairment 17:12
Dr. Lawrence Craven: the use of aspirin to treat myocardial infarction 18:13
Overview of what we’ve learned so far 20:48
Stewart Adams: the development of ibuprofen 21:40
A paper lost to time 23:29
How do you test if a drug is anti-inflammatory? 25:25
How do you make better aspirin? 26:55
1960: a trial comparing ibuprofen, baby aspirin and prednisone in patients with rheumatoid arthritis 30:03
Aspirin, ibuprofen and other NSAIDs 32:49
Nobel Prize winner Dr. John Vane 33:40
Dr. Vane: what triggered prostaglandin production? 35:42
Another guinea pig experiment 37:37
Nobel Prize winner Dr. Bengt Samuelsson 39:00
Interesting tidbits: early studies looking at the side effects of NSAIDs 40:01
1968: gastric ulcer formation and prostaglandins in rats 40:25
1973: renal blood flow and prostaglandins in dogs 41:53
1974: aspirin vs ibuprofen vs indomethacin for the heart 44:03
Aspirin vs ibuprofen vs indomethacin 44:20
On the next episode 46:09
Thanks for listening 46:37

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Adams SS. Inflammopharmacology. 1999;doi:10.1007/s10787-999-0002-3.

https://www.aspirin-foundation.com/history/the-aspirin-story/.

Buchanan WW, et al. J Rheumatol. 2002;29(6):1321-3.

Cryer B, et al. Gastroenterology. 1999;doi:10.1016/s0016-5085(99)70545-7.

Desborough MJR, et al. Br J Haematol. 2017;doi:10.1111/bjh.14520.

Halford GM, et al. Platelets. 2012;doi:10.3109/09537104.2011.632032.

Harris SC, Fosdick LS. Theoretical considerations of the mechanisms of antipyretic analgesia. NWU Bull. 1952;53: 6–9.

Jasani MK, et al. Ann Rheum Dis. 1968;doi:10.1136/ard.27.5.457.

Robert A, et al. Gastroenterology. 1968;55(4):481-7.

Disclosures: Brown reports no relevant financial disclosures.

The Discovery of Non-Steroidal Anti-inflammatory Drugs (NSAIDs), Part 1 May 16, 2024

Humans have had an insatiable appetite for inhibiting production of prostaglandins for centuries! This series delves into the history of aspirin and NSAIDs, looking at the understanding of the prostaglandin pathway.

· Intro 0:12

· In this episode 0:23

· What are NSAIDs? 0:53

· Prostaglandins 5:50

· What are prostaglandins? 7:19

· Where do prostaglandins come from? 8:45

· So, what do we do with prostaglandins? 13:15

· How did they figure out prostaglandins? 13:55

· Naming the prostaglandin 21:25

· Phospholipids 24:46

· Arachidonic acid 25:28

· Arachidonic acid into prostaglandins: how do you prove it? 26:32

· How does arachidonic acid turn into prostaglandins? 27:27

· Cyclo-oxygenase 28:36

· mRNA and COX-2 32:50

· On the next episode 35:55

· Summary 36:38

· Thanks for listening 37:49

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Botting RM. Pharmacol Rep. 2010;doi:10.1016/s1734-1140(10)70308-x.

Flower RJ. Br J Pharmacol. 2006;doi:10.1038/sj.bjp.0706506.

Flower RJ. Br J Pharmacol. 2019;doi:10.1111/bph.14588.

Kurzrok R, et al. Exp Biol Med. 1930;doi:10.3181/00379727-28-5265.

https://www.nobelprize.org/prizes/medicine/1970/euler/biographical/.

von Euler US. J Physiol. 1936;doi:10.1113/jphysiol.1936.sp003433.

Urticarial Vasculitis, Part 2: Walking the Balance Beam of Allergy and Rheumatology Apr 18, 2024

This episode digs into the pathophysiology of urticaria vasculitis from anti-C1q to the story of bradykinin.

· Intro 0:11

· In this episode 0:22

· Review of episode 83 1:23

· Listen to previous episode, The Complement System for Dunces 4:09

· Anti-C1q antibodies 6:26

· Lupus, anti-C1q and lupus nephritis 9:33

· What happens when you inject anti-C1q in a mouse? 12:56

· The allergy component: anti-C1q, urticaria and angioedema 17:36

· Bradykinin-mediated angioedema and C1q deficiency 24:20

· What is the kinin kallikrein system? 26:21

· French researchers in 1909: human urine injected in dogs 27:30

· How is this relevant to urticarial vasculitis? 31:08

· SERPING1 gene mutation 31:23

· Summary 32:06

· COPD association with urticarial vasculitis 33:51

· Coming up in episode 85 35:28

· Thanks for listening 35:45

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Busse P, et al. J Allergy Clin Immunol Pract. 2022;doi:10.1016/j.jaip.2021.11.011.

Davis MDP, et al. J Allergy Clin Immunol Pract. 2018;doi:10.1016/j.jaip.2018.05.006.

Dorn JM, et al. Ann Allergy Asthma Immunol. 2023;doi:10.1016/j.anai.2023.06.014.

Marzano AV, et al. J Allergy Clin Immunol. 2022;doi:10.1016/j.jaci.2022.02.007.

Siegert CE, et al. Clin Immunol Immunopathol. 1993;doi:10.1006/clin.1993.1066.

Stojan G, et al. Lupus. 2016;doi:10.1177/0961203316645205.

Venzor J, et al. Clin Rev Allergy Immunol. 2002;doi:10.1385/CRIAI:23:2:201.

Wisnieski JJ, et al. Medicine. 1995;doi:10.1097/00005792-199501000-00003.

Urticarial Vasculitis: Attack of the Nettles, Part 1 Feb 28, 2024

Is it an allergy or an autoimmune vasculitis, or a little of both? Find out the story of urticarial vasculitis, how this disease was recognized and eventually sorted out from other types of urticaria.

· Intro 0:12

· In this episode 0:21

· Case study 1:22

· Chronic spontaneous urticaria, hives and nettles 7:57

· Dermatographism and witchcraft? 10:15

· Causes of urticaria 11:17

· Theory of inflammation and histamines 11:40

· Urticaria and treatments with histamines 12:09

· Types of urticaria 13:02

· Mayo Clinic study 13:39

· Chronic urticaria as a manifestation of necrotizing venulitis 16:10

· Connection between types of urticaria and leukocytoclastic vasculitis 20:02

· More case studies 20:38

· What do we know about treatments? 22:23

· In conclusion 24:15

· Coming up in part two 25:08

· Thanks for listening 25:47

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Czarnetzki BM. Int J Dermatol. 1989;doi:10.1111/j.1365-4362.1989.tb01314.x.

Kolkhir P, et al. J Allergy Clin Immunol. 2019;doi:10.1016/j.jaci.2018.09.007.

McDuffie FC, et al. Mayo Clin Proc. 1973;48(5):340-8.

Natbony SF, et al. J Allergy Clin Immunol. 1983;doi:10.1016/0091-6749(83)90096-9.

Soter NA. N Engl J Med. 1977;doi:10.1056/NEJM197706232962505.

COVID-19, long COVID and the rheumatologist with Leonard Calabrese, DO Jan 04, 2024

What should rheumatologists know about what we've learned about COVID-19 and long COVID in 2023? Hosted by Dr. Leonard Calabrese.

· Intro 0:11

· In this episode 0:21

· 2023: current status and controversies 0:35

· What is going on with COVID-19? 01:53

· What do we know about vaccine responses? What should we be telling our patients about vaccines in our immunocompromised population? 2:58

· Lancet Rheumatology MELODY study summary 3:08

· What about patients within the rheumatic and autoimmune disease space? 4:15

· Who is immunocompromised and why does it matter? 5:11

· What is the immunosuppression we are giving them? 6:39

· What to tell patients about getting vaccinated 8:56

· Long COVID 10:09

· What is long COVID? 10:26

· JAMA Network Open study on prevalence and characteristics associated with post-COVID conditions 14:19

· In the clinical arena, what should rheumatologists be thinking about? 16:38

· What about pathogenesis? What do we know about the controversies in this area? 18:58

· Autoimmunity: COVID-19 and autoimmune response 20:45

· What about therapies? 22:22

· The next generation of rheum agents: Immunomodulation with neonatal Fc receptor targeting? 24:40

· A question for the rheumatology community: do patients with immune mediated diseases get more long COVID than the control population? 25:40

· In conclusion 27:37

· Thanks for listening 28:38

Disclosures: Calabrese reports professional relationships with AbbVie, AstraZeneca, Bristol Myers Squibb, Galvani, Genentech, GlaxoSmithKline, Janssen, Novartis, Regeneron, Sanofi and UCB..

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

The Story of the Flu Vaccine Dec 07, 2023

It's that time of year again, everyone rolling up their sleeves to get a flu shot. This episode dives into the history of the struggles pinning down the causative agent of flu and the journey to the vaccine!

· Intro 0:12

· In this episode 0:17

· The history of the flu: 1892 3:10

· Rabies and dead virus 10:52

· A Sickness in the Serum, Part 2 14:31

· Vaccines and trials 19:13

· Pig influenza 23:21

· Influenza: a filterable agent we can’t see 27:10

· The trials of 1942 33:18

· PS: 1918 influenza 39:13

· Finding the 1918 influenza vaccine 39:54

· Thanks for listening 47:54

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Hicks DJ, et al. Clin Exp Immunol. 2012;doi:10.1111/j.1365-2249.2012.04592.x.

Rosenau MJ, et al. JAMA. 1925;doi:10.1001/jama.1925.02670070040019.

Taubenberger JK, et al. Antivir Ther. 2007;12(4 Pt B):581-91.

Tobin J. The first flu shot. https://heritage.umich.edu/stories/the-first-flu-shot/. Accessed December 6, 2023.

It's in the Air: Silica exposure and the risk of autoimmunity, Part 4 Nov 15, 2023

What is silica? How does it impact your risk of developing autoimmunity if you inhale it, inject it or even snort it up your nose? Listen and find out!

· Intro 0:12

· In the previous episodes 0:28

· The Ajax incident of 1979 1:15

· Silica and its association with autoimmune disease 4:11

· The history of silica and the health risks 5:21

· Rheumatoid scleroderma, etc. 8:14

· Cardiff pneumoconiosis medical panel 9:49

· Databases 12:51

· Silica exposure and the development of serologies 15:02

· What would happen if you injected silica into the veins? 16:51

· Anca vasculitis 18:33

· Thanks for listening 23:23

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Blanc PD, et al. Am J Med. 2015;doi:10.1016/j.amjmed.2015.05.001.

Boudigaard SH, et al. Int J Epidemiol. 2021;doi:10.1093/ije/dyaa287.

Conrad K, et al. Lupus. 1996;doi:10.1177/096120339600500112.

Hoy RF, et al. Allergy. 2020;doi:10.111/all.14202.

Klockars M, et al. Br Med J (Clin Res Ed). 1987;doi:10.1136/bmj.294.6578.997.

Park CG, et al. Environ Health Perspect. 1999;doi:10.1289/ehp.99107s5793.

Pollard KM. Front Immunol. 2016;doi:10.3389/fimmu.2016.00097.

Autoimmunity, Part 3: The Lupus Gradient Oct 30, 2023

In this episode, we dig through the data of lupus in Africa and speak with experts on the Lupus Gradient, the impact of malaria and what we can learn from it all.

· Intro 0:12

· In the previous episode 0:30

· Lupus Gradient 2:01

· Back to Dr. Brian Greenwood 3:48

· Polyarthritis 4:04

· Rates of autoimmune diseases 6:00

· Malaria and mouse models 7:33

· Back to lupus 8:48

· First case of lupus 15:14

· Prevalence of lupus 17:15

· Papers on lupus 21:23

· Dr. Mickael Essouma 23:38

· Dr. Essouma, how did you conduct this study? 24:01

· Did you ever believe there was a gradient? 26:09

· Dr. Sandro Vento 30:56

· Dr. Vento, do you believe there was a lupus gradient? 31:51

· What are the connections to infectious disease? 38:51

· That’s a wrap! 43:04

· Coming up in part 4 44:55

· Thanks for listening 45:05

Disclosures: Brown reports no relevant financial disclosures. Healio could not confirm relevant financial disclosures for Essouma and Vento at the time of posting.

Mickael Essouma, MD, is physician from Cameroon specialized in internal medicine at the University of Yaounde I in Cameroon, with a complimentary certificate on rheumatology from the EULAR online course and a certificate on lupus from the European Lupus Society (SLEuro). He is an advocate of lupus and other autoimmune diseases in Africans.

Sandro Vento, MD, is the dean of faculty of medicine at the University of Puthisastra, Phnom Penh, Cambodia and a consultant and collaborating specialist at Mayo Clinic Center for Tuberculosis, WHO Collaborating Center.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Bae SC, et al. Arthritis Rheum. 1998;doi:10.1002/1529-0131(199812)41:123.0.CO;2-D.

Bryc K, et al. Am J Hum Genet. 2015;doi:10.1016/j.ajhg.2014.11.010.

Essouma M, et al. J Autoimmun. 2020;doi:10.1016/j.jaut.2019.102348.

Gilkeson GS, et al. Lupus. 2011;doi:10.1177/0961203311404915.

Micheletti SJ, et al. Am J Hum Genet. 2020;doi:10.1016/j.ajhg.2020.06.012.

Symmons DP. Lupus. 1995;doi:10.1177/096120339500400303.

Vento S, et al. Front Med. 2020;doi:10.3389/fmed.2020.00202.

The Geography of Autoimmunity, Part 2 Aug 17, 2023

This episode delves into what we can learn about the impact of the environment on autoimmunity, digging into how rates of autoimmunity can vary drastically in different parts of the world.

· Intro 0:12

· In this episode 0:16

· Dr. Brian Greenwood 0:22

· The geography of autoimmunity 7:01

· Type 1 diabetes 10:31

· Finland and type 1 diabetes 13:57

· Socioeconomics 17:59

· Genetics and autoimmune diseases 24:19

· Migration studies 24:53

· Denmark and multiple sclerosis 30:06

· Coming up in part 3 36:02

· Thanks for listening 38:16

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Bach JF. N Engl J Med. 2002;doi:10.1056/NEJMra020100.

Bodansky HJ, et al. BMJ. 1992;doi:10.1136/bmj.304.6833.1020.

Dean G, et al. J Neurol Neurosurg Psychiatry. 1997;doi:10.1136/jnnp.63.5.565.

Hammond SR, et al. Brain. 2000;doi:10.1093/brain/123.5.968.

Hawkes CH, et al. Mult Scler Relat Disord. 2019;doi:10.1016/j.msard.2019.08.001.

Karvonen M, et al. Diabetes Care. 1999;doi:10.2337/diacare.22.7.1066.

Kondrashova A, et al. Diabetes Care. 2007;doi:10.2337/dc06-0711.

Marciulionyte D, et al. Diabetologia. 2001;doi:10.1007/s001250051574.

Nielsen NM, et al. Brain. 2019;doi:10.1093/brain/awz088.

Patterson CC, et al. Diabetologia. 2012;doi:10.1007/s00125-012-2571-8.

Sandy JL, et al. Pediatr Diabetes. 2021;doi:10.1111/pedi.13191.

The Environment and Autoimmunity, Part 1 Jul 12, 2023

This episode delves into the history of the hygiene hypothesis. What do we know about different exposures changing risk for asthma and allergies, and do these exposures have the same protection for autoimmunity?

· Intro 0:12

· In this episode 0:18

· Hygiene hypothesis 0:33

· Allergic rhinitis (or Hay fever) 2:32

· Pollen and the allergy skin test 8:58

· Exposure and cleanliness 10:22

· Allergic rhinitis and Cree Native Americans 11:51

· Appendicitis 13:10

· Family size and asthma 14:36

· Rural versus urban populations 17:41

· Dust 18:31

· Children, day care and infections 22:43

· The “old friends” theory 28:29

· Farming and allergies 30:07

· The Amish and the Hutterites 33:02

· Mice, dust and asthma 34:47

· Thanks for listening 37:40

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Emanuel MB. Clin Exp Allergy. 1988;doi:10.1111/j.1365-2222.1988.tb02872.x.

Flohr C, et al. Clin Exp Allergy. 2010;doi:10.1111/j.1365-2222.2009.03346.x.

Genuneit J. Pediatr Allergy Immunol. 2012;doi:10.1111/j.1399-3038.2012.01312.x.

Karvonen AM, et al. J Allergy Clin Immunol. 2019;doi:10.1016/j.jaci.2019.07.035.

Perkin MR, et al. Front Allergy. 2022;doi:10.3389/falgy.2022.1051368.

Rantala AK, et al. Epidemiol. 2020;doi:10.1097/EDE.000000000001163.

Sangrador CO, et al. Allergol Immunopathol (Madr). 2018;doi:10.1016/j.aller.2018.03.006.

Stein MM, et al. N Engl J Med. 2016;doi:10.1056/NEJMoa1508749.

Strachan DP. BMJ. 1989;doi:10.1136/bmj.299.6710.1259.

Weber J, et al. Am J Respir Crit Care Med. 2015;doi:10.1164/rccm.201410-1899OC.

An Afternoon with the Glaucomfleckens: On hypermobility and physician burnout Jun 28, 2023

On this special episode of Rheuminations, I interview comedian and ophthalmologist William Flanary, MD, and Kristin Flanary, also known as the Glaucomfleckens, on hypermobility and physician burnout.

Kristen Flanary highlights what it's like to live with hypermobility, and Dr. William Flanary discusses his thoughts on physician burnout and using their podcast, Knock Knock, Hi, as comedy relief.

· Intro 0:11

· In this episode 0:45

· Interview with Dr. William and Kristin Flanary, also known as Doctor and Lady Glaucomflecken 2:49

· Rheumatology and ophthalmology overlap 3:11

· Can you tell me a few things about yourselves? 7:48

· Kristin Flanary, MA: when did you notice your hypermobility and when did you start having complications from it? 12:19

· Do you ever fully dislocate or do you kind of feel like you’re about to? 19:53

· Chest compressions and William Flanary 25:23

· Have you done any bracing? 26:24

· Dr. Linda Bluestein, @hypermobilityMD, on the Glaucomfleckens podcast 30:24

· William Flanary, MD: can you talk about your experience with physician burnout? And are you optimistic about AI solving the physician burnout problem? 31:16

· Artificial Intelligence with Cardiologist Dr. Eric Topol | Knock Knock, Hi with the Glaucomfleckens, @EricTopol 37:01

· Can you tell us more about your podcast, Knock Knock, Hi? 41:06

· Thank you 44:59

Disclosures: Brown and the Flanarys report no relevant financial disclosures.

William E. Flanary, MD, is an ophthalmologist and part-time comedian, also known as Dr. Glaucomflecken. You can follow him on Twitter @DGlaucomflecken.

Kristin Flanary, MA, is a marketing and communications specialist, also known as Lady Glaucomflecken. You can follow her on Twitter @LGlaucomflecken.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

The Black Death and Autoimmunity Apr 03, 2023

Was your psoriasis caused by the Black Death? Learn more than you might have wanted to know about the Black Death and delve into the data on the immunologic/autoimmune ramifications of wiping out nearly half of Europe.

· Intro 0:11

· In this episode 1:09

· The Black Death 1:24

· The History of IV Immunoglobulin episode 2:07

· How the Black Death happened 4:07

· How many people died from the Black Death? 6:49

· Record keeping 6:53

· The modern immune system, the Black Death and HIV 8:43

· What is CCR5? 8:55

· Current data on autoimmune diseases 10:35

· ERAP2 15:55

· How yersinia pestis kills you 21:04

· The inflammasome 22:03

· The Inflammasome for Dunces episode 22:09

· Mediterranean fever and mouse model 24:49

· Takeaways 30:20

· Summary 30:59

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Wheelis M. Emerg Infect Dis. 2002;doi:10.3201/eid0809.100536.

Ratner D, et al. PLoS Pathog. 2016;doi:10.1371/journal.ppat.1006035.

Park YH, et al. Nat Immunol. 2020;doi:10.1038/s41590-020-0705-6.

Patin E. Nat Immunol. 2020;doi:10.1038/s41590-020-0724-3.

Galvani AP, et al. Proc Natl Acad Sci USA. 2003;doi:10.1073/pnas.2435085100.

Vascular Ehlers Danlos Syndrome for the Rheumatologist, Pt 2: Extra-Cellular Matrix Reloaded Feb 28, 2023

In this episode we explore ways in which the extracellular matrix can be manipulated, including the story of doxycycline, TGF-beta in Marfan syndrome and whether beta blockers can reduce vascular events in vascular EDS.

· Intro 0:12

· Review of previous episode 0:28

· In this episode 2:26

· The pressure against the vessels 4:06

· The pressure against the wall 8:44

· Matrix metalloproteinases 10:16

· Tadpole study – collagen breakdown 10:35

· Tetracycline antibiotics 14:05

· Rat model – periodontal disease and hydroxyproline 14:24

· Chemically modified tetracyclines 20:14

· Mouse model – tetracycline use 22:00

· Tetracyclines and other autoimmune conditions 23:22

· Marfan syndrome 24:45

· Fibrillin and Marfan syndrome 28:48

· TGF-beta 29:36

· Mouse model – Marfan syndrome and fibrillin 31:14

· ARBs and TGF-beta 33:51

· TGF-beta and vascular EDS 37:25

· Back to the mouse model 38:38

· Protein kinase C 39:56

· Summary 40:26

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Bowen CJ, et al. J Clin Invest. 2020;130:686-698.

Brooke BS. Lancet. 2010;doi:10.1016/S0140-6736(10)61155-5

Dietz HC, et al. Am J Med Genet C Semin Med Genet. 2005;doi:10.1002/ajmg.c.30068.

Dubacher N, et al. Cardiovasc Res. 2020;116:457-465.

Golub LM, et al. SAGE. 1998;doi:10.1177/08959374980120010501.

Gross J, et al. PNAS. 1962;doi:10.1073/pnas.48.6.1014

Habashi JP, et al. Science. 2006;312:117-121.

Morissette R, et al. Circ Cardiovasc Genet. 2014;7:80-88.

Mullen M, et al. Lancet. 2019;394:2263-2270.

Neptune ER, et al. Nat Genet. 2003;33:407-411.

Vascular Ehlers-Danlos Syndrome, Part 1 Jan 31, 2023

Dive into vascular Ehlers-Danlos syndrome. What is it? How does it present? Get clues to its diagnosis and learn more about collagen than you ever wanted to know.

Intro 0:12
In this episode 0:17
Why vascular Ehlers-Danlos syndrome? 0:28
Case study: Dr. Mories 2:20
What can we learn about vascular Ehlers-Danlos syndrome? 05:02
Collagen and elastin 05:57
Collagen: horses and glue 07:07
More about collagen 10:35
Why is it a problem to miss a little bit of collagen? 14:14
The problem in vascular Ehlers-Danlos syndrome 15:06
The history of vascular EDS 15:41
How is vascular Ehlers-Danlos syndrome diagnosed? 16:36
A vascular Ehlers-Danlos syndrome diagnosis 22:33
Mouse models 23:29
Clinical and genetic features of vascular Ehlers-Danlos syndrome 24:39
Question of vasculitis 25:55
The skin: the most common symptom of vascular EDS 28:00
Family history, de novo mutations and pregnancy 29:43
Surgery or vascular intervention 31:39
How do patients do in the long-term? 32:54
Summary 34:00
Preview of part 2 35:42
Thanks 36:25

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Barabas AP. J Cardiovasc Surg (Torino). 1972;13(2):160-7.

Chow MJ, et al. Biophys J. 2014;doi:10.1016/j.bpj.2014.05.014.

Liu X, et al. Proc Natl Acad Sci USA. 1997;doi:10.1073/pnas.94.5.1852.

Mories A. Scott Med J. 1960;5:269-72.

Pepin M, et al. N Engl J Med. 2000;doi:10.1056/NEJM200003093421001.

Pepin MG, et al. Genet Med. 2014;doi:10.1038/gim.2014.72.

Piez KA. Matrix Biol. 1997;doi:10.1016/s0945-053x(97)90037-8.

Pope FM, et al. Proc Natl Acad Sci USA. 1975;doi:10.1073/pnas.72.4.1314.

Wagenseil JE, et al. J Cardiovasc Transl Res. 2012;doi:10.1007/s12265-012-9349-8.

Zilocchi M, et al. AJR Am J Roentgenol. 2007;doi:10.2214/AJR.07.2370.

Making Sense of Sensory Ganglionopathies, Part 2 Jan 18, 2023

In this episode, Dr. Benjamin Claytor walks us through his approach to suspected sensory ganglionopathies. I also cover other neurologic complications of Sjogren’s syndrome and some interesting history on vitamin B6.

Intro 0:12
In this episode 0:46
Neurologic complications of Sjogren’s Syndrome 1:55
Intro of Dr. Benjamin Claytor 6:00
The interview 6:49
Case study: process of diagnosis 7:17
Dorsal root ganglion in Sjogren’s 10:46
Facial numbness in sensory ganglionopathies 11:42
Dorsal root ganglion biopsies 13:36
Prognosis of sensory ganglionopathies vs other distal neuropathies 14:03
Sensory loss and weakness 15:51
Sensory ataxia 16:24
Attacks on the dorsal root ganglion 18:25
Loss of fibers in the dorsal root ganglion and regrowth 19:21
Treating cancer and sensory ganglionopathies 20:03
Idiopathic patients and treatments 20:45
Interview wrap-up 21:43
Pearls of wisdom from the interview 22:11
History of sensory ganglionopathies 23:35
Thanks 29:09

Disclosures: Brown and Claytor report no relevant financial disclosures.

Benjamin Claytor, MD, is assistant professor of neurology at the Neuromuscular Center at Cleveland Clinic.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Antopol W, et al. J Neuropathol Exp. 1942;doi:10.1097/00005072-194207000-00006.

Pavlakis PP, et al. J Autoimmun. 2012;doi:10.1016/j.jaut.2012.01.003.

Schaumburg H, et al. N Engl J Med. 1983;doi:10.1056/NEJM198308253090801.

Making Sense of Sensory Ganglionopathies and Sjogren’s Syndrome Dec 15, 2022

A sensational (or lack thereof) series on the signs and symptoms of the spellbinding sensory ganglionopathies.

Intro :12
Today’s episode :16
Anatomy review 1:32
Large fiber vs. small fiber nerves 4:47
Case presentation 6:11
Neurologic examination of patient 8:31
What is pseudoathetoid posturing? 10:11
What does it mean to be length independent? 14:30
What is sensory ganglionopathy? 16:19
How did the differential evolve throughout history? 18:50
How do things get out of the synovium? 23:19
Why does rheumatology get involved? 26:12
Case series of patients with Sjogren’s syndrome and sensory ganglionopathy 28:20
How do we treat it? 32:48
Summary 34:09
Thank you 36:59

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Amato AA, et al. N Engl J Med. 2020;doi:10.1056/NEJMra2023935.

Denny-Brown D. J Neurol Neurosurg Psychiatry. 1948;doi:10.1136/jnnp.11.2.73.

Griffin JW, et al. Ann Neurol. 1990;doi:10.1002/ana.410270313.

Malinow K, et al. Ann Neurol. 1986;doi:10.1002/ana.410200416.

Long COVID: Some facts, unanswered questions and implications for rheumatology – Part 2 Oct 10, 2022

In part two, Leonard Calabrese, DO, discusses the symptoms of long COVID and the role that rheumatologists play in diagnosing and treating patients with long COVID.

Brought to you by Tremfya.

Intro 1:06
Calabrese introduction 1:11
In this episode 1:36
Defining long COVID 1:49
Reviewing symptoms of long COVID 2:51
Long COVID fatigue 3:44
Studies and research on fatiguability 4:38
Phenomena of post-exertional malaise 6:18
Chronic fatigue syndrome 7:25
Neurocognitive dysfunction 7:52
Co-factors of intercurrent mood disorders and neurocognitive dysfunction 9:30
Pandemic-related sequelae 10:30
What about pain? 10:53
Long COVID pain and criteria for fibromyalgia 11:40
Pandemic-related long COVID 13:16
Diagnoses of long COVID 14:46
Immunopathogenesis 15:27
What about infections and autoimmunity? 17:50
What about treatments for long COVID? 19:28
Validation of long COVID 20:52
What do rheumatologists have to do with long COVID? 21:56
Wrap up 21:13
Thanks 24:02

Disclosures: Calabrese reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

Long COVID: Some facts, unanswered questions and implications for rheumatology – Part 1 Sep 30, 2022

In this episode, Leonard Calabrese, DO, reviews the history and controversies of post-infection sequelae, as well as the facts and epidemiology of long COVID.

Intro :12
Calabrese introduction :15
COVID-19 and the history of modern medicine :48
In this episode 1:39
The course of COVID-19 2:05
COVID-19 vaccines and immunity 2:50
Controversy, facts, fascination, long COVID 3:16
The history of post-acute sequelae 3:59
Post-infectious sequelae 10:15
What is long COVID and how do we define it? 11:02
How common is long COVID? 13:50
The epidemiology of long COVID 15:32
What are protective factors? 16:53
Preview of Part 2 17:36
Shoutout to rheumatologists 18:46
Conclusion 19:08
Wrap up of Part 2 preview 20:11
Thanks 21:02

Disclosures: Calabrese reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

The Story of the Synovium Aug 25, 2022

How is the synovial fluid produced? Who figured it out? It’s a ripping yarn involving corpses, cats, anti-hypertensives, steroids and streptococcus.

Brought to you by Tremfya.

Intro :11
Today’s episode :15
Synovium 101 :22
Overview of the synovium and synovial fluid 2:06
How they figured it out? Dr. Marian Ropes 5:37
Investigating synovial fluid 7:46
Cows experiment and where synovial fluid comes from 11:25
Clinical review of synovial fluid 14:57
What’s inside the fluid? 18:54
What makes up the fluid? 20:51
How do things get out of the synovium? 23:19
How are things absorbed into the synovium? 27:21
How well do steroids get picked up systemically? 29:39
Summary 32:30
Thank you 34:59

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Edwards JC. J Anat. 1994;184:493-501.

Rhinelander FW, et al. J Clin Invest. 1939;doi:10.1172/JCI101011.

Shaffer MF, et al. J Exp Med. 1939;doi:10.1084/jem.70.3.293.

Stout A, et al. PM R. 2019;doi:10.1002/pmrj.12042.

SAPHO Part 2: An Abundance of Acronyms (AAOA) Jul 26, 2022

What does the PAPA spectrum disorder teach us about SAPHO? Is SAPHO an autoinflammatory condition or part of the SpA spectrum? Why have antibiotics been used to treat this condition? Find out in this episode!

Brought to you by Tremfya.

Intro :01
Welcome to another exciting episode of Rheuminations :11
About today’s episode :17
A summary of SAPHO Part 1 :24
What to expect in this episode 1:28
Earlier long-term data 2:27
A more recent paper from Italy 6:47
Therapeutics in detail 12:17
Summary so far 21:39
IL-1 inhibition in SAPHO 22:32
Monogenic pediatric conditions 33:58
Why can’t we check the genes in SAPHO? 40:00
Episode summary 41:55
We went through a lot in this paper 45:29
Thanks for listening 43:53

Disclosure: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum and be sure to check out Rheum + Boards – your destination for rheumatology education and quizzes!

References:

Agak GW, et al. J Invest Dermatol. 2014;134:366-373.

Aksentijevich I, et al. N Engl J Med. 2009;360:2426-2437.

Assmann G, Simon P. Best Pract Res Clin Rheumatol. 2011;25:423-434.

Boursier G, et al. J Invest Dermatol. 2021;141:1141-1147.

Cai R, et al. Front Cell Dev Biol. 2021;doi:10.3389/fcell.2021.643644.

Colina M, et al. Arthritis Rheum. 2009;61:813-821.

Daoussis D, et al. Semin Arthritis Rheum. 2019;48:618-625.

Eun IS, et al. J Clin Neurosci. 2021;92:153-158.

Ferguson PJ, El-Shanti H. Biomolecules. 2021;11:367.

Grosse J, et al. Blood. 2006;107:3350-3358.

Guignard S, et al. Joint Bone Spine. 2002;69:392-396.

Hayem G, et al. Semin Arthritis Rheum. 1999;29:159-171.

Holzinger D, Roth J. Curr Opin Rheumatol. 2016;28:550-559.

Hurtado-Nedelec M, et al. J Rheumatol. 2010;37:401-409.

Liao HJ, et al. Rheumatology (Oxford). 2015;54:1317-1326.

Lindor NM, et al. Mayo Clin Proc. 1997;72:611-615.

Nguyen MT, et al. Semin Arthritis Rheum. 2012;42:254-265.

Trimble BS, et al. Agents Actions. 1987;21:281-283.

Yeon HB, et al. Am J Hum Genet. 2000;66:1443-1448.

You H, et al. J Clin Immunol. 2021;41:565-575.

SAPHO Part 1 May 20, 2022

What is SAPHO? What does the ‘H’ stand for, again? This episode explores some basics about the condition and delves into the history of how this disease came to be.

Intro :01
Welcome to another exciting episode of Rheuminations :11
About today’s episode :17
What does the acronym ‘SAPHO’ stand for? :37
How do you define this condition? 2:35
So, what is SAPHO syndrome? 4:59
Are any of the letters specific for SAPHO syndrome? 15:20
How the puzzle pieces were put together 15:48
Over the next ensuing decades, when did we start realizing that patients could have dermatologic manifestations? 23:00
So, what about hyperostosis? 30:46
Why isn’t the Sonozaki group getting the credit? 39:22
So, how did we get SAPHO? 40:26
How did they get 85 patients? 42:50
We went through a lot in this paper 45:29
Next episode preview 46:29
Thanks for listening 47:03

Disclosure: Brown reports no relevant financial disclosures.

References:

Chamot AM, et al. Rev Rheum Mal Osteoartic. 1987;54:187-196.

Giedion A, et al. Ann Radiol (Paris) 1972;15:329-342.

Köhler H, et al. Ann Intern Med. 1977;87:192-194.

Nguyen MT, et al. Semin Arthritis Rheum. 2012;42:254-265.

Raposo I, Torres T. Am J Clin Dermatol. 2016;17:349-358.

Romani M, et al. Clin Podiatr Med Surg. 2021;38:541-552.

Sonozaki H, et al. Ann Rheum Dis. 1981;40:547-553.

Windom RE, et al. Arthritis Rheum. 1961;4:632-635.

The Glucocorticoid Toxicity Index with John Stone, MD, MPH Mar 16, 2022

Glucocorticoids can do a lot of harm over time. In this episode, John Stone, MD, MPH, walks us through the Glucocorticoid Toxicity Index (GTI), a validated tool to measure steroid toxicity over time that we’ll be seeing more of in the future.

Intro :11
Stone introduction :26
About the GTI 1:13
Professional development opportunities for rheumatologists 2:32
The interview 4:27
What is the GTI, how did it come about and how do you think rheumatologists now and in the future will be utilizing it? 5:28
What are the difficulties in measuring steroid toxicities in trials? 10:58
How did you go about putting this instrument together? 13:04
What makes up the GTI? 19:11
Can you explain the Cumulative Worsening Score and the Aggregate Improvement Score? 20:53
Walk us through a patient coming in and being evaluated for the GTI 25:49
What's the future of the GTI in your opinion? 30:32
Do you think the GTI is going to be something that can eventually be used in day-to-day clinical practice? 33:42
Thank you, Dr. John Stone 34:43

John Stone, MD, MPH, is director of clinical rheumatology at Massachusetts General Hospital.

Disclosures: Brown reports no relevant financial disclosures. Stone is one of the experts who developed the Glucocorticoid Toxicity Index.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

A Cat in Wolves' Clothing, Part 3: An ID Perspective Feb 11, 2022

In this episode, Cassandra Calabrese, DO, dual-boarded in infectious disease and rheumatology, walks us through when to suspect Bartonella (it’s not always a house cat!), how to diagnose and how to treat.

Intro :01
Welcome to another exciting episode of Rheuminations :11
About today’s episode :17
10th Annual Basic and Clinical Immunology for Busy Clinicians starts 2/26 2:18
A look at upcoming episodes 3:00
Check out Healio’s Rheum + Boards – new questions coming soon! 3:15
The interview with Dr. Cassandra Calabrese 4:08
Is there always a cat exposure? 5:19
Are there other animals to look out for? Or other scenarios? 6:15
Endocarditis and Bartonella – consider these when things aren’t adding up 7:20
What about Bartonella quintana, do you always treat it? 9:43
It seems Bartonella can be more subtle than other infectious endocarditis, is that true? 10:49
When suspicious, how do we test for Bartonella? 11:57
Titer is important 13:57
How do you treat this? 14:43
What are long-term outcomes like? 16:38
Thank you, Dr. Calabrese 17:35
Warthan-Starry stain 17:54
Thanks for listening 21:24

Cassandra Calabrese, DO, is associate staff in the department of rheumatic and immunologic disease and the department of infectious disease at Cleveland Clinic Foundation.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

Disclosures: Brown and Calabrese report no relevant financial disclosures.

References:

Wright JR. Arch Pathol Lab Med. 2021;145:1297-1306.

A Cat in Wolves' Clothing, Part 2: The History of Bartonella Dec 10, 2021

Is this episode clinically relevant? No. Is it important? I think so! The story of Bartonella features a cast of characters, including a medical student who died trying to understand the disease, as well as some scientists with some less than ethical experiments. Enjoy!

Intro :01
Welcome to another exciting episode of Rheuminations :11
About today’s episode 1:12
More discussion of Bartonella quintana 2:52
How did we figure out the lice were actually the problem? 7:32
When do we figure out what this infection organism is? 11:51
A quick refresher of Koch’s postulates 12:58
How did they get the volunteers to do this? 13:33
The story of how Bartonella got its name 17:00
What is Bartonella bacilliformis? 17:38
Who is Richard Strong? 26:29
How do we finally prove that Carrion’s disease is what Carrion had proven? 28:25
About Bartonella henselae 32:21
Recapping the episode 36:39
Thanks for listening 37:24

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

Disclosure: Brown reports no relevant financial disclosures.

References:

Anstead GM. Lancet Infect Dis. 2016;16:e164–172.

Salinas-Flores D. Revista de la Facultad de Medicina, Universidad Nacional de Colombia. 2016;64:517.

Schultz MG. Am J Trop Med Hyg. 1968;17:503-515.

Vinson JW, et al. Am J Trop Med Hyg. 1969;18:713-22.

A Cat in Wolves’ Clothing: Bartonella and the Rheumatologist Nov 11, 2021

Bartonella is an important mimic of a variety of autoimmune diseases, and it can be subtle. This episode tackles the ways in which this strange organism can present to a rheumatologist.

Brought to you by Genentech

Intro :01
Today’s episode :15
Overview of Bartonella 1:57
Inspiration for this episode 4:17
Bartonella, what are you? 7:24
About Bartonella quintana 12:32
Take-away so far 16:07
Core symptoms and rheumatologic aspects 17:15
About serologies 24:51
Key takeaways from this episode 28:09
Check out Rheum + Boards on Healio at com/rheumandboards 28:31

Disclosure: Brown reports no relevant financial disclosures.

References:

Aslangul E, et al. J Rheumatol. 2014;doi:10.3899/jrheum.130150.

Beydon M, et al. Rheumatology (Oxford). 2021;doi:10.1093/rheumatology/keab691.

Im JH, et al. Vector Borne Zoonotic Dis. 2018;18:291-296.

Jacobs RF, Schutze GE. Clin Infect Dis. 1998;26:80-84.

Maman E, et al. Clin Infect Dis. 2007;45:1535-1540.

Raybould JE, et al. Infect Dis Clin Pract (Baltimore). 2016;24:254-260.

Zangwill KM, et al. N Engl J Med. 1993;329:8-13.

Paget's and the Rheumatologist: Why Haven't I Seen This Yet? Aug 18, 2021

What is Paget’s? Why is it declining across much of the globe? Find out, plus hear an interview with the head of the center for osteoporosis and metabolic bone disease at Cleveland Clinic, Chad Deal, MD.

Brought to you by GSK.

Intro :11
Today’s episode :27
What is Paget’s? 1:07
The history of Paget’s 5:35
How often is this symptomatic? 9:30
The epidemiology of Paget’s 13:22
The data on viruses and Paget’s disease 21:08
An interview with Dr. Chad Deal25:09
The numbers are showing a decline in Paget’s disease, are you seeing that? 26:03
Identifying Paget’s disease … who’s picking this up? 27:01
Can you walk us through those studies again? 27:58
Can you tell us a little bit about hypervascularity found in these patients? 30:32
Can you walk us through the history of how the treatments have changed? 31:37
Paget’s kind of just doesn’t go anywhere … is that what you’ve seen in your practice? 35:05
What if the patient has poor or borderline kidney function? Do they have other options? 37:07
Have you seen familial cases? Are people more prone to get it if someone in the family has it? 38:32
A discussion on osteosarcoma 39:55
Dr. Deal, thank you so much for your time and your knowledge about metabolic bone 42:46
Episode summary 42:52
I hope you learned something and thanks for listening! 44:47

Disclosure: Brown reports no relevant financial disclosures. Healio was unable to confirm relevant financial disclosures for Deal at the time of publication.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Cundy T. Metabolism. 2018;80:5-14.

Haddaway MJ, et al. Br J Radiol. 2007;80:523-526.

Poór G, et al. J Bone Miner Res. 2006;21:1545-1549.

Renier JC, Audran M. Rev Rhum Engl Ed. 1997;64:35-43.

Shaw B, et al. Proc Natl Acad Sci USA. 2019;10463-10472.

Singer FR. Nat Rev Endocrinol. 2015;11:662-671.

Wermers RA, et al. J Bone Miner Res. 2008;23:819-825.

Music by Lesfm from Pixabay.

A Sickness in the Serum, Part 3: The Search for Immune Complexes Jul 29, 2021

The final episode in this trilogy delves into the advancement in laboratory techniques that allowed for more accurate measurements of immune complexes, leading to studies in the ‘50 and ‘60s that clearly demonstrated the potential pathogenicity of immune complex-mediated disease.

Brought to you by GSK.

Intro :20
Recap and in this episode :40
The precipitant reaction 3:29
The antibody story 11:25
Frank Dixon 18:20
When did people start using these techniques? 20:15
On the quest to see if immune complexes are pathogenic 24:09
Frank Dixon’s findings using radioactive iodine tagging 28:22
Episode wrap-up 29:00
Thanks for listening! 32:11

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Germuth FG Jr, et al. Johns Hopkins Med J. 1967;120:225-251.

Kano K, Milgrom F. Vox Sanguinis. 1980;38:121-137.

McCluskey RT, et al. J Exp Med. 1960;111:181-194.

Waksman BH. Medicine (Baltimore). 1962;41:93-141.

A Sickness in the Serum, Part 2: The Birth of Immune Complex Disease Jul 08, 2021

The second episode in the series delves into the experiments and observations of Dr. Clemens (Baron) von Pirquet who first proposed that antibodies and antigens join forces to wreak havoc.

Brought to you by GSK.

Intro :10
Today’s episode :26
A recap of the previous episode :43
About Baron von Pirquet 4:40
What’s going on in the study of infectious disease and immunology in the early 1900s? 6:41
Writing the paper, “Serum Sickness” 13:13
What are the antibodies doing at that time? 19:10
What happened to Dr. Pirquet? 20:44
Pirquet’s medical student, Bela Schick 25:35
Episode wrap-up 27:27
The next episode 27:56
Thanks again for listening! 29:17

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Shulman ST. J Pediatric Infect Dis Soc. 2017;6:376-379.

Silverstein AM. Nat Immunol. 2000;1:453-455.

A Sickness in the Serum, Part 1: Serum Sickness and the Rheumatologist Jun 16, 2021

This episode delves into the clinical presentation of serum sickness along with a dash of Arthus reaction, to boot!

Brought to you by GSK.

Intro :10
Today’s episode :26
Let’s get into some cases 4:11
The Arthus reaction 6:06
What is another example of the same thing happening but on a systemic level? 7:25
Breaking down the clinical features of serum sickness 14:20
How confident are we that the compliment levels always drop? 16:26
How common is serum sickness? 19:45
The mechanistics of rituximab 21:36
A preview of parts two and three 27:37
Episode wrap-up 28:38

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Bayer G, et al. Eur J Intern Med. 2019;67:59-64.

Karmacharya P, et al. Semin Arthritis Rheum. 2015;35-334-340.

Lawley TJ, et al. J Invest Dermatol. 1985;85:129s-132s.

The Iron Fist, Part 2: Iron and Bone Jun 01, 2021

Why is hemochromatosis so common? What is iron actually doing to the joint? Does phlebotomy help? What’s going on with iron and Popeye? These are the questions we tackle in the second episode of hemochromatosis: Iron and Bone!

Brought to you by GSK.

Intro :19
Today’s episode :29
Why is hemochromatosis so common? 1:06
The history of Popeye the Sailor Man 3:37
Treatment with phlebotomy 8:35
Why doesn’t join pain improve? 12:03
What is Kashin-Beck disease? 14:18
Mouse studies from the 1970s 19:45
What about histology? 25:36
Episode wrap-up 28:34

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Adams PC, et al. Hepatology. 1997;25:162-166.

Adams PC, et al. N Engl J Med. 2005;352:1769-1778.

Brighton CT, et al. Arthritis Rheum. 1970;13:849-857.

Heiland GR, et al. Ann Rheum Dis. 2010;69:1214-1219.

Hiyeda, K. Jap Med Sci. 1939;4:91-106.

Powell LW, et al. Lancet. 2016;388:706-716.

Rametta R, et al. Int J Mol Sci. 2020;21:3505.

Sella EJ, Goodman AH. J Bone Joint Surg Am. 1973;55:1077-1081.

Sutton M. Internet Journal of Criminology. 2010;1-34.

The Iron Fist, Part 1: Hemochromatosis and the Rheumatologist May 13, 2021

In this episode, we dig into hemochromatosis to better understand what it is, how it affects the joints, available screening methods, as well as clues to presentation and physical exam findings.

Brought to you by GSK.

Intro :10
Today’s episode :26
What is hemochromatosis? 1:42
What does the iron do? 3:03
How much iron is in the body? 5:30
When do you suspect it? 7:46
What do we want to know about the joints? 9:33
About Ralph Schumacher Jr., MD, and his work 12:15
How have Schumacher’s observations held up? 14:42
What about radiographs … can they help? 16:09
What about hand OA and the gene mutation? 16:44
So, what about people with undiagnosed hemochromatosis? What do their hands look like? 18:09
What about chondrocalcinosis? 19:13
Tune in next time for part two 21:59
Episode wrap-up 22:25

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Bulaj ZJ, et al. N Engl J Med. 2000;343:1529-1535.

Carroll GJ, et al. Arthritis Care Res. 2012;64:9-14.

Hamilton EB, et al. Q J Med 1981;199:321–329.

Jordan JM. Curr Opin Rheumatol. 2004;16:62-66.

Rametta R, et al. Int J Mol Sci. 2020;21:3505.

Ross JM, et al. J Rheumatol. 2003;30:121-5.

Schumacher HR. Arthritis Rheum. 1964;7:41–50.

Timms AE, et al. Ann Rheum Dis. 2002;61:745–747.

Ulvik RJ. Tidsskr Nor Laegeforen. 2016;136:2017-2021.

VEXAS May 04, 2021

In this episode, I interview the NIH team who brought you VEXAS! Hear different points of view of this disease, how it was discovered, clinical presentations, as well as where this research could lead. Then, we wrap up with Dr. Kastner’s historical take on autoinflammatory disorders!

Intro :11
In this episode :12
Big thanks to Peter Grayson, MD, MSc 2:07
About our guests 2:30
The interview 5:10
How did VEXAS come about? 5:37
You had an idea of where to start looking? 6:58
What should rheumatologists know about ‘somatic mutation’? 12:31
Do you think this could be a clue to other conditions? 13:37
Can you tell us about some of the unique aspects that we see in these patients with MDS that make them atypical? 17:14
How’s the clinician going to see or note the vacuoles? 18:53
Do we have kind of a pathway for how the vacuoles are forming based on what we know about ubiquitization or is that unclear? 20:51
What’s going to raise the antenna that this isn’t “run of the mill x disease”? 23:33
How, in your experience, have patients responded to diagnoses being changed? 37:15
Where does everyone see the therapy going for this condition in the future? 41:15
Do we think that with this approach that this is going to “reshuffle the deck” of what we call certain diseases from multiple different specialties over the next decade? 44:02
Would you mind walking us through a little bit about FMF and how the different variants you saw led to further discoveries? 49:46
What was known about IL1 at the time? How did that knowledge of IL1 come along? 52:53
It’s such a true honor to have you all on 57:42

David Beck, MD, PhD, is a genetics fellow at the NIH. He can be reached at david.beck@nih.gov.

Marcella A. Ferrada, MD, is Lawrence Shulman scholar at NIAMS. She can be reached at ferradama@mail.nih.gov.

Peter Grayson, MD, MSc, is head of the Vasculitis Translational Research Program at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and associate director of the NIAMS fellowship program. He can be reached at peter.grayson@nih.gov.

Dan Kastner, MD, PhD, is an NIH distinguished investigator in the Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch; director in the Division of Intramural Research; and head of the Inflammatory Skin Disease Section at the National Human Genome Research Institute.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

Disclosures: Beck, Brown, Ferrada, Grayson and Kastner report no relevant financial disclosures.

Parvovirus B19: The Other 19 Apr 01, 2021

In this episode, we delve into Parvovirus B19: What does it do? How does it affect the joints? How was it discovered? Does it only infect young female schoolteachers? Find out!

Brought to you by Actemra

Intro :12
Shout out to Cleveland Clinic Biologic Therapies Summit 1:22
In this episode 2:11
An overview of the virus 3:46
What causes the aplastic crisis? 6:16
What does the virus do in humans? 11:46
A two-phase trial on young adults 14:29
A summary of studies 18:55
So, what happens to these patients? 22:59
How about a long-term study? 24:39
Summing up Parvovirus 19 26:42
The big takeaway from this episode 27:33
The next episode 28:06

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Anderson MJ, et al. J Infect Dis. 1985;152:257-265.

Chorba T, et al. J Infect Dis. 1986;154:383-393.

Moore TL. Curr Opin Rheumatol. 2000;12:289-294.

Mortimer PP. Nature. 1983;302:426-429.

Ogawa E, et al. J Infect Chemother. 2008;14:377-382.

Potter CG. J Clin Invest. 1987;79:1486-1492.

Reid DM, et al. Lancet. 1985;1:422-425.

Speyer I, et al. Clin Exp Rheumatol. 1998;16:576-578.

Takahashi Y, et al. Proc Natl Acad Sci USA. 1998;95:8227-8232.

White DG, et al. Lancet. 1985;1:419-421.

Young N, et al. J Clin Invest. 1984;74:2024-2032.

Young NS, Brown KE. N Engl J Med. 2004;350:586-597.

The Birth of a Disease: The Story of Psoriatic Arthritis Mar 11, 2021

This episode details how psoriatic arthritis and the spondyloarthropathies came to be recognized as a distinct clinical entity after decades of nerdy arguing.

Brought to you by Actemra.

Intro :10
Shout out to Cleveland Clinic Biologic Therapies Summit :30
In this episode 1:29
A 30,000-foot view 2:34
When did PsA separate from rheumatoid arthritis? 3:34
Mary Stults Sherman 7:11
Verna Wright and Dr. John Moll put PsA on the map 9:09
Recognizing PsA as a disease 15:20
An anecdote about Wright 16:18
Putting the SpA puzzle pieces together 18:19
The severity of disease 19:08
Episode wrap-up 20:46

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Ankylosing Spondylitis, Churchill Livingstone, Edinburgh, London, Melbourne, New York, 1980.

Espinoza LR, Helliwell P. Clinical Rheumatology. 2014;33:1335-1336.

Gladman DD, et al. Q J Med. 1987;62:127-141.

Kane D, et al. Rheumatology. 2003;42:1460-1468.

Moll JMH. Reumatismo. 2007;59 Suppl 1:13-18.

Moll JM, Wright V. Semin Arthritis Rheum. 1973;3:55-78.

Seronegative polyarthritis, North-Holland Pub. Co., New York, Amsterdam, 1976.

Sound effects obtained from https://www.zapsplat.com

Wright V. Am J Med. 1959;27:454-462.

Wright V. Ann Rheum Dis. 1956;15:348-356.

Wright V. BMJ. 1994;309:1739-1740.

ANCA Vasculitis and the Complement System, Part 2: On to the Humans Feb 23, 2021

The final episode summarizes the human data on complement in ANCA vasculitis, with a quick discussion of the trials of C5a receptor antagonism.

Brought to you by Actemra.

Intro :10
Welcome :21
Recap of previous episodes :22
In this episode 2:12
Let’s start with neutrophil data 5:24
Studies in humans 11:54
A summary of the data so far 21:20
What does all this amount to? 25:41
Trials of avacopan 28:25
Side effect profile 36:25
Thanks for listening 37:06

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Augusto JF, et al. PLoS One. 2016;https://doi.org/10.1371/journal.pone.0158871.

Bekker P, et al. PLoS One. 2016;https://doi.org/10.1371/journal.pone.0164646.

Chen SF, et al. Arthritis Res Ther. 2015;https://doi.org/10.1186/s13075-015-0656-8.

Falk RJ, et al. Proc Natl Acad Sci USA. 1990;87:4115-4119.

Gou SJ, et al. Clin J Am Soc Nephrol. 2013;8:1884-1891.

Gou SJ, et al. Kidney Int. 2013;83:129-137.

Jayne DRW, et al. J Am Soc Nephrol. 2017;28:2756-2767.

Jayne DRW, et al. N Engl J Med. 2021;384:599-609.

Merkel PA, et al. ACR Open Rheumatol. 2020;2:662-671.

Schreiber A, et al. J Am Soc Nephrol. 2009;20:289-298.

Xiao H, et al. Am J Pathol. 2007;170:52-64.

ANCA Vasculitis and the Complement System, Part 1: The Mouse’s Tale Feb 03, 2021

This episode walks us through the initial research that paved the way for a game changing therapeutic in ANCA vasculitis, as well as the story of how host Adam J. Brown, MD, finally learned how to spell complement.

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

Intro :10
Welcome :21
Today’s episode :24
So how did we get there? 4:18
How do we start teasing apart the effect of the complement in ANCA vasculitis? 8:13
Discussing and simplifying the mouse model 9:00
Quickly reviewing the complement cascade 12:06

Brought to you by GSK. Consider the long-term impact of disease activity flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com.

Taking the puzzle pieces away in the mouse model 17:04
What about the next steps? 22:05
What happens when you block C5a? 25:12
CCX168: Summing up the mouse tale 28:44
In the next episode 30:20
Thanks for listening 30:46

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Brilland B, et al. Autoimmun Rev. 2020;19:102424.

Freeley SJ, et al. J Pathol 2016;240:61-71.

Haas M, Eustace JA. Kidney Int 2004;65:2145-2152.

Huugen D, et al. Kidney Int 2007;71:646-654.

Marder SR, et al. Arg. J Immunol. 1985;134:3325-3331.

Schreiber A, et al. J Am Soc Nephrol. 2009;20:289-298.

Xiao H, et al. Am J Pathol. 2007;170:52-64.

Xiao H, et al. J Clin Invest 2002;110:955–963.

Xiao H, et al. J Am Soc Nephrol, 2014;25:225–231.

The Complement System for Dunces Jan 21, 2021

Here I break down the confusing system that is the ire of medical learners who aim to memorize it, only to forget it later. Join me on a medieval journey that will help you visualize this complex system in a way that will stay with you.

Brought to you by GSK. Consider the long-term impact of disease activity flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com.

Intro :10
Welcome :24
How do you explain the complement system? :44
What is the complement system? 1:39
How does it complement the adaptive immunity? 3:43
Two major aspects of the complement system 4:50
Formation of the membrane attack complex 5:21
Why is this pathway so confusing? 5:55
Why do I have to memorize all of this? 8:33
Let’s talk about the cascades themselves 11:15
Breaking down the three pathways 12:55

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

The alternative pathway – walking to the beat of its own drum 16:15
A medieval tale of the classic and lectin pathway 22:36
The tale of the alternative pathway 28:00
Summary 31:55
In the next episode 32:40

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Music: The Medieval Banquet by Shane Ivers - https://www.silvermansound.com

COVID-19 and the Rheumatologist: The Good, the Bad and the Ugly Jan 08, 2021

We end the year with Leonard Calabrese, DO, giving us a summary of what we’ve learned about COVID-19 from the perspective of a rheumatologist.

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

Intro :10
Calabrese introduction :24
In this episode :43
Nobody has complete control of the literature on COVID-19 1:39
What was ugly about COVID-19? 2:16
What was bad about COVID-19? 4:05
What good came from the COVID-19 pandemic? 7:07

Brought to you by GSK. Consider the long-term impact of disease activity flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com.

The good things continued 10:20
JAK inhibitors 11:30
The best outcomes: Vaccines 14:15
Pertinent questions for the rheumatology community 16:45
Recap 20:12
Conclusion 21:41

Disclosures: Calabrese reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

Infectious Endocarditis for the Rheumatologist, Part 3: The Immune System Behaving Badly Dec 18, 2020

The completion of the Endocarditis for the Rheumatologist trilogy! This episode focuses on the glomerulonephritis of endocarditis as well as the immunologic abnormalities you can see on labs.

Brought to you by GSK. Consider the long-term impact of disease activity flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com.

Intro :11
In this episode :22
Recap of previous episodes :39
About episode three 1:00
How labs can give a clue to endocarditis being a culprit 1:23
The immune complex nature of infective endocarditis 6:30
How do you measure immune complex? 9:10
What are the effects of immune complex formation on the organ systems? 12:37

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

Cryoglobulins and rheumatoid factor in infective endocarditis 15:12
The kidneys and infective endocarditis 16:45
Glomerulonephritis and infective endocarditis 24:15
ANCA-positive vasculitis and infective endocarditis 29:09
A summary of infective endocarditis 32:21
Takeaways 33:28
A preview of next episode 33:48
Conclusion 34:12

Disclosure: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Bayer AS, et al. N Engl J Med. 1976;295:1500-1505.

Boils CL, et al. Kidney Int. 2015;87:1241-1249.

Forte WC, et al. Arq Bras Cardiol. 2001;76:43-52.

Hurwitz D, et al. Clin Exp Immunol. 1975;19:131-141.

Langlois V, et al. Medicine (Baltimore). 2016;95:e2564.

Levy RL, Hong R. Am J Med. 1973;54:645-652.

Ma T-T, et al. PLoS One. 2014;9: https://doi.org/10.1371/journal.pone.0097843.

Messias-Reason IL, et al. Clin Exp Immunol. 2002;127:310-315.

Petersdorf RG. N Engl J Med. 1976;295:1534-1535.

Spain DM, King DW. Ann Intern Med. 1952;36:1086-1089.

Williams Jr RC, Kunkel HG. J Clin Invest. 1962;41:666-675.

Tire squealing sound effect by Mike Koenig.

Endocarditis for the Rheumatologist, Part 2: What You Might See in the Clinic Dec 09, 2020

This episode focuses on the clinical aspects of endocarditis you can catch in the exam room, emphasizing the joint and skin manifestations, along with some interesting historical insights on Osler nodes and Janeway lesions.

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

Intro :11
In this episode :22
About episode two 2:28
Rheumatologic manifestations of infectious endocarditis 4:28
Musculoskeletal manifestations of infectious endocarditis in the back 5:55
The lack of patterns for infectious endocarditis causing joint pain 9:48
Myalgias and the connection with endocarditis 12:48
The skin and its connection with endocarditis 15:37
What are Janeway lesions 17:13
What are Osler nodes? 19:28

Brought to you by GSK. Consider the long-term impact of disease activity flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com.

What causes these lesions? 21:24
Differentiating Osler’s nodes and Janeway lesions 25:20
What are splinter hemorrhages? 28:08
Petechiae and its association to infective endocarditis 31:43
What about leukocytic vasculitis? 33:17
Other puzzle pieces to look for 37:18
A preview of next episode 40:30
Conclusion 42:12

Disclosure: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Chahoud J, et al. Cardiol Rev. 2016;24:230-7.

Farrior JB, Silverman ME. Chest. 1976;70:239-43.

Godeau P, et al. Rev Med Interne. 1981;2:29-32.

Gunson TH, Oliver GF. Australas J Dermatol. 2007;48:251-5.

Heffner JE. West J Med. 1979;131:85-91.

Loricera J, et al. Clin Exp Rheumatol. 2015;33:36-43.

Koslow M, et al. Am J Med. 2014;S0002-9343(14)00188-0.

Murillo O, et al. Infection. 2018;46.

Meyers OL, Commerford PJ. Ann of the Rheum Dis. 1977;36:517-519.

Parikh SK, et al. J Am Acad Dermatol. 1996;35:767-8.

Young J. et al. J R Coll Physicians Lond. 1988;22:240-3.

Endocarditis for the Rheumatologist, Part 1: A Bit of Background Nov 20, 2020

Infectious endocarditis can present with rheumatic features in 15% to 25% of cases. This series focuses on what a rheumatologist should know about the clinical puzzle of endocarditis.

Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com

Intro :11
In this episode :22
About episode one 2:33
How did people diagnose infectious endocarditis back in the day? 5:15
What is a Gulstonian Lecture? 6:25
So, who was Dr. Emanuel Libman? 13:33

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

How Gustav Mahler’s endocarditis diagnosis was made 19:15
The evolution of diagnosing endocarditis 20:45
The story of Alfred S. Reinhart and his self-diagnosis of endocarditis 21:45
Clinical signs and symptoms of endocarditis and how they hold up today 28:00
Recap and a preview of next episode 33:20
Conclusion 35:15

Disclosure: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Flegel KM. CMAJ. 2002;167:1379-1383.

Harrison's Principles of Internal Medicine, Nineteenth edition, McGraw-Hill Education, New York, 2015.

Levy D. Br Med J (Clin Res Ed). 1986;293:1628-1631.

Libman E, Celler HL. Am J Med Sci. 1910;140.

Osler W. Br Med J. 1885;1:467-470.

Parsons WB Jr, et al. J Am Med Assoc. 1953;153:14-16.

Pelletier LL Jr, Petersdorf RG. Medicine (Baltimore). 1977;56:287-313.

Ramin S. Hektoen International. 2013;5.

Inflammatory Bowel Disease for the Rheumatologist Nov 03, 2020

How common is asymptomatic bowel involvement in patients with peripheral or axial SpA? Can we use NSAIDs in these patients? What’s the difference between sulfasalazine and mesalamine? Listen to hear what a rheumatologist should know about IBD!

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

Intro :11
In this episode :20
Let’s start with some basics of IBD 4:11
If a patient has axSpA, what are the chances they’ll develop IBD? 5:14
What about silent disease? 7:32
When should we send our SpA patients to a GI specialist? 11:22
Two medications: budesonide and mesalamine 13:33

Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com

This category of drugs – 5-ASA 16:26
NSAIDs 20:02
A look at COX inhibitors 23:06
Selective inhibition with COX-2 seems to be an attractive option for IBD 28:47
Conclusion 29:10

Disclosure: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Altomonte L, et al. Clin Rheumatol. 1994;13:565-570.

Dougados M, et al. Joint Bone Spine. 2011;78:598-603.

de Winter JJ, et al. Arthritis Res Ther. 2016;18:196.

El Miedany Y, et al. Am J Gastroenterol. 2006;101:311-317.

Long MD, et al. J Clin Gastroenterol. 2016;50:152-160.

Mayberry J. J Gastrointestin Liver Dis. 2013;22:375-377.

Miao X-P, et al. Curr Ther Res Clin Exp. 2008;69:181-191.

Mielants H, et al. J Rheumatol. 1995;22:2273-2278.

Morris AJ, et al. Lancet. 1991;doi: https://doi.org/10.1016/0140-6736(91)91300-J.

Redfern JS, Feldman M. Gastroenterology. 1989;96:596-605.

Sandborn WJ, et al. Clin Gastroenterol Hepatol. 2006;4:203-211.

Stolwijk C, et al. Ann Rheum Dis. 2015;74:65-73.

Svartz N. Acta Medica Scandinavica. 1942;doi: https://doi.org/10.1111/j.0954-6820.1942.tb06841.x.

Takeuchi K, et al. Clin Gastroenterol Hepatol. 2006;4:196-202.

Tanaka K, et al. Eur J Pharmacol. 2008;603:120-132.

Van Praet L, et al. Ann Rheum Dis. 2013;72:414-417.

Part 4, The Story of the Antibody: Two Arms and a Stick Oct 15, 2020

The last episode in the series highlighting how the structure of the antibody was discovered, as well as how a chicken butt was critical in understanding B cell biology.

Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com

Intro :11
In this episode :15
Recap: What we know about the antibody so far 1:12
Discovering the structure of the antibody 3:34
What else can we learn about the light chain 7:04
An understanding of what these proteins were 9:49

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

A story about a chicken butt 11:40
Backtracking to 1898 – where do antibodies come from? 16:49
An important paper in 1945 argues the lymphocyte is the antibody maker 18:59
Where is the bursa of Fabricius in humans? 20:46
A study from Australia 21:48
The bone marrow is what did it 23:00
Thanks for listening! 24:48

Disclosures: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Black CA. Immunol Cell Biol. 1997;doi: 10.1038/icb.1997.10.

Coons AH, et al. J Exp Med. 1955;102:49-60.

Cooper MD. Nat Rev Immunol. 2015;191-197.

Edelman GM. J Am Chem Soc. 1959;81:3155-3156.

Ehrich WE, Harris TN. Science. 1945;101:28-31.

Fagraeus A. J Immunol. 1948;58:1-13.

Glick B, et al. Poultry Sci. 1956;35:224-225.

Osmond DG, Nossal GJ. Cell Immunol. 1974;13:132-145.

Porter RR. Biochem J. 1959;73:119-126.

Ryser JE, Vassalli P. J Immunol. 1974;113:719-728.

Part 3: The History of IV Immunoglobulin Oct 02, 2020

Learn about the discovery of immunodeficiencies leading to the use of pooled immunoglobulin as therapy, the struggle to use it intravenously and the eventual use in autoimmune disease.

Intro :11
In this episode :15
Splitting Part 3 into two episodes :26
Part A of the history of IV Ig and the antibody :53
A recap on Cohn fractionation 2:40
The history and uses of IV Ig 4:30
What led to the recognition and research of primary immunodeficiencies 7:08
How Charles Janeway Sr. paved the way for IV Ig from intramuscular Ig 9:01
What are protein aggregates? 12:54
Understanding the various mechanisms of Ig reactions 15:49
Managing patients with low IgA and anti-IgA antibodies 18:36
How to go from treating immunodeficiency to treating autoimmunity 21:40
The modern understanding and mystery of IV Ig 25:30
Quick summary 26:05
Thanks for listening! 27:30

Disclosure: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Barandun S, et al. Vox Sang. 1962;7:157-174.

Eibl MM. Immunol Allergy Clin North Am. 2008;28:737-764, viii.

Furusho K, et al. Lancet. 1983;2:1359.

Gallagher PE, Buckley RH. J Allergy Clin Immunol. 1982;69:120.

Guo Y, et al. Front Immunol. 2018;9:1299.

Imbach P, et al. Lancet. 1981;1:1228-31.

Intravenous Immunoglobulin: Prevention and Treatment of Disease. NIH Consens Statement Online. 1990;8:1-23.

Kustiawan I. PLoS ONE. 2018;13: e0195729. https://doi.org/10.1371/journal.pone.0195729.

MRC Working Party on Hypogammaglobulinaemia. Hypogammaglobulinaemia in the United Kingdom. London: Her Majesty’s Stationery Office; 1971.

Oransky I. Lancet. 2003;362:409.

Sandler SG, et al. Transfus Med Rev. 1995;9:1-8.

Part 2: The History of Convalescent Serum and the Story of the Antibody Aug 18, 2020

Part 2 of this series explores how we began to measure antibody levels and how serotherapy evolved and was used to investigate multiple diseases (I’m looking at you, pneumonia). We’ll also learn how advances in laboratory techniques like electrophoresis paved the way for a better understanding of the antibody.

Intro :11
In this episode :15
Recap of Part 1 :22
In this episode :53
The mechanism of action was theoretical 2:30
The story of convalescent serum 6:22
Pneumonia: “The captain of the men of death” 6:58
How culturing was done then 10:56
A big break: Isolating the antibody 14:26
A 30,000-foot look at pneumonia 17:13
Type 1 pneumonia trials 20:20
1918 influenza pandemic 23:31
Measles 27:59
The story of the antibody 30:30
More fun naming conventions 35:25
Cone fractionation 38:35
Quick summary 42:20
Thanks for listening! 44:27

Disclosure: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Black CA. Immunol Cell Biol. 1997;doi: 10.1038/icb.1997.10.

Bullowa JGM. JAMA. 1928;90:1354-1358.

Cecil RL, Sutliff WD. JAMA. 1928;91:2035-2042.

Felton LD. Boston Med Surg J. 1924;190:819-825.

Hooper JA. LymphoSign Journal. 2015;2 181-194.

Luke TC, et al. Ann Intern Med. 2006;145:599-609.

McGuire LW, Redden WR. Am J Public Health. 1918. 741-744.

McKhann CF, Chu FT. Am J Dis Child. 1933;45:475-479.

Podolsky SH. Am J Public Health. 2005;95:2144-2154.

Podolsky SH. J R Soc Med. 2009;102:203-207.

Tiselius A, Kabat EA. J Exp Med. 1939;69:119-131.

The History of Convalescent Serum and the Story of the Antibody, Part 1 Jul 15, 2020

COVID-19 has brought up the use of the old remedy convalescent serum. What is it? Did it work? This series walks us through the history of the serum, how it was discovered, how it was first used, and how it inspired the field of immunology.

Intro :11
In this episode :15
A quick tale :20
Outline of these three episodes 2:51
Quick definitions 3:50
How it all began 7:16
A solo paper on diphtheria 12:57
A trial of children 17:07
Giving fluids from a horse 21:57
What happened with tetanus? 25:12
Switching gears to our understanding of antibodies 27:09
The next target: snakes 29:17
The plague 32:00
Summary of Part 1, what’s next 39:05

Disclosure: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Butler T. Clin Microbiol Infect. 2014;20:202-209.

Crum FS. Am J Public Health. 1917;7:445.

Eibl MM. Immunol Allergy Clin North Am. 2008;28:737-764, viii.

Graham BS, Abrosino DM. Curr Opin HIV AIDS. 2015;10:129-134.

Grundbacher FJ. Immunol Today. 1992;13:188-190.

Hawgood BJ. Toxicon. 1999;37:1241-1258.

Kantha SS. Keio J Med. 1991;40:35-39.

Kaufmann SHE. mBio. 2017;8:e00117-17.

Klass, Perri. “An Apocryphal Christmas Miracle.” The New York Times, The New York Times, 23 Dec. 2019, www.nytimes.com/2019/12/23/well/family/diphtheria-antitoxin-Christmas-miracle.html.

Lindenmann J. Scand J Immunol. 1984;19:281-285.

Meyer KF, et al. Ann N Y Acad Sci. 1952;55:1228-1274.

Ramon G. Bull Soc Centr Med Vet. 1925;101:227-234.

von Behring, Emil. Geschichte der Diphtherie (mit besonderer Berücksichtigung der Immunitätslehre). Leipzig, Germany, Thieme, 1893.

von Behring E. Ueber das Zustandekommen der Diphtherie-Immunität und der Tetanus-Immunität bei Thieren. German Medical Weekly; 1890.

Glucocorticoids in the Setting of Active Infection Jun 22, 2020

With COVID-19 and the question of whether glucocorticoids could be beneficial, this episode digs into the data on the use of glucocorticoids in the setting of infections, from pneumonia and septic arthritis, to meningitis and septic shock.

Intro :11
In this episode :25
The first published case series of patients with serious infection 6:45
Otolaryngologic infections 7:43
Pneumonia, malaria and flu 8:26
Cortisone in strep throat 9:22
Major severe infections 11:26
A review article 12:12
Specific organ systems 13:25
Dexamethasone for bacterial meningitis 25:28
Septic shock 26:19
Dearth of data on glucocorticoids for influenza 32:10
Summary and take-home 35:19

Disclosure: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Annane D, et al. JAMA. 2002;288:862-871.

Annane D, et al. N Engl J Med. 2018;378:809-818.

Bennett IL, et al. JAMA. 1963;183:462-465.

Blum CA, et al. Lancet. 2015;385:1511-1518.

de Gans J, van de Beek D. N Engl J Med. 2002;347:1549-1556.

Dellinger RP, et al. Crit Care Med. 2013;41:580-637.

Fogel I, et al. Pediatrics. 2015;136:e776.

Hahn EO, et al. J Clin Invest. 1951;30:274-281.

Hartman FA, Merle Scott WJ. Proc Soc Exp Biol and Med. 1931;28:478-479.

Hinshaw LB, et al. J Surg Res. 1980;28:151-170.

Nedel WL, et al. World J Crit Care Med. 2016;5:89-95.

Odio CM, et al. Pediatr Infect Dis J. 2003;22:883-888.

Perla D, Marmorston J. Endocrinology. 1940;27:368-374.

Stern A, et al. Cochrane Database Syst Rev. 2017;12:doi:10.1002/14651858.CD007720.pub3

Venkatesh B, et al. N Engl J Med. 2018;378:797-808.

Wenner WF, Cone AJ. Arch Otolaryngol. 1934;20:178-187.

Whitehead KW, Smith C. Proc Soc Expert Biol and Med. 1932;29:672-673.

Wysenbeek AJ, et al. Ann Rheum Dis. 1998;57:687–690.

Zhou Y, et al. Sci Rep. 2020;10:https://doi.org/10.1038/s41598-020-59732-7.

The History of Whipple's Disease Jun 09, 2020

This episode delves into the history of Whipple’s disease — from its initial description, to the lengthy process of proving it’s an infectious disease.

Intro :11
In this episode :12
The initial case report 1:35
How I fit into the history of Whipple’s 4:46
Back to the case report 6:56
Bodies in the intestines 10:12
More about George Hoyt Whipple 10:50
Whipple may not have been the first to identify this condition 14:19
First treatment with antibiotics 15:55
Personality change after antibiotics 19:12
Whipple’s disease intestines have positive staining 20:20
Using the electron microscope in Whipple’s disease 21:18
Summary and take-home 25:19

Disclosure: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Bayless, TM. Adv intern Med. 1970;16:171-189.

Black-Schaffer B. Proc Soc Exp Biol Med. 1949;72:225-227.

Fenollar F, et al. N Engl J Med. 2007;356:55‐66.

Hendrix JP, et al. Arch Intern Med (Chic).1950;85:91-131.

Morgan AD. Gut. 1961;2:370-372.

Paulley JW. Gastroenterology. 1952;22:128-133.

Raoult D, et al. N Engl J Med. 2000;342:620-625.

Relman DA, et al. N Engl J Med. 1992;327:293-301.

Whipple GH. Bull Johns Hopkins Hosp. 1907;18:382-391.

Whipple’s Disease: When Should a Rheumatologist Take a Whiff of Whipple’s? May 20, 2020

This episode dives into the rare Whipple’s disease, focusing on the articular manifestations of this infectious masquerader and when a rheumatologist should consider it in the differential.

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

Intro :20
In this episode :28
Background on the organism 5:25
An important point when making the diagnosis 7:48
Who gets infected? 8:55
What is Whipple’s disease? 11:48
This disease is fatal 15:53
A look at the joints 16:28
What happens when you give these patients immunosuppression? 26:36
How to diagnose 28:38
Summary so far 31:00

Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com

Other organ manifestations of Whipple’s disease 32:08
Summary and take-home 44:36

Disclosure: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Bousbia S, et al. Emerg Infect Dis. 2010;16:258-63.

Chan RY, et al. Ophthalmology. 2001;108:2225-2231.

Dobbins 3rd WO, et al. Arthritis Rheum. 1987;30:102-105.

Durand DV, et al. Medicine (Baltimore). 1997;76:170-84.

Fenollar F, et al. BMC Infect Dis. 2011;11:171.

Feurle GE, et al. Eur J Clin Invest. 1979;9:385-389.

Geissdörfer W, et al. J Clin Microbiol. 2012;50:216-22.

Guérin A, et al. Elife. 2018;7:e32340.

Heffner DK. Lancet. 2007;370:738-9; author reply 739.

Keita AK, et al. PLoS Negl Trop Dis. 2011;5:e1403.

Lagier JC, et al. Medicine (Baltimore). 2010;89:337-345.

Lozupone C, et al. Am J Respir Crit Care Med. 2013;187:1110-7.

McAllister Jr. HA, Fenoglio Jr. JJ. Circulation. 1975;52:152-6.

O’Duffy JD, et al. Arthritis Rheum. 1999;42:812-817.

Puéchal X. Joint Bone Spine. 2016;83:631-635.

Puéchal X, et al. Arthritis Rheum. 2002;46:1130-1132.

Puéchal X, et al. Arthritis Rheum. 2007;56:1713-1718.

Raheja AA, et al. Clin Imaging. 2010;34:143-147.

Ramos JM, et al. J Med Case Rep. 2015;9:165.

Raoult D, et al. Emerg Infect Dis. 2010;16:776-82.

Schöniger-Hekele M, et al. Appl Environ Microbiol. 2007;73:2033-2035.

Stein A, et al. Am J Respir Crit Care Med. 2013;188:1036-7.

Additional resource:

Neurosigns.org’s video on oculomasticatory myorhythmia can be viewed at: https://www.youtube.com/watch?v=Zwb5bt749Jo

The History of Cryoglobulinemic Vasculitis: Dry Humors, Part 3 Apr 23, 2020

This episode explores the history of cryoglobulinemic vasculitis, from the first person who froze a tube of blood and noticed something strange happened, to the discovery of hepatitis C. We also throw in how the lab test for cryoglobulins is performed and some of the data we have on therapy.

Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com

Intro :20
In this episode :45
How is this test done? 1:30
What is the first description of cryoglobulins? 4:15
The first time “cryoglobulins” is used 10:26
Hepatitis C is discovered and linked to cryoglobulinemia 16:28
What do we know about the pathophysiology? 19:38
Why does HCV do this? 22:12

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

What’s in the blood as a result of immune complex? 24:52
What do we know about autoimmune diseases and the prevalence of cryoglobulins? 26:03
What about treatment? 28:25
Summary of this three-part series 36:16

Disclosure: Brown reports no relevant financial disclosures.

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Brouet JC, et al. Am J Med. 1974;57:775-788.

Cacoub P, et al. Clin Gastroenterol Hepatol. 2019;17:518-526.

De Vita S, et al. Arthritis Rheum. 2012;64:843-853.

Fuentes A, et al. Curr Rheumatol Rep. 2019;21:doi:10.1007/s11926-019-0859-0.

Lerner AB, Watson CJ. Am J Med Sci. 1947;214:410-415.

Lospalluto J, et al. Am J Med. 1962;32:142-147.

Meltzer M, Franklin EC. Am J Med. 1966;40:828-836.

Pascual M, et al. J Infect Dis. 1990;162:569-570.

Ragab G, Hussein MA. J Adv Res. 2017;8:99-111.

Tzioufas AG, et al. Arthritis Rheum. 1986;29:1098-1104.

Wintrobe MM, Buell, MV. Bull. Johns Hopkins Hosp. 1933;52:156-165.

Dry Humors, Part 2 Apr 08, 2020

In Part 2, I sit down with nephrologist Ali Mehdi, MD, and neurologist Ghulam Abbas Kharal, MD, MPH, to discuss their different specialty perspectives on working up patients with suspected cryoglobulinemic vasculitis.

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

Intro :20
Introduction of Ali Mehdi, MD :45
Interview with Dr. Mehdi 2:02

Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com

Introduction of Ghulam Abbas Kharal, MD, MPH 25:01
Interview with Dr. Kharal 26:37
To hear more of my interview with Abbas, keep listening 44:47
Thank you, Dr. Kharal 53:07

Ghulam Abbas Kharal, MD, MPH, is a Partners Neurology Resident at Massachusetts General Hospital, Brigham & Women's Hospital, Harvard School of Medicine.

Ghulam Abbas Kharal, MD, MPH, is a staff neurologist at Cleveland Clinic. Kharal did his training in a combined program at Massachusetts General Hospital and Brigham & Women's Hospital, Harvard School of Medicine.

Ali Mehdi, MD, is a Nephrology Fellow at the Cleveland Clinic. Mehdi did his Internal medicine residency and chief year at the Cleveland Clinic.

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

Dry Humors, Part 1 Mar 27, 2020

Try your hand at this medical mystery, which is followed by some didactics on a fascinating disease which will hopefully make sense of this inscrutable title.

Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com

Intro :22
What to expect in each episode :30
The case: A 75-year-old man with Sjogren’s and MALT lymphoma presents with recurrent cerebral infarcts of multiple territories 1:10
- Rheumatology is consulted 6:11
- Decreased sensation in toes occurs between strokes 7:14
- What’s going on with this patient? 8:36
- What additional labs can we perform? 9:36
- We spin the urine 11:10
- What kind of vasculitis are Sjogren’s and lymphoma associated with? 12:22
- C3 and C4 had already been performed 13:00
- An overall picture of this patient 13:54
- What about the strokes? 14:19
- Should we do more imaging? 15:57
- At this point we can make a clinical decision 16:33
- Why make a decision so quickly vs. waiting for biopsy? 18:18
- Two things you must check before moving forward with a cryoglobulinemic vasculitis 19:46
- Spoiler alert: The patient is doing really well 20:16

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

What is cryoglobulinemic vasculitis? 21:00
What are these immunoglobulins? There are three types of cryoglobulins 22:55
Usually driven by another identifiable disease 25:18
What is making these immunoglobulins? 26:49
We don’t know why these immunoglobulins behave this way 27:18
How do you explain the kidneys? 28:28
What’s occurring at the tissue level? 29:35
How does type 1 present? 30:50
Type 2 and type 3 31:12
What other organ systems are involved? 33:11
I hope you enjoyed this patient presentation 36:00
What we’ll discuss in episodes 2 and 3 36:05
Thanks for listening 38:03

**Coming soon from Healio, Unmasking COVID-19, a podcast hosted by Gitanjali Pai, MD, infectious disease physician at Memorial Hospital and Physicians’ Clinic in Stilwell, Oklahoma. In this timely new show, Dr. Pai will explore COVID-19’s impact on vulnerable patient populations by answering questions from experts in various medical fields, including oncology, endocrinology and rheumatology. To submit your question for Dr. Pai, email covid19podcast@healio.com.**

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum @LCalabreseDO @CCalabreseDO

Disclosure: Brown reports no relevant financial disclosures.

References:

Fuentes A, et al. Current Rheumatology Reports. 2019;21:60.

Silva F, et al. J Autoimmun. 2019;105:102313.

The Rheumatologist, Cancer and the Breakthrough, Part 2 Mar 11, 2020

In this episode, Leonard H. Calabrese, DO, is joined by his colleague and daughter Cassandra Calabrese, DO, as they discuss specifics of irAEs, including unusual toxicities, rheumatic conditions associated with checkpoint inhibitors and the rheumatologist’s role in this new area of medicine.

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

Intro :22
Recap of Part 1 :40
An interview with Cassandra Calabrese, DO 2:02
- The number of patients with irAEs will grow 2:22
- How many people actually experience irAEs? 3:40
- Any examples of unusual toxicities? 5:49
- What’s the timeline? 6:51
- Have you seen patients with delayed onset? 8:10
- Most of our patients have had one irAE or another beforehand 9:04
- Who’s the captain of this ship? 10:15
- What about inflammatory arthritis? 10:55
- What about polymyalgia rheumatica? 13:48

Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com

What about sicca, is it Sjogren’s? 16:22
Can you tell us about myositis in this context? 18:38
An overview of the guidelines 21:47
Check out our article in March Current Opinions in Rheumatology 24:12
What about patients with preexisting autoimmunity? 24:33
Are you worried about blunting tumor response? 27:10
Are there any biomarkers to predict this? 28:30
How have you been working with oncologists to manage/educate? 29:42
What about meetings? 31:04
Rheumatologists have a special place in this new area of medicine 31:45

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum @LCalabreseDO @CCalabreseDO

Disclosure: Brown and Cassandra Calabrese report no relevant financial disclosures. Leonard Calabrese reports serving as an investigator and a consultant to Horizon Pharmaceuticals.

Cassandra Calabrese, DO, is associate staff member in the department of rheumatic and immunologic disease and department of infectious disease at the Cleveland Clinic. Leonard H. Calabrese, DO, is chief medical editor of Healio Rheumatology and director of the RJ Fasenmyer Center for Clinical Immunology at the Cleveland Clinic.

The Rheumatologist, Cancer and the Breakthrough Feb 20, 2020

Checkpoint inhibitors have changed the field of oncology, as well as our understanding of autoimmunity. This episode, hosted by Leonard H. Calabrese, DO, walks us through the history of checkpoint inhibitors — from Dr. William Coley’s use of infections in cancer to the development of PD-1 inhibitors.

Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com

Intro :20
In this episode with Dr. Calabrese 3:07
- Book recommendations 4:28
- Harnessing the power of the immune system to fight cancer 5:33
- William Coley and a patient 6:30
- The search for Fred Stein 11:40
- Coley designs an experiment 13:09
- A different strain of streptococcus 16:16
- The beginning of cancer therapy and immunotherapy 19:18
- Where do we go from there? 20:49

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

What about tumor immunology? 21:55
The breakthrough 24:01
What do immunology and checkpoints have to do with it? 26:47
What happens when the danger signal cannot be dispatched? 34:02
Why do we, as rheumatologists, care about this? 36:04
CHAI and LATTE 38:49
Check out some papers on immunopathogenesis of irAEs 40:56
Checkpoint inhibitors for autoimmune diseases; RA and GCA 41:41
Come back for part 2 43:00

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum @LCalabreseDO

Disclosures: Brown reports no relevant financial disclosures. Calabrese reports serving as an investigator and a consultant to Horizon Pharmaceuticals.

Leonard H. Calabrese, DO, is chief medical editor of Healio Rheumatology and director of the RJ Fasenmyer Center for Clinical Immunology at the Cleveland Clinic.

Rock 'n' Rheum: An Interview with Peter Grayson, MD Jan 27, 2020

Join Peter Grayson, MD, MSc, and I as we discuss a range of topics, including imaging in large-vessel vasculitis, doctors going into research, Twitter, rock ‘n’ roll and Disney World.

Intro :10
A bit about Peter Grayson :55
Come see me in Phoenix in February 3:35
The interview 4:07
- How did you make it to the NIH? 4:27
- Why do you think MDs aren’t going into research these days 6:45
- Social media and major meetings 9:43
- Tell us about the NIH rock ‘n’ roll band 11:10
- What imaging modalities are most used for large-vessel vasculitis? 13:32
- What is PET scan? 14:23
  - Do you think PET scanning is the best imaging modality? 15:29
  - What are the limitations to PET? 17:48
  - Does vessel size affect PET scanning? 20:01
  - Are these machines available in most hospitals? 21:12
  - Grayson’s secret sauce 22:27
  - How do glucocorticoids affect imaging? 23:19
  - Are you ever using PET as follow-up? 25:07
- Do you have hope for any specific targets for Takayasu’s arteritis? 27:12
  - What drives the surgical intervention process for these patients? 28:23
  - Collateral artery formation 30:30
- Where do you think Takayasu’s will be in 10 years? 31:35
Thank you, Dr. Grayson 33:36

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

Disclosures: Brown and Grayson report no relevant financial disclosures.

Peter Grayson, MD, MSc, is head of the Vasculitis Translational Research Program at National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), and associate director of the NIAMS Fellowship Program, Systemic Autoimmunity Branch.

An Interview of Excitatory Motor Unit Action Potentials Dec 18, 2019

This interview with Chester V. Oddis, MD, will have you standing from a seated position without the need to use your arms as we discuss the inflammatory myopathies. We cover the classification, pathophysiology and treatment approaches to these diseases, as well as all the antibodies you must learn about for boards!

Intro :20
The interview 1:05
- How did you become involved in inflammatory myopathies? 1:12
- What’s your approach to a patient with suspected inflammatory myopathy? 1:50
- What’s your opinion on the pathogenesis of these antibodies? 6:20
- Any pearls for muscle biopsy? 9:30

Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com

Any pearls for reading EMGs? 12:20
What should we look for once we have a biopsy? 14:16
What do we know from a cytokine perspective? 17:52
Where do you think we’ll be with inflammatory myopathies in 10 years? 21:50

Thank you, Dr. Oddis 24:12

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

Disclosures: Brown reports no relevant financial disclosures. Oddis reports receiving clinical trial support from Corbus Pharmaceuticals and Genentech.

Chester V. Oddis, MD, is professor of medicine and director of the Myositis Center in the division of rheumatology and clinical immunology at University of Pittsburgh Department of Medicine.

all CAPS: A Story of Ice and Fire - Part 2 Nov 27, 2019

Things get a little nerdy in this episode, which focuses on the basic science of what makes the inflammasome tick in CAPS, as well as data on the use of interleukin 1 inhibition. Hint: Listen to “The Inflammasome for Dunces” episode first, and this one will make more sense.

Intro :20
Recap of Part 1 :33
Overview of this episode 1:56
Familial cold autoinflammatory syndrome 3:04
Muckle-Wells syndrome 6:34
The two checkpoint problem 8:36
What do we know about the inhibition of the inflammasome? 11:13
Back to the trebuchet analogy 11:48

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com

A paper on CARD8 in the setting of CAPS 13:50
Let’s talk about prostaglandins 15:27
There are over 100 mutations in CAPS 18:15
Let’s talk about treatment 18:42
One caveat 25:41
That’s CAPS 26:45
Reach out to me via email and on Twitter 27:03
Episode recap 27:41

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com.

Disclosure: Brown reports no relevant financial disclosures.

References:

Agostini L, et al. Immunity. 2004;20:319-325.

Brogan PA, et al. Arthritis Rheum. 2019;71:1955-1963.

Marsaud C, et al. J Rheumatol. 2014;41:1721-1722.

Hawkins PN, et al. NEJM. 2003;348:2583-2584.

Hoffman HM, et al. Lancet. 2004;364:1779-1785.

Hoffman HM, et al. Clin Ther. 2012;34:2091-2103.

Ito S, et al. Arthritis Res Ther. 2014;16:doi:10.1186/ar4483.

Kuemmerle-Deschner JB, et al. Ann Rheum Dis. 2011;70:2095-2102.

Lachmann HJ, et al. NEJM. 2009;360:2416-2425.

Mamoudjy N, et al. Orphanet J Rare Dis. 2017;12:doi:10.1186/s13023-017-0589-1.

Rosengren S, et al. J Allergy Clin Immunol. 2007;119:991-996.

Ross JB, et al. J Cutan Med Surg. 2008;12:8-16.

Tassi S, et al. Proc Natl Acad Sci USA. 2010;107:9789-9794.

Thornton BD, et al. Am J Kidney Dis. 2007;49:477-481.

all CAPS: A Story of Ice and Fire - Part 1 Nov 07, 2019

This first episode delves into the clinical aspects of the Cryopyrin-Associated Periodic Syndromes and includes some helpful tips for sorting out some of the autoinflammatory diseases in the spectrum.

Intro :10
Cryopyrin-Associated Periodic Syndromes (CAPS) :25
Outline of Part 1 2:25
What is CAPS? 3:12
Case #1 – a 25-year-old female with urticaria after cold exposure 4:25
Case #2 – a 55-year-old female with progressive deafness 5:45
The index case of familial cold autoinflammatory syndrome 9:00
The final disease in the spectrum 11:00
A lot of names for the same disease 13:50
Genetics prove these three diseases are in the same spectrum 14:22
Over 100 mutations have been found to-date 16:31
Let’s talk about mosaicism 17:03
Disease characteristics of CAPS 18:15
- Neutrophilic infiltrate in chronic urticaria vs. CAPS 20:00
- Schnitzler syndrome 20:45
- Sensorineural hearing loss 21:58
- Joint pain 24:10
Complication: Amyloidosis 25:29
These diseases were very debilitating 28:38
Episode recap 29:46
Part 2 sneak peek 30:38
Come say hi at ACR! 30:51

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Ahmadi N, et al. Otolaryngol Head Neck Surg. 2011;145:295-302.

Aksentijevich I, et al. Arthritis Rheum. 2002;46:3340-3348.

Alecu M, et al. Romanian Journal of Morphology and Embryology = Revue Roumaine de Morphologie et Embryologie. 2015;56:7-14.

Hassink SG, Goldsmith DP. Arthritis Rheum. 1983;26:668–673.

Hoffman HM, et al. Nat Genet. 2001;29:301-305.

Hoffman HM, et al. J Allergy Clin Immunol. 2001;108:615-620.

Kile RM, Rusk HA. JAMA. 1940;114:1067-1068.

Levy R, et al. Ann Rheum Dis. 2015;74:2043-2049.

Marzano AV, et al. Clin Exp Rheumatol. 2018;36 Suppl 110:32-38.

Muckle TJ, Wells M. Q J Med. 1962;31:235-248.

Prieur AM, Griscelli C. Rev Rhum Mal Osteoartic. 1980;47:645–649.

Tran TA. Open Access Rheumatol. 2017;9:123-129.

The Inflammasome for Dunces Oct 01, 2019

A quick take on one of the little-appreciated engines of the innate immune system.

Intro :10
A little about this episode :25
The inflammasome is a component of the innate immune system 3:12
Remember NLRP3 4:12
The toll-like receptors 5:05
Triggering the inflammasome 7:05
The proteins 8:04
A medieval battle and a trebuchet 9:56
A disclosure 17:00
I hope you enjoyed this episode 18:06

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Booshehri LM, Hoffman HM. J Clin Immunol. 2019;39:277-286.

Hasudungan A. Immunology – NOD like receptors and the inflammasome [Video]. YouTube. https://www.youtube.com/watch?v=biunM2iD8qM&t=4s. Published March 29, 2015. Accessed September 4, 2019.

The History of Rheumatic Fever Aug 09, 2019

“Acute rheumatic fever is proceeded by an infection with Group A strep” is a mantra that all health care workers know. This episode digs through the history of how we came to understand this fact, as well as how our understanding of the pathophysiology and treatment of rheumatic fever developed.

Intro :10
Why I made this episode :30
Outline of this episode 1:55
Rheumatic fever was really bad 3:10
The early 1700s 4:10
A big leap 6:15
The Jones criteria 11:07
History of the bacteriology 14:23
The heroic ASO titre 20:51

Rheuminations is powered by Healio 21:40

Another breakthrough: penicillin 21:51
Not all group A strep is the same 25:06
The decline of rheumatic fever 25:56
What about the host? 29:30
The joints 38:56
Summary 40:28
Never appreciated how bad rheumatic fever was 42:18

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

A History of Medical Bacteriology and Immunology, First Edition, Butterworth-Heinemann, Oxford, 1970.

Aspinall GO, et al. Infect Immun. 1994;62:2122-2125.

Carapetis JR, et al. Nat Rev Dis Primer. 2016;doi:10.1038/nrdp.2015.84.

Cox CJ, et al. J Immunol. 2013;doi:10.4049/jimmunol.1102592.

Engel ME, et al. PLoS One. 2011;6:e25326.

FW Denny, et al. JAMA. 1950;143:151-153.

Gray LA, et al. J Infect Dis. 2017;216:1460-1470.

Kaplan MH, et al. Lancet. 1962;1:706-710.

Karthikeyan G, Guilherme L. Lancet. 2018;392:161-174.

Khandke KM, et al. J Exp Med. 1987;doi:10.1084/jem.166.1.151.

Paul O, et al. Clin Cardiol. 1990;13:367-369.

Quinn A, et al. Infect Immun. 2001;69:4072-4078.

Robertson KA, et al. BMC Cardiovasc Disord. 2005;5:11.

Rojas Manuel, et al. J Autoimmun; 2018;95:100-123.

Tandon R, et al. Nat Rev Cardiol. 2013;10:171-177.

A Wandering Fire Aug 01, 2019

Join me as I explore a case of fever and migratory inflammatory arthritis, then discuss the case with the double-boarded rheumatologist/infectious disease expert, Cassandra Calabrese, DO.

Intro :10
My new book :24
Inside this episode 1:20
Case presentation 1:38
Introducing Dr. Cassandra Calabrese 9:22
The interview 10:40
Was the patient’s presentation typical for rheumatic fever? 10:58
Do most rheumatic fever cases have migratory arthritis? 13:23
How different is this from reactive arthritis? 15:42
What’s the deal with aspirin in this condition? 17:26
What are the skin manifestations? 18:19
Tell us about Sydenham chorea 20:23
What’s the difference between valvulitis and carditis? 22:07
Tell us about heart disease and recurrence 23:13
Can you talk about rheumatic fever recurrence? 24:32
Continuous prophylaxis 25:41
Can you walk us through the ASO (antistreptolysin O) titer? 26:20
How long is this on the differential? 28:38
Summary of our discussion 29:43
Thank you, Dr. Calabrese 32:18

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

Cassandra Calabrese, DO, is a rheumatologist in the department of rheumatic and immunologic disease and the department of infectious disease at Cleveland Clinic.

IgG4-related Disease with John Stone, MD Jul 03, 2019

John Stone, MD, MPH, is the world leader in the field of IgG4-related disease research. In this episode, he breaks down the histology of IgG4-related disease, important aspects of what is known about the pathophysiology of the disease, as well as future directions in treatment.

Intro :10
Inside this episode :13
IgG4-related disease background :31
An anecdote 1:15
The interview 4:09
History of IgG4-related disease 4:18
IgG4 pathology and terms 7:48
What makes IgG4 different from other IgG subclasses? 10:23
What do we know about the interplay between B and T cells? 12:31
What is SLAMF7? 16:30
What happens to T cells during B-cell depletion? 18:22
Antigens involved in IgG4 21:06
Future of treatment 23:10
Thank you, Dr. Stone 24:32

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

John Stone, MD, MPH, is director of clinical rheumatology at Massachusetts General Hospital.

An Inflamed Eye-Opening Interview Jun 11, 2019

In this episode, James Rosenbaum, MD, an expert in inflammatory eye disease, breaks down how systemic autoimmune conditions can affect the eye and highlights pearls that Rheumatologists should know.

Intro :10
Inside this episode :15
Introducing Dr. Jim Rosenbaum :51
The interview 1:26
Some basic terms 1:45
TEON pneumonic 5:45
Microbiome work 7:06
Evaluation of inflammatory eye disease 9:01
Workup for inflammatory eye disease 10:23
How do ophthalmologists rule out infection? 18:00
Is there anatomic overlay between the eye and joints? 23:10
A pen light and history 25:30
Treatment algorithm 27:27
What excites you the most about the future of inflammatory eye disease? 33:31
Thank you, Dr. Rosenbaum 37:03

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

James T. Rosenbaum, MD, is professor of ophthalmology, medicine and cell biology; head of the division of arthritis and rheumatic diseases and Edward E. Rosenbaum Professor of Inflammation Research at Oregon Health and Science University.

Hypophosphatasia: One of the 4 H's of the bonepocalypse May 16, 2019

We journey into the world of metabolic bone in this episode and explore the varied clinical manifestations of hypophosphatasia. We also interview the head of the center for osteoporosis and metabolic bone disease at the Cleveland Clinic, Chad Deal, MD.

Intro :10
The four H’s of chondrocalcinosis :18
What we’ll cover in this episode :52
A general overview 2:33
The first description of hypophosphatasia 3:39
History of this condition 13:00
Two cases 16:00
The interview 17:55
Various presentations 18:42
Laboratory findings 21:13
Differentiating the terminology 24:55
The relationship between this and chondrocalcinosis 27:11
Mechanisms of pain 28:15
Treatment options 29:30
Thank you, Dr. Deal 38:00
Episode recap 38:10

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Linglart A, Biosee-Duplan M. Curr Osteoporos Rep. 2016;14:95-105.

Rathbun JC. Am J Dis Child. 1948;75:822-831.

Robison R. Biochem J. 1923;17:286–293.

Turan S, et al. J Clin Res Pediatr Endocrinol. 2011;3:7-11.

Whyte MP. Bone. 2017;102:15-25.

Trials and Tribulations of Tumor Necrosis Factor, Part 2: Even More Necrosis Apr 17, 2019

This ripping yarn delves into the history of tumor necrosis factor in relation to rheumatoid arthritis with emphasis on the original studies that set the stage for the use of TNF inhibition in RA.

Intro :11
What we’ll cover here :16
Recap of Part 1 1:25
What I discovered when doing this episode 1:22
What this episode won’t address 2:40
Let the tale begin 3:12
A look at matrix metalloproteinases 3:32
A breakthrough in understanding RA 6:28
Two key players: Dr. Mark Feldman and Dr. Ravinder Maini 6:53
The first cytokine research conducted in RA: IL-1 8:00
The next cytokine: Tumor necrosis factor 11:16
What do we know about cytokine production within the joint? 14:33
IL-6 and TGF-beta 19:16
A bit about IL-10 23:57

*Visit Healio.com/rheum for daily news and updates*

How do we choose which cytokines to block to make improvements in RA? 25:16
What about in vivo data? 29:45
The history of infliximab 34:00
Infliximab is approved for RA treatment 45:13
TNF in RA: from bedside, to bench then back to bedside 46:06
It’s important to recognize the researchers who discovered these pathways 46:18
Remember the scientists next time you prescribe a TNF inhibitor 47:05
Read the latest news and commentary on Healio.com/rheumatology and Follow us on Twitter @HealioRheum and @HRheuminations for updates 47:34

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Brennan FM, et al. J Autoimmun. 1989;2 Suppl:177-186.

Brennan FM, et al. Lancet. 1989;2:244-247.

Butler MD, et al. Eur Cytokine Netw. 1995;6:225-230.

Chu CQ, et al. Arthritis Rheum. 1991;34:1125-1132.

Dayer JM, et al. J Exp Med. 1985;162:2163-2168.

Di Giovine FS, et al. Ann Rheum Dis. 1988;47:768-772.

Feldmann, M. Nat Rev Immunol. 2002;2:364-371.

Feldmann M, Maini SR. Immunol Rev. 2008;223:7-19.

Fontana A, et al. Rheumatol Int. 1982;2:49-53.

Haworth C, et al. Eur J Immunol. 1991;21:2575-9.

Houssiau FA, et al. Arthritis Rheum. 1988;31:784-8.

Keffer J, et al. EMBO J. 1991;10:4025-4031.

Kulkarni AB, Karlsson S. Am J Pathol. 1993;143:3-9.

Kuruvilla AP, et al. PNAS. 1991;88:2918-2921.

Maini RN, et al. Arthritis Rheum. 1998;41:1552-1563.

Malaviya AN, Mehra NK. Indian J Med Res. 2018;148:263–278.

McInnes IB, Schett G. Nat Rev Immunol. 2007;7:429-442.

Mitchison NA, Medawar PB. Proc R Soc Lond [Biol]. 1964;https://doi.org/10.1098/rspb.1964.0093.

Pettipher ER, et al. Proc Natl Acad Sci U S A. 1986;83:8749-8753.

The Beautiful Cure: The Revolution in Immunology and What It Means for Your Health, University of Chicago Press, Chicago, 2018.

Williams RO, et al. Proc Natl Acad Sci U S A. 1992;89:9784-9788.

Xu WD, et al. J Clin Invest. 1989;83:876-882.

Trials and Tribulations of Tumor Necrosis Factor, Part 1 Mar 08, 2019

In Part 1, we look at the original studies that led to the discovery of TNF in two separate labs where researchers were looking for two completely different things. We’ll learn how these discoveries then fueled the use of TNF in the failed trials as an anti-cancer agent, and the eventual development of antibody therapy against TNF in septic shock.

Intro :11
The origins of this episode and what we’ll cover here and in Part 2 :18
- What Part 1 will cover 2:01
  - Early cytokine research in general
  - codiscovery of TNF
  - TNF as anticancer agent
  - TNF’s role in cachexia
  - trials of anti-TNF in the setting of septic shock
- What part 2 will cover 2:59
  - TNF’s role in rheumatoid arthritis
- TNF in the late 1800s 3:18
- Lipopolysaccharide from gram-negative bacteria is first isolated and discovered 8:16
- Fast forward to the 1960s, enter Memorial Sloan Kettering Cancer Center 9:08
- Anthony Cerami studies cachexin in his Rockefeller lab 11:10
  - Focus on cachexia 12:27
- Late 1980s: TNF is produced and given to humans using recombinant technology 20:01
- Studies of TNF in patients with various types of cancer 20:48
  - High doses seem to induce shock-like illness 21:38
  - TNF-secreting tumor is created and tested 25:21
- Some take away 26:12
- Studying TNF led to the discovery that it’s associated with shock 26:33
- Money pours into research on blocking TNF 27:00
- A look at studies of TNF in infection 27:22
- Study of TNF in sepsis 30:20
- Let’s talk about anti-TNF and what it’s doing 34:00
- Studies of anti-TNF in humans 36:00
- Rat and baboon studies don’t always correlate with humans 40:25
- Episode recap 40:45
- Stay tuned for Part 2 42:20
- Follow us on Twitter @HRheuminations and leave us a review in iTunes 42:50

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Beutler B, et al. Science. 1985;229:869–871.

Blick M, et al. Cancer Research. 1987;47:2986-2989.

Carswell E, Williamson B. Cancer Imm. 2012;12:4.

Feldman M. Nat Rev Immunol. 2002;2:364-371.

Fong Y, et al. J Exp Med. 1989;170:1627-1633.

Kawakami M. Mol Med. 2014;doi:10.2119/molmed.2014.00177.

Lv S, et al. Int J Clin Pract. 2014;68:520-528.

Marks JD, et al. Am Rev Respir Dis. 1990;141:94-97.

McCarthy EF. Iowa Orthop J. 2006;26:154-158.

Michi HR, et al. N Engl J Med. 1988;318:1481-1486.

Oliff A. Cell. 1988;54:141-142.

Opal SM, et al. J Infect Dis. 1990;161:1148-1152.

Qui P, et al. Expert Opin Investig Drugs. 2011;20:1555-1564.

Tracey KJ, et al. Nature. 1987;330:662-4.

Waage A, et al. Lancet. 1987;1:355-7.

Löfty Diagnosis Feb 15, 2019

Take a listen to this medical mystery and learn about a not-so-rare condition — depending on where you live. Hear some interesting historical stories about the physicians who helped establish the diagnosis, as well as an interview with a renowned expert.

Intro :11
A 57-year-old woman presents with multiple-week history of joint pain. She also complains of lesions on her forearms. :32
- Initial lab results 1:30
- She arrives at my office 1:50
- Review of her vitals 1:57
- Physical exam findings and patient history 2:05
- What about the nodules on her skin? 3:20
- Tests leading to diagnosis 4:40
- What’s the diagnosis? 4:55
A personal anecdote 5:20
Symmetrical polyarticular inflammatory arthritis in the setting of erythema nodosum 6:18
What do we know about Löfgren Syndrome? 7:45
History of this diagnosis 8:35
What we know 100 years later 11:13
Focus on the inflammatory arthritis of Löfgren Syndrome 14:25
Are these different diseases? 18:07
Summary of what we’ve discussed so far 19:13
Unsung heroes who showed sarcoidosis is associated with inflammatory arthritis 20:40
Introduction of Dr. Daniel Culver 28:26
An update on sarcoidosis with Dr. Culver 29:17
- Why should we care about staging on X-ray? 29:22
- Are there any clues that it may be sarcoid based on histology and morphology of the granuloma itself? 30:56
- How does bronchoalveolar lavage help? 32:58
- How often do you see remissions in non-Löfgren’s sarcoidosis? 34:41
- What are your thoughts on the serum biomarkers? 36:34
- Can you comment with your thoughts on the link between the environment and the disease? 38:25
- What about infectious triggers? 40:06
- Do you think genetic studies will eventually be used for diagnosis or prognosis? 41:18
- Where do you think we’ll be with the diagnosis and treatment of sarcoidosis in 10 years? 42:38
Thank you, Dr. Dan Culver 44:28
Episode recap 44:40
Follow us on Twitter @HRheuminations and leave us a review in iTunes 45:18

Daniel Culver, DO, is director of the Interstitial Lung Disease Program at Cleveland Clinic and director of The Sarcoidosis Center of Excellence at Cleveland Clinic.

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @AdamJBrownMD @HealioRheum @HRheuminations

References:

Grunewald J, Eklund A. Am J Respir Crit Care Med. 2009;179:307-312.

Le Bras E, et al. Arthritis Care Res (Hoboken). 2014;66:318-322.

Lofgren S, Lundback H. Acta medica Scandinavica. 1952;142.

Maña J, et al. Am J Med. 1999;107:240-245.

Palmer DG, Schumacher HR. Ann Rheum Dis. 1984;43:778–782.

Segura BT, et al. Medicina Clinica (Barc). 2014;143:166-9.

Lupus: A Tale of Two Clinics Jan 24, 2019

In this guest episode, Leonard Calabrese, DO, provides the history of systemic lupus erythematosus, with special emphasis on the discovery of the LE cell and the two clinics involved in its detection.

Introduction of Leonard Calabrese, DO :11
In this episode … 1:44
A brief history of systemic lupus erythematosus and the major players 2:15
- Laurent-Theodore Biett 2:55
- Casanave 3:05
- von Hebra 3:24
- Moritz Kaposi 4:05
- Sir William Osler 5:25
Fast-forward to observations made during WWII era 7:00
The story of two clinics 8:55
- The Mayo Clinic 9:00
- The Cleveland Clinic 16:24
A race against time 18:29
Lupus is no longer a diagnostic problem 20:02
In a nutshell 20:15
Housekeeping items 20:51

Leonard Calabrese, DO, is head of Cleveland Clinic’s Section of Clinical Immunology, co-director of Center for Vasculitis Care and Research, and chief medical editor of Healio Rheumatology.

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @AdamJBrownMD @HealioRheum @HRheuminations @LCalabreseDO

The ACR Interviews: Richard Furie, MD Jan 04, 2019

Richard Furie, MD, is chief, division of rheumatology, at Northwell Health, and professor of medicine at Hofstra/Northwell School of Medicine. Join us in this ACR interview, as we discuss the story of interferon, lupus therapeutics — including B cell depletion — and the future of lupus research and treatments.

Intro :10

Background on Dr. Furie :16
The interview :56
- What advancements in the pathophysiology of lupus are you most excited about? 1:10
- The interferon story 1:23
- - The interferon story is not finished yet 7:18
  - Dendritic cells in lupus patients 7:41
  - What is “interferon signature?” 8:07
  - Do we see different clinical phenotype in patients with high interferon signature? 9:38
- What’s your opinion on the role of B cells? 10:07
- - Any other pathophysiology mechanisms being used to target B cells? 13:15
- Are we stretched thin in terms of number of lupus patients in trials? 15:21
- - How would designating lupus as an orphan disease change the way it’s investigated? 16:40
  - What is your main concern regarding study design? 17:37
- Looking 10 years ahead, do you think what we call “lupus” will still be referred to as such, or will it be decompartmentalized into different diseases? 21:26
- What’s the expense of cytokine profiling? 22:40
- What excites you the most about the future of lupus research? 23:21
Thank you, Dr. Furie 24:41
Recap 24:43
Shout out to the 7th Annual Basic and Clinical Immunology for the Busy Clinician: What is New and Hot in Immunology bootcamp in Scottsdale, AZ, Feb. 15-16, 2019 25:31

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. And be sure to follow us on Twitter @AdamJBrownMD and @HealioRheum.

This information is brought to you by Healio and is not sponsored by, nor a part of, the American College of Rheumatology.

Giant Cell Arteritis with John Stone, MD Dec 13, 2018

In this episode, John Stone, MD, MPH, director of clinical rheumatology at Massachusetts General Hospital, sits down to discuss his approach to giant cell arteritis and the results of the GiACTA trial. Learn why Stone believes the most important diagnostic test in GCA is the patient’s history.

Intro :10
Background on Dr. Stone :59
The interview 2:10
- Differentiating subtle GCA from the “classic case” 2:20
- Data from Stone’s recent paper in Rheumatology 5:17
- Using bilateral biopsies 9:00
- Recommendations for temporal artery biopsy – who, when, where 11:13
- Thoughts on imaging for GCA diagnosis 13:14
- IL-6 and treatment of GCA 15:16
- GiACTA trial – what surprised you most about the efficacy of prednisone alone? 19:05
  - Findings with tocilizumab 21:29
- Inflammatory markers in GCA 24:47
- Should we use tocilizumab right off the bat? 26:50
- What excites you the most about the future of this field? 29:59
Thank you, Dr. Stone 31:33
Recap 31:38

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. And be sure to follow us on Twitter @AdamJBrownMD and @HealioRheum.

The ACR Interviews: John J. O’Shea, MD Nov 29, 2018

John J. O’Shea, MD, is scientific director of the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases, and chief of their Molecular Immunology and Inflammation Branch. In this ACR interview, he joins me to talk about the JAK/STAT pathway, what we’ve learned from mouse models, current FDA-approved JAK inhibitors and the future of this exciting field.

Intro :10
Background on Dr. O’Shea :45
The interview 2:37
- How did you start looking into the JAK/STAT pathway? 3:16
- What should a clinician understand about this pathway? 5:22
- What do these cytokines have in common? 6:37
- What have we learned from mouse models? 8:48
- GWAS studies in JAK/STAT 11:49
- Can we quantify how much a certain cytokine may be using this pathway? 12:39
- Can you explain suppressor of cytokine signaling, aka SOCS? 14:15
- What do we know about how these different cytokines can have individual signaling controls? 16:40
  - An explanation of phenocopy 18:01
- What evidence do we have that JAK may circumvent STAT, and vice versa? 18:41
- An overview of FDA-approved JAK inhibitors and the pipeline 20:52
- What excites you the most about the future of this field? 23:26
- In a state of wonder over success of biologics 25:50
Thank you, Dr. O’Shea 27:20
Recap 27:30

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. And be sure to follow us on Twitter @AdamJBrownMD and @HealioRheum.

This information is brought to you by Healio and is not sponsored by, nor a part of, the American College of Rheumatology.

The ACR Interviews: Eric L. Matteson, MD Nov 15, 2018

In this ACR interview, the walking encyclopedia of medical history, Eric L. Matteson, MD, of The Mayo Clinic, sits down with me to discuss what excites him about medical history and then takes a deep dive into the history of vasculitis!

Intro :10
Background on Dr. Matteson :28
The interview 2:00
- How did you get into history? Why does it mean so much to you? 2:19
- Can you tell us about the archives at Mayo Clinic? 6:49
- An appreciation of present time and how we take some medications for granted 7:55
- Brief history of vasculitis 9:23
- Kussmaul and the first failed ophthalmoscope 14:20
- Kussmaul’s second failure: gastroscope 15:43
- When did we get to the small vessel vasculitis/glomerulonephritis description? 17:25
- The discovery of Wegener 20:44
  - Wegener was not the first to describe granulomatosis with polyangiitis, and the folly of naming diseases for individuals 23:24
- Thank you, Dr. Matteson 24:57
- Recap 25:05

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com.

This information is brought to you by Healio and is not sponsored by, nor a part of, the American College of Rheumatology.

The ACR Interviews: Martin J. Blaser, MD Nov 01, 2018

Martin J. Blaser, MD, is director of the Human Microbiome Program at NYU and author of the book, Missing Microbes. He sat down and spoke with us about how the microbiome plays a role in disease pathogenesis, including autoimmunity, and he also answered the question of whether all of our patients should be on probiotics!

Intro :11
Background on Dr. Blaser :35
The interview 1:20
- What is the microbiome? 1:25
- How unique are individual microbiomes? 1:49
- How does an individual’s microbiome change over time? 2:13
- Microbial diversity in different populations 3:12
- What’s your concern with the loss of microbiome diversity? 4:20
- A bit on Blaser’s research on obesity and antibiotic use 5:21
- Is the timing of antibiotic administration important, in terms of the side effects it can produce? 6:43
- Worldwide antibiotic prescribing rates 7:54
- The microbiome and autoimmunity 9:02
- The microbiome and type 1 diabetes, IBD 10:45
- Research with IL-17 12:23
- Microbiota transplants 13:09
- For how long is the microbiome perturbed after giving antibiotics? 13:57
- Diet and microbiome findings 14:54
- Probiotics, prebiotics and symbiotics 15:33
- In 10 years, how will people be investigating/manipulating the microbiome? 18:18
- Have we shown with research that introducing certain types of bacteria can be sustainable in the gut? 19:47
Thank you, Dr. Blaser 20:26
Summary 20:33

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com.

This information is brought to you by Healio and is not sponsored by, nor a part of, the American College of Rheumatology.

The History of Gout, Part 2 Oct 17, 2018

In this episode, explore data from the major study proving uric acid crystals are present in the synovial fluid of patients with gout, as well as the tale of two rheumatologists who injected their own knees (while still working in the hospital) with uric acid to prove it is the trigger for inflammation in gout. The episode finishes with some ripping yarns about the history of the medications we use to treat this condition.

Intro :10
Controversy surrounding uric acid’s role in gout :45
“Game changing” paper published in 1961 2:07
- The first description of pseudo gout 5:53
How do you prove uric acid triggered the inflammatory response? 6:37
One of my favorite studies 6:43
- Faires and McCarty inject themselves with uric acid 7:49
- Details of what they experienced 8:22
- 4 hours later … 8:52
- Both patients receive treatment 9:12
Review of what we’ve discussed so far 10:06
Let’s try and answer the question posited in The History of Gout, Part 1 10:35
Colchicine – previously a medicinal plant 10:41
A look at the history of urate-lowering therapy 12:59
- Probenecid was developed to reduce the excretion of penicillin 13:18
- The history of allopurinol 14:32
- Don’t give allopurinol to patients on azathioprine 17:21
The answer to the question posed in Part 1 17:49
Summary 18:12

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com.

References:

Barnett R. Lancet. 2018;391:2595.

Faires JS, Mccarty DJ. Lancet. 1962;280:682-685.

Kippen I, et al. Ann Rheum Dis. 1974;33:391-396.

Marson P, Pasero G. Reumatismo. 2011;63:199-206.

McCarty DJ, Hollander JL. Ann Intern Med. 1961;54:452-460.

Nuki G, Simkin PA. Arthritis Res Ther. 2006;doi: 10.1186/ar1906.

Rundles RW. Arch Intern Med. 1985;145:1492-1503.

Shyambhavee, Behera BK. J Pharmacol Clin Toxicol. 2017;5:1098.

Storey GD. Rheumatology. 2001;40:1189-1190.

West JB. Am J Physiol Lung Cell Mol Physiol. 2014;doi:10.1152/ajplung.00223.2014.

The History of Gout, Part 1 Oct 05, 2018

Do you know the etymology of the word “gout,” or how a simple microscope aided in the identification of tophi? Join me as I explore the history of this inflammatory arthritis and highlight the important scientists who shaped the modern era of gout.

Intro :10
What to expect in Part 2 :48
A question: Which urate-lowering therapy was made for an expressly different reason than to treat gout? 1:34
The first modern description of gout 1:54
Let’s go back to the Greeks 3:05
- Why is it called “gout?” 3:06
- An anecdote from medical school 4:13
- Hippocrates’ words of wisdom on gout 4:58
- First century AD: Gout is linked with excessive eating and drinking 6:01
Things get muddled 6:20
1683: The modern era of gout is described 6:42
“Gout Perspectives” published in The Lancet in 2018 7:06
Self-taught Dutch scientist, Antony van Leeuwenhoek, pioneers the microscope and identifies tophi 8:29
Swedish chemist Carl Wilhelm Scheele discovers uric acid 11:38
William Hyde Wollaston tests tophi and discovers it’s full of uric acid 12:57
Emperor of uric acid, Alfred Baring Garrod, associates elevated serum uric acid with gout 13:48
- If anyone knows how the thread test works, please email me 14:58
- He theorized that uric acid causes gout 15:37
A look back at what we know 16:09
What we don’t know: What’s in the joints of patients with acute gout? 16:22
Stay tuned for The History of Gout, Part 2 16:34

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com.

References:

Barnett R. Lancet. 2018;391:2595.

Faires JS, Mccarty DJ. Lancet. 1962;280:682-685.

Kippen I, et al. Ann Rheum Dis. 1974;33:391-396.

Marson P, Pasero G. Reumatismo. 2011;63:199-206.

Mccarty DJ, Hollander JL. Ann Intern Med. 1961;54:452-460.

Nuki G, Simkin PA. Arthritis Res Ther. 2006;doi: 10.1186/ar1906.

Rundles RW. Arch Intern Med. 1985;145:1492-1503.

Shyambhavee, Behera BK. J Pharmacol Clin Toxicol. 2017;5:1098.

Storey GD. Rheumatology. 2001;40:1189-1190.

West JB. Am J Physiol Lung Cell Mol Physiol. 2014;doi:10.1152/ajplung.00223.2014.

A Bovine Conundrum Sep 07, 2018

This episode discusses the case of an 85-year-old man with a history of hypertension and fairly recently diagnosed bladder cancer who presents with oligoarticular asymmetric inflammatory arthritis. Explore the details of this case and learn how bacillus Calmette-Guérin and reactive arthritis are related in this diagnostic conundrum.

Intro :10
An 85-year-old man with a history of hypertension and recently diagnosed bladder cancer presents with oligoarticular asymmetric inflammatory arthritis :18
- Details of his cancer history :32
- How BCG (bacillus Calmette-Guérin) is used for superficial bladder cancer :53
- Patient wakes with acute onset, rapidly progressing joint pain 1:21
- Results of synovial aspiration of his right wrist 2:06
- Physical exam findings and patient history 2:24
- Discharged from outside hospital 2:53
- Outpatient rheumatologist orders autoimmune serologies 3:03
- Second hospital admission 3:24
- Infectious disease evaluation 4:25
- Patient presents to Cleveland Clinic 4:54
- What do we have? 6:18
- The main concern is he’s been instilled with bacteria 6:45
- Could this be a reactive arthritis? 7:18
History of BCG 7:45
What do we know about what happens to these patients? 10:28
How do we define disseminated BCG infection vs. a reactive arthritis? 10:58
A single institution cohort of disseminated infection after BCG instillation 11:29
Comparing these definitions in our patient 14:34
A look at reactive arthritis 15:07
What do we use to treat these patients? 16:12
A look back at our patient 16:31
- Continued treatment with triple therapy 17:05
- A diagnostic conundrum 17:32
- The diagnosis, in hindsight 18:11
Summary 18:49

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com.

References:

Bernini L. Autoimmun Rev. 2013;12:1150-1159.

Meyer J. Postgrad Med J. 2002;78:449-454.

Pérez-Jacoiste Asín MA. Medicine (Baltimore). 2014;93:236-254.

To U. Case Rep Med. 2014;doi:10.1155/2014/362845.

TMI on TMA Aug 16, 2018

This episode covers a rare but life-threatening complication of lupus nephritis called complement-mediated thrombotic microangiopathy. Rheumatologist Lisa Zickuhr, MD, helps us better understand this often-overwhelming topic with a clinical case example, treatment options and practice pearls.

Intro :10
Introduction of Lisa Zickuhr, MD, rheumatologist :44
Complement-mediated thrombotic microangiopathy in lupus is an overwhelming topic 1:50
Definition of TMA 2:15
- What is MAHA? 3:10
- Four classic symptoms associated with TMA syndromes 3:35
- What causes TMA? 3:50
Complement-mediated TMA 5:35
How this is seen in clinical practice 9:10
Case example of complement-mediated TMA 10:10
- Summary of case presentation 13:05
- What’s next? 13:50
- Takeaways from this clinical presentation 15:48
Primary and secondary complement-mediated TMA 18:23
An argument for a primary etiology of complement-mediated TMA in lupus 18:51
CliffsNotes version for rheumatologists, HCPs caring for lupus patients 21:12
Therapy for complement-mediated TMA is two-pronged 22:35
Patient profile 24:05
Summary 25:10
Thank you to Dr. Lisa Zickuhr 26:13

Lisa Zickuhr, MD, is a rheumatologist at Washington University in St. Louis.

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com.

References:

Dragon-Durey MA, et al. J Am Soc Nephrol. 2005:555-563.

Dragon-Durey MA, et al. Semin Thromb Hemost. 2010:633-640.

George JN, et al. N Engl J Med. 2014 Aug 14;371:654-666.

Jönsen A, et al. Arthritis Res Ther. 2011;13:R206.

Laszlo MH, et al. Ann Intern Med. 1955;42:1308-1320.

Nesher G, et al. Semin Arthritis Rheum. 1994;24:165-72.

Zickuhr L, et al. Arthritis Care Res (Hoboken). 2018;doi: 10.1002/acr.23561.

A Diagnosis Divided Jul 31, 2018

A young woman presents with migraine-like headaches, black spots in her vision and emotional lability. Think you know the diagnosis? You may be surprised – this medical mystery is not what it seems. In this episode, learn more about this rare diagnosis, and gain clinical insight from neurologist Devon Conway, MD, and ophthalmologist Arthi Venkat, MD.

Intro :11
A 24-year-old woman presents with gradual worsening of a migraine-like headache accompanied by nausea :22
- Description of symptoms :37
- ER visit 1:23
- Onset of new symptoms 1:44
- Second ER visit 2:11
- Outpatient MRI findings 2:28
- Lumbar puncture findings 2:50
- Patient is admitted to hospital 3:52
- Second MRI findings 4:16
- Ophthalmology consult and results of fluorescein angiography 4:46
- Audiogram is ordered 5:17
- Case summary 5:40
- What is the most likely diagnosis? 6:05
Triad of Susac syndrome 6:27
Remember: This is not a vasculitis 7:11
History of Susac syndrome 7:40
CNS manifestations of the Susac triad 8:27
Consult with Devon Conway, MD 10:13
- Flare signals for non-radiologists/neurologists 11:05
- Anything specific that says “demyelinating” on MRI? 13:35
- Distinguishing the lesions in this case from those of MS 15:36
- Neurology work-up approach to this type of case 16:28
- The utility of lumbar puncture in this situation 18:05
- About ADEM (acute disseminated encephalomyelitis) 21:06
Ocular manifestations of Susac syndrome 22:26
Consult with Arthi Venkat, MD 23:17
- Ophthalmology differential in a patient with intermittent vision loss in various fields of vision 23:55
- Overview of branch retinal artery occlusions 25:22
- Difference between branch retinal artery occlusions and other ophthalmologic presentations common to rheumatologists 27:51
- How the ophthalmologic exam helps differentiate MS from Susac syndrome 30:07
Overview of sensorineural hearing loss in Susac syndrome 34:09
Do we know for sure this is an autoimmune disease? 34:59
Aggressive immunosuppression seems to halt the progression of disease 35:34
What are treatment options? 35:42
What do we know about long-term outcomes? 36:31
Who takes care of these patients? 37:29
Treatment, outcome of this patient 38:07
Episode/case summary 38:20

Devon Conway, MD, is a staff neurologist at Cleveland Clinic’s Mellen Center for Multiple Sclerosis.

Arthi Venkat, MD, is a retinal and uveitis specialist at Cole Eye Institute at Cleveland Clinic.

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com.

References:

Aubart-Cohen F, et al. Medicine (Baltimore). 2007;86:93-102.

Greco A, et al. Autoimmun Rev. 2014;13:814-821.

Rennebohm RM, et al. Int J Stroke. 2018;doi:10.1177/1747493017751737.

The History of Steroids Jul 10, 2018

Do you know which U.S. president had Addison’s disease? Or how rumors from WWII led to funding for research on cortisol? In this episode, take a trip down memory lane as we detail the history of steroids and the scientists whose work lead to the discovery of prednisone.

Intro :14
A query: What other disease is attributed to Thomas Addison? :40
Overview of the layers of the adrenal gland 1:18
History of the adrenal gland 2:10
Thomas Addison enters the scene 3:39
Kennedy and terminology 6:15
Charles Brown-Sequard helps describe function of adrenal glands 7:13
George Oliver and Edward Sharpey-Schafer help understand adrenal gland 8:44
Adrenaline is discovered 10:03
Steroid chemistry begins in earnest 10:14
Steroids discovered, but questions remain 10:25
WWII rumors spur research on cortin 11:15
Edward Calvin Kendall, Tadeus Reichstein and Philip Showalter Hench receive Nobel prize for their discoveries relating to the hormones of the adrenal cortex 12:23
Committee of 14 chemists assembled 14:24
1948: The case of Mrs. G 15:21
Pharmaceutical companies race to produce cortisone 17:08
How we arrived at prednisone 17:43
The answer to the question: “What other disease was described by Thomas Addison?” 18:34

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com.

References:

Benedek TG. Clin Exp Rheumatol. 2011;29:S-5-12.

Burns CM. Rheum Dis Clin North Am. 2016;doi: 10.1016/j.rdc.2015.08.001.

Lawrence L. Controversial ‘father’ of endocrinology: Brown-Séquard. Endocrine Today. February 2008. https://www.healio.com/endocrinology/news/print/endocrine-today/%7B0b1791e0-0e1c-42ac-bec3-d5b67bb054f6%7D/controversial-father-of-endocrinology-brown-squard. Accessed April 10, 2018.

Pearce JMS. J R Soc Med. 2004;97:297-300.

A Look at Biosimilars Jul 10, 2018

Biosimilars are a fascinating new category of medication and are quickly becoming part of the rheumatologist’s treatment armamentarium, but they can be confusing to understand. This episode will enhance your knowledge of this new class of medications by providing a better understanding of how biologics differ from most other medications, and why biosimilars aren’t just generics of biologics. This episode also takes a brief look into the history of drug regulation with a focus on biosimilars and how they’re FDA approved.

Intro :12
What is a biologic? 1:21
What makes a generic? 5:05
- History of drug regulation in the U.S. 5:10
What makes a biologic? 11:43
- Monoclonal antibodies 11:51
Where do biosimilars come from? 14:16
- Definition 15:03
- Manufacturing process 15:17
- FDA approval process 16:00
Trials of biosimilars 19:44

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com.

Resources:

Bridges SL Jr., et al. Arthritis Rheumatol. 2018;doi:10.1002/art.40388.

Hornecker JR. Generic Drugs: History, Approval Process, and Current Challenges. U.S. Pharmacist. 2009;34(6)(Generic Drug Review suppl):26-30.

Janssen WF. The Story of the Laws Behind the Labels. https://www.fda.gov/downloads/AboutFDA/WhatWeDo/History/FOrgsHistory/EvolvingPowers/UCM593437.pdf. Published June 1981. Accessed April 14, 2018.

Liu JKH. Ann Med Surg (London). 2014;doi:10.1016/j.amsu.2014.09.001.

Morrow T, Felcone LH. Biotechnol Healthc. 2014;1:24-26,28-29.

Giant Cell Arteritis with Leonard Calabrese, DO Jul 10, 2018

Leonard Calabrese, DO, details the clinical manifestations of giant cell arteritis, the complex scenarios rheumatologists face when working with GCA, and the pathogenesis of this disease. Calabrese also shares clinical pearls and tips for success.

Introduction of Leonard Calabrese, DO :12
Goals of this episode :31
The disease that rheumatologists love 1:02
History of giant cell arteritis 1:51
Gene Hunder, MD, defines large vessel involvement in late ‘80s, ‘90s 4:18
Epidemiology of giant cell arteritis 4:32
Manifestations in detail 5:13
- Cranial arteritis 5:20
- Jaw claudication 6:04
- Ocular involvement 6:44
Signs and symptoms 7:03
The most important thing about ocular ischemia in GCA 9:01
Stroke: A major complication of cranial ischemic GCA 9:25
PMR and/or systemic inflammatory presentations 11:33
A more recent presentation: inflammatory disease of unknown origin 12:19
Large vessel presentations 13:12
Diagnosis of GCA is based on clinical suspicion 14:00
Ophthalmologists must have hypervigilance 14:22
It’s a team sport to attack this disease 14:58
Overview of clinical manifestations 15:08
Histopathology 16:10
How the biopsy should be done 16:38
What about healed arteritis? 17:18
What about arteritis of the vasa vasorum? 17:41
Episode recap 17:54
The most important thing to know 18:17

Leonard Calabrese, DO, is head of Cleveland Clinic’s Section of Clinical Immunology, co-director of Center for Vasculitis Care and Research, and chief medical editor of Healio Rheumatology.

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com.

A Neck of Deception Jul 10, 2018

What do a fever, stiff neck and leukocytosis have in common with a large swollen knee? Listen to this medical mystery to see if you can figure out the diagnosis, then stick around to hear interesting information you may not know about the disease, including historical perspectives.

Intro :10
A 71-year-old man presents with unilateral knee swelling, fever and neck stiffness :37
- Medication overview 2:12
- Physical exam findings 2:24
- Laboratory findings 3:03
- Imaging results 3:33
- Rheumatology consult 4:30
- Now what? 5:08
- CT scan is ordered 6:04
- The meningitis mimicker 6:24
History of pseudo-gout 6:54
What do we know about chondrocalcinosis? 7:53
History of Crowned Dens syndrome 9:37
Cervical spine anatomy review 11:05
Data from a single center 12:40
Can this be dangerous? 13:40
Are we sure this is pseudo-gout? 14:20
The role of the CT in the diagnosis of this case 14:50
Treatment options 15:44
“Why not treat the patient with steroids from the start?” 16:12
Email me with questions, or if you know any cases of hydroxyapatite-induced Crowned Dens 16:39