Rheum Advisor on Air

In this episode, rheumatologist John Fitzgerald, MD, and nurse practitioner Wendy Wright, DNP, discuss new treatment guidelines and how the collaboration between primary care and rheumatology can improve both acute and long-term management of gout.

In this episode, in collaboration with Neurology Advisor, rheumatologists Patricia Katz and Alfred Kim, and neurologist Daniel Barone, discuss the relationship between sleep disorders in rheumatic diseases, including risk factors for sleep disorders, the manifestation of these sleep disorders, and how these specialties can work together to improve diagnosis and care for this patient population.

Results of the COVAD study showed that three-quarters of patients with rheumatoid arthritis reported adverse events related the COVID-19 vaccination; however, the majority of them were minor in severity.

Shilpa Venkatachalam, PhD, MPH, director of Patient-Centered Research Operations and Ethical Oversight at Global Healthy Living Foundation, and Shubhasree Banerjee, MD, assistant professor of clinical medicine at Penn Medicine, discuss the factors associated with vaccine hesitancy and skepticism and the steps that clinicians can take to improve COVID-19 vaccine uptake rates.

To understand the gaps, challenges, and future opportunities in rheumatology research, we speak with the co-authors of a recent paper published in Arthritis & Rheumatology: Laura Lewandowski, MD, pediatric rheumatologist and assistant clinical investigator and head of the Lupus Genomics and Global Health Disparities Unit at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) at National Institutes of Health (NIH); Evelyn Hsieh, MD, associate professor of rheumatology and epidemiology at the Yale School of Medicine and the chief of rheumatology at the VA Connecticut Healthcare System; and Chris Scott, MBChB, head of pediatric rheumatology at the Red Cross War Memorial Children's Hospital and University of Cape Town in South Africa.

Drs Allan Gibofsky and David Goldberg discuss legal considerations in the practice of telemedicine in the specialties of rheumatology and dermatology.

Gout has often been known for its predominance among men. While it is true that risk for gout is 3 times higher among men vs women due to high uric acid levels, postmenopausal women especially form a significant percentage of a population with symptoms of unaddressed gout and a disproportionate worsening in disease burden. For Arthritis Awareness Month and ahead of Gout Awareness Day, Angelo L. Gaffo, MD, discusses the importance of addressing the prevalence and impact of gout among women and improving provider and patient education in this regard.

Pain – the main manifestation of many rheumatic diseases, but also the most underappreciated, leads to worse disease outcomes and affects the quality of life of patients. Over the last decade or so, animal models and modern technology have highlighted the complex mechanisms that underlie chronic pain in rheumatology. To get further insight on the various aspects of chronic pain, we speak with Don L. Goldenberg, MD, about its pathophysiology and diagnostic classification criteria for chronic pain conditions. Deeba Minhas, MD, provides a perspective on addressing implicit biases among patients with rheumatic disease and pain.

Feelings of stress, fatigue, and exhaustion – what is being described as “burnout” – have become a common occurrence among providers, including rheumatologists, with important implications in clinical practice. Various surveys and studies have reported a substantial prevalence of burnout (approximately 50%) among rheumatology providers. Beth L. Jonas, MD, Reeves Foundation Distinguished Professor of Medicine and chief of the Division of Rheumatology, Allergy, and Immunology at the University of North Carolina at Chapel Hill, joins us on this episode to provide deeper insight on the issue of “burnout” from a clinical practice standpoint.

Juvenile idiopathic arthritis and lupus are the most common rheumatic diseases in children. However, more than 500,000 children develop other rheumatic diseases. The diagnosis, treatment, and management of these conditions often require a multidisciplinary approach owing to the diverse clinical manifestations that present in this patient population. In light of Rare Disease Day 2022, we spoke with Emily von Scheven, MD, a pediatric rheumatologist at the University of California San Francisco Benioff Children's Hospital and the executive committee chair of CARRA, and Vincent Del Gaizo, director of partnerships and patient engagement for CARRA and a parent of a pediatric patient with rheumatic disease.

Rheumatologists and neurologists are known to manage and collaborate between their specialties in the care of patients with shared diagnoses, such as disorders of the central nervous system, like giant cell arthritis and neuropsychiatric lupus. In this episode, done in collaboration with Neurology Advisor, neurologist Michael Kornberg, MD, and rheumatologist Laura C. Cappelli, MD, discuss the management of patients with rheumatologic conditions with neurologic manifestations, including defining the term "neurorheumatology," encouraging better collaboration between the 2 specialties, and improving access to care for this patient population.

The importance of patient perspectives, ie, the behaviors, concerns, and experiences of patients with rheumatic conditions, and patient-reported outcomes, were highlighted through several studies presented at the American College of Rheumatology (ACR) Convergence 2021. In this episode, Shilpa Venkatachalam, PhD, MPH, and Betty Hsiao, MD, discuss research carried out by their respective teams emphasizing the role of the patient voice in rheumatology research and clinical practice. 

The American College of Rheumatology (ACR) Convergence held in November 2021 included several important abstracts and sessions in gout research. In this episode, Ada Kumar, MD, of Horizon Therapeutics, and Suneet Grewal, MD, of East Bay Rheumatology Medical Group, provide an overview of the compelling news and research in gout, as presented at the ACR annual meeting.

There were several interesting research papers, posters, abstracts, and presentations on the diagnosis and treatment of lupus at the American College of Rheumatology (ACR) Convergence 2021, including the Great Debate that was about the use of voclosporin vs belimumab as add-on therapy in lupus nephritis. Karen Costenbader, MD, provides a comprehensive roundup of all the exciting and compelling news and research in lupus, as presented at ACR annual meeting.

Uveitis has been recognized as the most common extra-articular manifestation and potentially sight-threatening complication of juvenile idiopathic arthritis (JIA). The most common form of JIA-associated uveitis (JIA-U) is chronic anterior uveitis, which is initially asymptomatic but may lead to visual disability. JIA-U can extend into adulthood and have significant ocular morbidity as well. In this episode of the American College of Rheumatology (ACR) Convergence 2021 series, Mara Becker, MD, discusses the management of JIA-associated uveitis in adults, including collaboration with ophthalmologists, transition from pediatric rheumatology care, screening frequency, and treatment options.

There were some exciting and clinically meaningful research in scleroderma/systemic sclerosis presented by experts at the American College of Rheumatology (ACR) Convergence 2021. Tracy Frech, MD, provides a comprehensive overview of the studies presented at the ACR meeting this year, by categorizing them into 5 categories: practice pearls, treatment updates, pediatrics, outcome measures, and COVID-19-related research.

Health care disparities in rheumatology have been shown to have a significantly negative effect on quality of life and patient outcomes. There are several factors that drive health inequities in the US, including race, ethnicity, and socioeconomics, such as education, health care access, and income. In the first episode of the ACR Convergence 2021 series, we speak with rheumatologist Iris Y. Navarro-Millán, MD, who provides a deeper insight into understanding social determinants of health as drivers of health disparities in rheumatology and urges researchers and clinicians to look beyond just race and ethnicity when addressing these disparities.

Stay tuned for season 2 of the Rheum Advisor on Air podcast!

The recent US Food and Drug Administration (FDA) approval of anifrolumab for the treatment of systemic lupus erythematosus (SLE) came a decade after the approval of human monoclonal antibody belimumab. In this episode of the Rheumatology Advisor podcast, we speak with Mary K. Crow, MD, who provides a deeper insight into the evolution of lupus treatments over the years, with a focus on history, barriers in research, information regarding the anifrolumab approval, and the future of drug development in SLE. We also present the perspectives of a patient with lupus; Christele Felix serves as a Patient Advocate for Lupus Studies (PAL) for the Lupus Research Alliance, provides peer support for those interested in learning about clinical trials in lupus, and has presented on various topics, including health disparities, at the American College of Rheumatology (ACR) annual conference.

According to multiple studies and surveys, 50% to 80% of individuals continue to have lingering symptoms approximately 3 months after the onset of COVID-19. Now, musculoskeletal symptoms are becoming common lasting symptoms among “COVID-19 long haulers.” In this episode of the Rheumatology Advisor podcast, guest hosts Tylar Stanley and Samiha Tamboo have a conversation with Swati Deshmukh, MD, a musculoskeletal radiologist at Beth Israel Deaconess Medical Center and assistant professor of radiology at Harvard Medical School, about “long COVID,” including evidence of musculoskeletal symptoms, and its effect on patients with rheumatologic disease.

An estimated 80% of patients with systemic sclerosis (SSc) have pulmonary involvement, with interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) being the most common of these lung manifestations. In fact, both these conditions have been identified as the leading causes of SSc-related mortality. In this episode of the European Alliance of Associations for Rheumatology (EULAR) 2021 Virtual Congress series, Toby Maher, MD, a professor of medicine and pulmonologist, describes the increased prevalence of lung involvement in scleroderma and the need for routine screening among these patients.

Research has shown the importance of diet and nutrition in reducing disease burden in rheumatic diseases, such as osteoarthritis, rheumatoid arthritis, and gout. But how can providers effectively communicate about the role of diet and nutrition to their patients with rheumatic and musculoskeletal diseases (RMDs)? In this episode of the EULAR 2021 series, Elena Nikiphorou, MBBS/BSc, MD, discusses the importance of emphasizing diet and lifestyle, along with pharmacologic treatment, to patients with RMDs.

In the first episode of the European Alliance of Associations for Rheumatology (EULAR) 2021 Virtual Congress series, we spoke with co-authors Jeffrey Sparks, MD, and Zachary Wallace, MD, about their research – the association between disease-modifying antirheumatic drug (DMARD) use and COVID-19 outcomes in rheumatoid arthritis (RA) – conducted on behalf of the COVID-19 Global Rheumatology Alliance. The study was presented by Dr Sparks and Dr Wallace at the EULAR 2021 meeting and has been published in BMJ. 

Owing to the overlap, and possible transition, of care between psoriasis, a systemic condition typically presenting as skin manifestations, and psoriatic arthritis (PsA), a chronic heterogeneous inflammatory arthritis, a multidisciplinary approach is required during patient management. We're joined on this episode by a dermatologist and rheumatologist, and Penn Medicine colleagues, Joel Gelfand, MD, and Alexis Ogdie, MD, who provide deeper insight into the overlap and transition of care between patients with psoriasis and PsA.

Pediatric rheumatologists and providers are uniquely positioned to build and foster relationships of trust with their patients. However, while providing care for the rheumatic condition, should physicians be allowed to inquire about the sexual orientation and gender identity of their patients? In this episode, we tackle important questions about the ethical considerations during the development of treatment plans for pediatric patients with rheumatic diseases. Karen Onel, MD, the chief of the Pediatric Rheumatology Division at the Hospital for Special Surgery, New York, along with third-year fellows in pediatric rheumatology Nayimisha Balmuri, MD, and Jacob Spitznagle, MD, speak with us about their clinical practice experiences and the importance of representing pediatric patients in a way that centers and considers their personhood holistically, especially among populations in which mental health issues and other psychosocial stressors are present.

In part 1 of this series, experts provided insight into a few data registries in rheumatology, including ArthritisPower, CorEvitas, and the American College of Rheumatology (ACR)’s RISE registry. In the second part, we’re discussing 2 more data registries in rheumatology. Yukiko Kimura, MD, provides an overview of the updates and future plans of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry for pediatric rheumatology; and Pedro Machado, MD, PhD, describes the engaging data and work stemming from the COVID-19 Global Rheumatology Alliance.

The potential for big data and data registries in rheumatology is immense. In this 2-part series, we’re getting updates and the future plans of some of the big databases and data registries in rheumatology. Michael George, MD, talks to us about ArthritisPower, Jeff Greenberg, MD, discusses the work of CorEvitas, and Christie Bartels, MD, provides further insight into the American College of Rheumatology (ACR)’s RISE Registry.

Recent studies have indicated the persistence of gender gaps in terms of promotion, publication, and federal funding in academic rheumatology in the United States, despite an increase in the number of women rheumatologists in the workforce over the years. Authors of a paper published in Nature Reviews Rheumatology noted, “To move forward, we must find ways to address the gender gap in rheumatology with the goal of creating a workforce as diverse as the patient population it serves.” In this episode, we are speaking with the authors, Shereen Mahmood, MD, and Irene Blanco, MD, to get further insight into the existing inequities among women in academic rheumatology, and how gender gaps can be bridged and parity achieved.

Messages and characters portrayed through film, television, and digital media have far-reaching effects and consequences on society. For many decades, the onscreen portrayal of gout has promoted inaccurate beliefs about its causes and management, such as self-indulgence and social status, as well as an association with humor, shame, and embarrassment. Subsequently, these misrepresentations have negatively affected the mental health and quality of life of patients with gout. How can rheumatologists and providers address the issue? This episode features Nehad Soloman, MD, a rheumatologist at Arizona Arthritis & Rheumatology Associates, and Christina Derksen, one of the study authors on a paper about the fictional depictions of gout in film and television, published in BMC Rheumatology.

Inflammatory syndromes often have overlapping clinical manifestations, making them difficult to diagnose and categorize. Using a genome-first approach, researchers at the National Institutes of Health (NIH) have discovered an inflammatory disease called vacuoles, E1 enzyme, X-linked, autoinflammatory and somatic syndrome (VEXAS) that is caused by mutations in the UBA1 gene. In this episode, Peter Grayson, MD, MSc, a study author on the recent paper published in the New England Journal of Medicine, gives us further insight into the discovery of the VEXAS syndrome and the overall importance of rare rheumatic disease research at the genetic and molecular level.

Multisystem autoimmune rheumatic diseases are rare or ultra-rare disorders linked to significant mortality and morbidity. However, with the rise of new technology, including data registries and advanced genetic analysis, rare rheumatic disease research is being propelled forward to inform future therapeutic options and improve patient outcomes. In light of Rare Disease Day 2021, Dr Jonathan Miner, MD, PhD, discusses his work and contributions to the rare disease space, and speaks to the importance of research and the management of patients with rare rheumatic diseases.

In the past year, coronavirus disease 2019 (COVID-19) has presented unique challenges to rheumatology practices and care. Although not at the frontline, rheumatologists have had to face difficult decisions regarding, and not limited to, immunosuppressant management and the continuity of care for patients. But with the COVID-19 vaccines at the helm, what does the current rheumatology landscape look like and what is potentially in store for the future of patient care? In this episode, Amit Ladani, MD, a rheumatologist at West Virginia University Hospital, gives us his point-of-view.   Editor’s Note: Please note that this episode was developed and edited before the American College of Rheumatology (ACR) released clinical guidance regarding COVID-19 vaccines in patients with rheumatic and musculoskeletal diseases. We will be providing updated information soon.

Pregnancy for patients with antiphospholipid syndrome (APS) and lupus has historically been associated with complications, including increased risk for preeclampsia, fetal growth restriction, and fetal death, but outcomes have improved in the last 2 decades. However, identifying, predicting, and preventing the risk for pregnancy complications in this population still remains challenging. Taking us on a deep dive into the subject is the 2020 recipient of the Rheumatology Research Foundation Shaun Ruddy Memorial Lectureship, Jane Salmon, MD, the Collette Kean Research Chair at the Hospital for Special Surgery and professor of medicine and obstetrics and gynecology at Weill Cornell Medicine, New York.

There is a significant prevalence of mental health disorders among pediatric patients with rheumatic disease, increasing the risk for adverse outcomes not just in mental health, but also the underlying rheumatic condition. Pediatric rheumatologists, along with mental health professionals, are positioned to provide mental health screening and interventions for this patient population; however, it has been observed that there are significant gaps in the area of mental health in pediatric rheumatology.

Imaging is an important aspect in the diagnosis and monitoring of large vessel vasculitides, including Takayasu and giant cell arteritis. However, traditional imaging modalities have consistently posed setbacks in terms of diagnostic accuracy for these conditions. Our featured guest on this episode Anisha Dua, MD, gives us a brief insight into the various challenges observed with large vessel vasculitis imaging, particularly temporal artery biopsy, and how the inclusion of certain modalities, including ultrasound and magnetic resonance imaging (MRI), may improve diagnosis in these patients and our understanding of large vessel vasculitis.

To facilitate high-quality patient care and to include new and emerging evidence, the American College of Rheumatology (ACR) has developed and updated the guidelines for the management of rheumatoid arthritis (RA). Our featured guest on this episode is Stanley Cohen, MD, who gives us a glimpse into the scope and new updates to the ACR guidelines, which are currently in the draft stage.

Approved by the US Food and Drug Administration for the treatment of refractory gout, pegloticase, in combination with immunomodulatory agents, is an area of gout treatment that has shown much promise.  Our featured guest on this episode is Brian LaMoreaux, MD, MS, an investigator on many gout studies, who provides an overview of the notable research in pegloticase treatment in gout, as presented at the American College of Rheumatology (ACR) 2020 annual meeting.

There is growing evidence - both in animal models and humans - to suggest the significant role of the microbiome in the etiology of rheumatic diseases. Over the years, multiple microbial agents and changes in the composition of the microbiota have been associated with specific autoimmune diseases, only emphasizing the importance of the microbiome in rheumatology research today. To give us further insight into this relevant topic, we are joined in this episode by Maximilian Konig, MD, of the Division of Rheumatology at the Johns Hopkins Hospital in Baltimore, Maryland, and Veena Taneja, PhD, associate professor of immunology in the Department of Immunology and Rheumatology at the Mayo Clinic in Rochester, Minnesota.

Compared with men, women have a higher incidence of autoimmune disease and are more affected by rheumatic and musculoskeletal diseases (RMDs). Therefore, in light of the American Medical Association (AMA)’s Women in Medicine Month, we’re highlighting the importance of recognizing women’s health in rheumatology. The American College of Rheumatology (ACR) also recently released guidelines for the management of reproductive health in women with RMDs. Our featured guest is Mehret Birru-Talabi, MD, PhD, assistant professor of medicine and associate rheumatology fellowship program director in the Division of Rheumatology and Clinical Immunology at the University of Pittsburgh, Pennsylvania. We will also be getting an expert input from lead author of the ACR guidelines on reproductive health in RMDs, Lisa Sammaritano, MD, attending physician, director of the Rheumatology Reproductive Health Program at the Barbara Volcker Center for Women and Rheumatic Disease in the Hospital for Special Surgery, New York, and professor of clinical medicine at Weill Cornell Medicine, New York.

With the increase in remote monitoring of patients and the provision of telemedicine services during the coronavirus disease 2019 (COVID-19) pandemic, the role of digital health in medicine, as wearables, electronic health records, sensors, apps, and other technologies, has come to the forefront. Especially in chronic care like rheumatology, the advent of digital health innovations and the digitization of healthcare has created new avenues for both clinicians and patients toward more efficient disease management and, in turn, potentially better health outcomes. Our featured guests are W. Benjamin Nowell, PhD, MSW, director of patient-centered research at Global Healthy Living Foundation (GHLF) and CreakyJoints®, and Jeffrey Curtis, MD, MS, MPH, professor of medicine in the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham.

Although biosimilars have been proven to have equivalent efficacy and no clinically meaningful differences in safety and immunogenicity from their reference products, its use in rheumatology has generated much debate among clinicians, patients, drug manufacturers, and payers. While several of these biopharmaceuticals are still in the pipeline, biosimilars of originators, including adalimumab, etanercept, and infliximab have been approved for the treatment of patients with rheumatic diseases. In this episode, we get further insight into the current state of biosimilars development and adoption in the United States vs other countries, interchangeability among adult and pediatric patients with rheumatologic conditions, nonmedical switching to biosimilars, and an overview of its potential cost benefits for the healthcare system.   Our featured guest is Jonathan Kay, MD, professor of medicine and population and quantitative health sciences, Timothy S. and Elaine L. Peterson Chair in Rheumatology, and director of clinical research, Division of Rheumatology at the University of Massachusetts Medical School in Worcester, Massachusetts.

In this episode, we get expert perspectives on the immunopathology and management of the cytokine storm in adult and pediatric patients with COVID-19. Our featured guests are Scott W. Canna, MD, assistant professor of the departments of pediatrics and immunology at the University of Pittsburgh Children’s Hospital and Randy Q. Cron, MD, PhD, professor of pediatrics and medicine at the University of Alabama at Birmingham and director of the Division of Pediatric Rheumatology at Children's of Alabama.

Ethnic/racial and gender disparities remain deep-rooted in medicine and rheumatology today. In this episode and in what is one of the most pertinent topics of our times, we discuss and highlight the disproportionate burden of rheumatic diseases and coronavirus disease 2019 (COVID-19) in ethnic minorities and the gender disparities observed in rheumatology care before and during the COVID-19 pandemic.   How can rheumatologists and rheumatology professionals, in coalition with the patient community, address the issue of potential bias and the existing health disparities?   Our featured guests are Candace H. Feldman, MD, MPH, ScD and Rosalind Ramsey-Goldman, MD, DrPH, the authors of a recent article published in Arthritis and Rheumatology on the urgent action needed with regard to the widening disparities in patients with rheumatic diseases during COVID-19. 

Telerheumatology is booming now, but will the use of technology persist after the coronavirus disease 2019 (COVID-19) pandemic resolves? Could it be the new normal? In part 2 of this series, we’re getting perspectives from an allopathic and an osteopathic physician specializing rheumatology on the evolution of telemedicine and what the future may look like for the management of rheumatologic conditions.  Our featured guest is Zsolt Kulcsar, DO, MPH, MBA, section chief at White Plains Hospital Physician Associates and physician lead of telehealth services and medical director at East Post Road Ventures in White Plains, New York.

The coronavirus disease 2019 (COVID-19) pandemic has brought telehealth to the forefront of modern medicine. Telemedicine in rheumatology, or telerheumatology, may be the future of diagnosis and treatment in rheumatology. In this 2-part episode series, we’re delving deeper into the world of telerheumatology, and asking, “Could this be the new normal?” Our featured guest is John K. Botson, MD, RPh, CCD, president of Alaska Rheumatology Alliance and rheumatologist at Orthopedic Physicians Alaska. 

COVID-19 has not only had a negative influence on the health of individuals globally, but it has also mentally and physically affected healthcare professionals. In this first episode, also in light of Mental Health Awareness Month, we discuss the effect of the pandemic specifically on the health of rheumatologists and rheumatology providers, and how this, in turn, may have an impact on clinical practices and delivering patient care. Featured guest is Max I. Hamburger, MD, Founder and Executive Chairman of United Rheumatology and Managing Partner of Rheumatology Associates of Long Island, as well as the President of the New York State Rheumatology Society. Dr. Hamburger can be reached at: maxhamburger@unitedrheumatology.com. For more, visit RheumatologyAdvisor.com or follow us on Twitter.

In this series, we look at emerging topics in the field of rheumatology from various experts. These perspectives may be related to the diagnosis and treatment of rheumatic diseases, current guidelines, practice management, patient care, and much more. Rheum Advisor on Air is the official podcast of Rheumatology Advisor, a leading publication founded by the Haymarket Medical Network.