Rheuminations

In this episode, we dive into the history of polymyalgia rheumatica, how it was discovered and its link to giant cell arteritis. Intro 0:01 In this episode 0:10 What is polymyalgia rheumatica (PMR)? 0:24 The history of PMR 02:12 PMR in the 1950s: A formally recognized disease 04:52 What was probably PMR in the 1880s 06:27 Naming PMR: Senile rheumatic gout 07:26 1957: The witch's shot and finally landing on polymyalgia rheumatica 08:30 Where is PMR coming from? 14:42 Injecting joins with saline 16:39 A biopsy study in 1964 19:54 Technetium bone scintigraphy in 1971 and bone scan history 23:01 First look at a PMR ultrasound in 1993 27:00 1997: First use of MRI on PMR patients in Italy 27:49 Going back to 1962: PMRs association with giant cell arteritis 30:40 A paper on muscular involvement in giant cell arteritis: 80-year-old ‘robust' partially blind seaman 32:15 First systematic approach: The link between PMR and giant cell arteritis 35:14 80 cases of PMR 38:13 Swedish autopsy studies 41:07 Introduction of advanced imaging in the 1990s 42:40 Summing up PMR through the decades 43:28 That is the end! 45:25 Thanks for listening 45:50 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: Bruk MI. Ann Rheum Dis. 1967;doi:10.1136/ard.26.2.103. Cantini F, et al. J Rheumatol. 2001;28(5):1049-55. De Miguel E, et al. Rheumatology (Oxford). 2024;doi:10.1093/rheumatology/kead189. Dixon AS, et al. Ann Rheum Dis. 1966;doi:10.1136/ard.25.3.203. Hamrin B, et al. Ann Rheum Dis. 1968;doi:10.1136/ard.27.5.397. Salvarani C, et al. Ann Intern Med. 1997;doi:10.7326/0003-4819-127-1-199707010-00005. Shah S, et al. Rheumatology (Oxford). 2025;doi:10.1093/rheumatology/keae569. Disclosures: Brown reports no relevant financial disclosures.

In the final part of this series, Joseph Parambil, MD, walks us through the approach of managing pulmonary hypertension, reviews the pathophysiology and digs into the mechanisms and the differences in the medications. Intro 0:12 In this episode 0:17 Interview with Joseph Parambil, MD 2:53 Reviewing and clarifying pathophysiology prior to initiating therapeutics 4:13 Evaluating patients in terms of their functional status and how does that play a role in initiating therapies 4:25 Vasoreactivity testing 10:21 The categories of medications 14:40 Endothelin receptor antagonists 37:07 TGF pathway 42:13 Scleroderma patient and treatment 50:19 Do patients get a repeat right-heart catheterization? 55:51 What about the TGF-beta? 56:55 Thank you, Dr. Parambil 58:34 Thanks for listening 59:17 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 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.

In this episode, we dive into the early therapies and how our understanding of vascular physiology drastically changed the management of pulmonary hypertension. Intro 0:12 In this episode 0:18 Recap of part 1 & 2 0:31 What part 3 is about 2:31 WHO conference in 1975: Treating pulmonary hypertension 3:48 The Discovery of Non-Steroidal Anti-inflammatory Drugs (NSAIDs), Part 1 5:20 Epoprostenol 6:18 Prostacyclin 10:37 Endothelin antagonists 11:41 Phosphodiesterase type 5 (PDE5) inhibitors 14:08 Interaction of nerves and blood vessels 15:06 The Soups VS the Sparks 17:36 A dreamed experiment 19:06 Acetylcholine 23:23  Enter “the calabar bean” 24:45 Acetylcholine and vasodilation: 1976 26:01 Rabbit aorta 27:45 Nitric oxide 29:38 Why are we using nitric oxide to treat pulmonary hypertension? 31:31 Tachyphylaxis 33:48 TNT factories 35:09 Nitrous oxide and tachyphylaxis 36:52 Pfizer in the 1980s 38:06 Understanding the trigger of pulmonary hypertension 40:53 PDE5 and nitric oxide and pulmonary hypertension 43:07 The end of the ripping yarns 44:20 Coming up in part 4 46:17 Thanks for listening 47:29 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: Bernard C. C R Soc Biol. 1851;3:163-164. Furchgott RF, et al. Nature. 1980;doi:10.1038/288373a0. Galiè N, et al. N Engl J Med. 2005;doi:10.1056/NEJMoa050010. Ghofrani HA, et al. Nat Rev Drug Discov. 2006;doi:10.1038/nrd2030. Giordano D, et al. Biochim Biophys Acta. 2001;doi:10.1016/s0167-4889(01)00086-6. Guthrie F. Q J Chem Soc. 1859;doi:10.1039/QJ8591100245. Higenbottam T, et al. Lancet. 1984;doi:10.1016/s0140-6736(84)91452-1. Marsh N, et al. Clin Exp Pharmacol Physiol. 2000;doi:10.1046/j.1440-1681.2000.03240.x. Montastruc JL, et al. Clin Auton Res. 1996;doi:10.1007/BF02281906. Nejad SH, et al. Future Cardiol. 2024;doi:10.1080/14796678.2024.2367390. Tansey EM. C R Biol. 2006;doi:10.10116/j.crvi.2006.03.012. Warren JV. Trans Am Clin Climatol Assoc. 1988;99:10-6. Disclosures: Brown reports no relevant financial disclosures.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 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.

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. 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.

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.  

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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

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! 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.

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. 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: 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. 

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

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.

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.

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. 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: 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.

This podcast series is sponsored by Vectra®. Discussion does not constitute or imply endorsement of the product. In this episode, Adam J. Brown, MD, and Leonard H. Calabrese, DO, discuss how rheumatologists can evaluate their patients for cardiovascular risk, how to counsel patients about risk factors, and the role of general wellness and wellbeing in the management of rheumatoid arthritis. Intro 0:11 Today's episode 0:32 Intro of Dr. Leonard H. Calabrese 0:48 How do you discuss cardiovascular risk with RA patients? 2:07 When do you bring up the topic of cardiovascular risk with a patient? 5:18 What lifestyle changes do you discuss with RA patients concerned about cardiovascular risk? 7:36 How do you address fatigue when discussing lifestyle adjustments with patients? 12:35 When fatigue lingers despite effective therapeutics 15:49 The importance of adopting wellness behaviors 18:00 Empowering patients to make lifestyle modifications 21:03 Thanks for listening 23:04

This podcast series is sponsored by Vectra®. Discussion does not constitute or imply endorsement of the product. In this episode, Adam J. Brown, MD, and Jeffrey Curtis, MD, discuss the multiple biomarkers associated with cardiovascular risk in rheumatoid arthritis, as well as the reasoning behind the development of a biomarker-based cardiovascular risk model.  Intro :10 Intro of Dr. Jeffrey Curtis :22 Today's episode :56 Tell us about your background and how you got to where you are? 3:29 What do rheumatologists need to be using other than existing score-based systems to predict cardiovascular risk? 5:06 Are traditional risk factor calculators helpful? What are they missing? 6:32 Considering disease level/activity when looking at overall cardiovascular risk 8:07 A high-level look at multiple biomarker-based tests 9:38 How were the 12 individual biomarkers originally selected? 11:42 How do you go about implementing the test? How do you get patients? 17:23 How is the test ordered and how do you walk a patient through it? 19:48 How is the timeframe based? 21:56 When are physicians ordering this test? 23:46 The use of biomarker information in educating patients about additional risk factors 26:36 What's going into the score generated by test? 27:36 How to use the resulting score in conversations with patients 28:19 Additional work and responsibility for rheumatologists as a result of this test being available 30:16 Thanks for listening 33:17 Additional work and responsibility for rheumatologists as a result of this test being available 31:45 Thanks for listening 34:50

This podcast series is sponsored by Vectra®. Discussion does not constitute or imply endorsement of the product. In this episode, Adam J. Brown, MD, and Jon Giles, MD, explore the history of cardiovascular risk in rheumatoid arthritis from the 1950s onward, including the emergence of data surrounding inflammation and cardiovascular disease, as well as the need for therapeutics that go beyond simply treating joint pain. Intro :11 Intro of Dr. Jon Giles :22 Today's episode 1:36 How did you become interested in cardiovascular disease in rheumatology? 2:18 When did cardiovascular risk become part of the discussion about RA? 4:33 How to follow patients over time and develop a better sense of cardiovascular risk through studies. 7:23 Are there unique cardiovascular risk factors among RA patients? 10:19 CRP levels as predictive of cardiovascular events 12:09 The biology behind cytokines associated with cardiovascular risk 14:22 Are current interventions and therapeutics making a difference? 16:27 General awareness among patients and physicians of cardiovascular disease and RA 18:29 Roles and responsibilities in cardiovascular risk management 21:15 How do we screen for cardiovascular risk beyond lipid panels? 22:27 Where is the field of cardiovascular risk and RA going? 24:01 Steroids, NSAID's, and cardiovascular risk 25:43 Episode wrap up 27:04 Thanks for listening 27:49

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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.

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

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

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.

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.