Podcasts about rheumatic diseases

Kaleb Michaud is a professor of rheumatology at the University of Nebraska Medical Center and the director of Spielbound Board Game Cafe.Michaud grew up in Kansas, where he developed a passion for music and astrophysics. He holds a bachelor's degree in physics from the University of Rochester and a PhD from Stanford University. When he was 3 years old, Michaud was diagnosed with rheumatoid arthritis, an autoimmune disease causing painful swelling and stiffness in joints and connective tissues. A doctor told Michaud's parents that he may not survive past his early 20s. Living with the chronic illness inspired Michaud's career change in 2001, when he returned to Kansas to work at the National Data Bank for Rheumatic Diseases. He joined the staff of UNMC in 2007 and is now a professor in the Division of Rheumatology and Director of the Rheumatology Fellowship Research ProgramMichaud is also a board game enthusiast with a personal collection of more than 6,000 games. He serves as the director of Spielbound, a nonprofit board game cafe he founded in 2014 at 33rd and Harney Streets.In this episode, Michaud and Michael Griffin are talking about Michaud's love of board games, how living with chronic pain inspired his rheumatology research and how he balances his diverse interests. 

In this episode, podcast host Mel Brooke, BIRDs Patient and Public Engagement Programme talks with Dr. Andrew Allard about Palindromic Arthritis. Andrew explains what Palindromic Arthritis is and when the term used. He talks about symptoms, treatments and a longer term outlook for people who have may have received this diagnosis.  Dr Allard is a Consultant Rheumatologist at the Royal National Hospital for Rheumatic Diseases, RUH Bath, the Lead Consultant for the Rheumatoid Arthritis service and Principle Investigator on Clinical Trials and Studies related to Rheumatoid Arthritis. He also runs subspecialty clinics in Early Inflammatory Arthritis and Psoriatic Arthritis, a weekly musculoskeletal ultrasound list and has an interest in immunotherapy-induced rheumatic disease.    Useful Links: Versus Arthritis Bath Institute for Rheumatic Diseases Podcasts  Connect with Us: Have questions or thoughts about our information Podcast library?  Interested in joining BIRDs patient research panel?  Email Mel at  ppe@birdbath.org.uk Be sure to subscribe, rate, and review the podcast to help us continue sharing information that matters! The Patient and Public Engagement Programme is supported by hands-off sponsorships from Eli Lilly and Company Limited, UCB and Amgen -all of whom have provided grant funding but who have were not involved in the development, content or editorial control of this podcast, nor the subsequent review and approval of these materials or general running of the patient and public engagement programme. We would also like to thank The Arnold Clark Community Fund, The Cumber Family Charitable Trust, Medlock Charitable Trust, The Ray Harris Charitable Trust and The Hospital Saturday Fund. Thank you to all our sponsors for helping us to bring you information that supports you and helps to increase your knowledge of rheumatic diseases. Please visit the⁠ ⁠⁠⁠⁠⁠⁠⁠BIRD website ⁠⁠⁠⁠⁠⁠⁠⁠ to sign up for news.

The Journal of Rheumatology's Editor-in-Chief Earl Silverman discusses this month's selection of articles that are most relevant to the clinical rheumatologist. Cardiovascular Events During Pregnancy: Implications for Adverse Pregnancy Outcomes in Individuals With Autoimmune and Rheumatic Diseases - doi.org/10.3899/jrheum.2024-0306 Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada Living Treatment Recommendations for the Management of Axial Spondyloarthritis - doi.org/10.3899/jrheum.2023-1237 Incidence of Pneumocystis jirovecii Pneumonia and Prophylaxis-Associated Adverse Events Among Patients With Systemic Lupus Erythematosus - doi.org/10.3899/jrheum.2023-1038 Epidemiological characteristics of patients with juvenile dermatomyositis in China: a multicenter study - doi.org/10.3899/jrheum.2024-0003 Knowledge of and Stated Adherence to the 2020 ACR Guideline for Gout Management: Results of a Survey of US Rheumatologists - doi.org/10.3899/jrheum.2023-0981

Yvonne C. Lee, MD, shares key takeaways from her ACR Convergence presentation on sleep disturbances in patients with rheumatoid diseases. Additionally, Dr. Lee gives an overview of the meeting's standout presentations.

Yvonne C. Lee, MD, shares key takeaways from her ACR Convergence presentation on sleep disturbances in patients with rheumatoid diseases. Additionally, Dr. Lee gives an overview of the meeting's standout presentations.

In the first episode of this two-part series, podcast host Mel Brooke, BIRDs Patient and Public Engagement Programme talks with Christopher Joyce, Extended Scope Podiatrist (MSK and Rheumatology), Homerton Healthcare NHS Foundation Trust, London. Episode one focusses on common foot and ankle problems and the Forefoot (toes and ball of foot). If you can please rate our podcasts on your listening platform. Useful Links: HCPC check the register RCOP “find a podiatrist” (and don't forget you can ask your GP or a member of your rheumatology team for advice) The Patient and Public Engagement Programme is supported by hands-off sponsorships from Eli Lilly and Company Limited, UCB and Amgen -all of whom have provided grant funding but who have were not involved in the development, content or editorial control of this podcast, nor the subsequent review and approval of these materials or general running of the patient and public engagement programme. We would also like to thank The Arnold Clark Community Fund, The Cumber Family Charitable Trust, Medlock Charitable Trust, The Ray Harris Charitable Trust and The Hospital Saturday Fund. Thank you to all our sponsors for helping us to bring you information that supports you and helps to increase your knowledge of rheumatic diseases. Please visit the ⁠⁠⁠⁠⁠⁠BIRD website ⁠⁠⁠⁠⁠⁠ for more podcasts.

In the second episode of this two-part series, podcast host Mel Brooke, BIRDs Patient and Public Engagement Programme talks with Christopher Joyce, Extended Scope Podiatrist (MSK and Rheumatology), Homerton Healthcare NHS Foundation Trust, London.  Episode two focusses on Midfoot (arch area)  and the Rearfoot (ankle) and questions sent in by BIRDs patient audience. If you can please rate our podcasts on your listening platform. Useful Links: HCPC check the register RCOP “find a podiatrist” (and don't forget you can ask your GP or a member of your rheumatology team for advice) The Patient and Public Engagement Programme is supported by hands-off sponsorships from Eli Lilly and Company Limited, UCB and Amgen -all of whom have provided grant funding but who have were not involved in the development, content or editorial control of this podcast, nor the subsequent review and approval of these materials or general running of the patient and public engagement programme. We would also like to thank The Arnold Clark Community Fund, The Cumber Family Charitable Trust, Medlock Charitable Trust, The Ray Harris Charitable Trust and The Hospital Saturday Fund. Thank you to all our sponsors for helping us to bring you information that supports you and helps to increase your knowledge of rheumatic diseases. Please visit the ⁠⁠⁠⁠⁠⁠BIRD website ⁠⁠⁠⁠⁠⁠ for more podcasts.

Jan Dutz, MD, FRCPC - Clinical Updates on Targeting IL-17 in Rheumatic Diseases: Striking at the Heart of Inflammatory Processes in PsA and axSpA

Join Professor Peter Nash from the Griffith University in Brisbane, and Professor Daniel Blockmans, from the Department of Internal Medicine at the University Hospitals Leuven, as they discuss his recent paper ‘Efficacy and safety of upadacitinib in patients with giant cell arteritis (SELECT-GCA): A double-blind, randomized controlled Phase 3 trial', published in Annals of the Rheumatic Diseases on June 2024.

Some families come together during traumatic times, and others drift apart. We all handle things differently in the best of times. During traumatic times, these differences can feel even bigger. The families that have the conversations - the uncomfortable conversations - learn how to navigate the unclear healing paths ahead. Together. Sisters Molly Cohen & Leslie Rott lost their father unexpectedly almost ten years ago. They had the conversations - and continue to have the conversations, and heal, together. On today's episode of The Be Ruthless Show, Molly and Leslie share their story of loss and their different paths towards healing. Respecting those differences led them to heal through writing, again together, in a co written / co authored chapter in Faces of Grief (available this December!) Connect with them both on social media and meet them in person at Pilates in the Park this August, and Healing Together Through the Holidays this December. Leslie Rott Leslie Rott has a master's degree and a PhD in Sociology from the University of Michigan, and a master's degree in Health Advocacy from Sarah Lawrence College. She was diagnosed with lupus and rheumatoid arthritis in 2008, at the age of 22. She is a blogger, e-patient, health activist, patient advocate, healthcare disruptor, sociologist, and writer. She authors the blog Getting Closer to Myself (www.gettingclosertomyself.blogspot.com) and has contributed to a variety of other health-related sites, including CreakyJoints, Health Central, Health Line, Lupus News Today, Mango Health, and Rheumatoidarthritis.net. Leslie's story has been featured in the U.S. Pain Foundation Invisible Project: RA/RD Edition, Women's Health magazine (twice!), Real Life Diaries: Living with Rheumatic Diseases, and on a jacket, “Double Major,” that she proudly wears as a member of the Walking Gallery of Healthcare. She currently works as the Compliance & Experience Officer at a community healthcare company in Royal Oak, Michigan. Leslie lives in Beverly Hills, Michigan, with her son and husband. Molly Cohen Molly Cohen is a graduate student at Sara Schenirer/Yeshiva University's Wurzweiler School of Social Work. She received her bachelor of arts in Spanish with a minor in biology from Wayne State University. She is passionate about perinatal and maternal mental health and helping others through some of life's most difficult moments. Although she is unsure of her future career, she is grateful for the opportunity to find her path through social work. She interned at Jewish Family Service of Metro Detroit and is currently interning at a Perinatal and Youth mental health clinic. Molly lives in Southfield, Michigan, with her husband and daughter. Remember that you can reach out anytime - with questions, feedback, to work with me, for referrals and resources, and just for support and connection: sam@samantharuth.com Join the Griefhab Community: https://www.facebook.com/groups/griefhab7/ Join Team Ruthless for SIX support groups EVERY week PLUS EVERY holiday: https://samantharuth.com/team-ruthless Learn more about Pilates in the Park: https://www.eventbrite.com/e/926158042637?aff=oddtdtcreator Learn more about Healing Together Through the Holidays: https://samantharuth.com/healing-together-through-holidays

In this information podcast episode, host Mel Brooke on behalf of BIRDs Patient and Public Engagement Programme, talks about Pagets Disease of the Bone with expert guest Dr Sarah Hardcastle, a Consultant Rheumatologist at the RNHRD, RUH Bath who explains what  Pagets Disease is, talks through the symptoms that people can experience and how people are diagnosed with the condition, available treatment options and more. If you can please rate our podcasts on your listening platform. Useful Links: Please visit the ⁠⁠⁠BIRD website ⁠⁠⁠ for more podcasts  ·      Pagets association (they also have online peer groups) RNHRD is now a Center of Excellence for this association. ·      Versus Arthritis ·      RNHRD website Please note: All content for BIRD's PPE podcasts are created for information purposes only and not intended to be a substitute for individual medical advice, diagnosis, or treatment. Always seek the advice of your physician or health provider with any questions you may have about your medical condition. Reliance on any information provided by BIRD or any of the expertpodcast guests is solely at your own risk. The Patient and Public Engagement Programme is supported by hands-off sponsorships from Eli Lilly and Company Limited, UCB and Amgen -all of whom have provided grant funding but who have were not involved in the development, content or editorial control of this podcast, nor the subsequent review and approval of these materials or general running of the patient and public engagement programme. We would also like to thank The Arnold Clark Community Fund, The Cumber Family Charitable Trust, Medlock Charitable Trust, The Ray Harris Charitable Trust and The Hospital Saturday Fund. Thank you to all our sponsors for helping us to bring you information that supports you and helps to increase your knowledge of rheumatic diseases. To find out more about BIRD and the PPE Programme visit:  ⁠⁠⁠⁠⁠The Bath Institute for Rheumatic Diseases⁠⁠⁠⁠⁠

In this fascinating episode recorded at #BSR24, Dr Melanie Sloan joins Prof Ernest Choy to discuss the latest results from the INSPIRE study, which seeks to understand neuropsychiatric symptom prevalence and impact in people with systemic autoimmune rheumatic diseases (SARDs). Dr Melanie Sloan is a researcher in the Department of Public Health and Primary Care at the University of Cambridge. Her research focuses on improving patient-clinician relationships, as well as trialling interventions for patients with SARDs.  Want to find out more about Melanie's research? Here's your further reading list: Prevalence and identification of neuropsychiatric symptoms in SARDs Neuropsychiatric symptoms in lupusAttribution of neuropsychiatric symptoms and prioritisation of evidence in lupusProdromal neuropsychiatric symptoms in lupusKeywords: autoimmune diseases, lupus, rheumatology, nightmares, daymares, mental health, psychosis, communication. Thanks for listening to Talking Rheumatology Research! Join the conversation on Twitter using #TalkingRheumResearch, tweet us @RheumJnl, or find us on Instagram. Want to read more rheumatology research? Explore Rheumatology and Rheumatology Advances in Practice.

What is the link between artificial nighttime outdoor light, air pollution, and stroke? Find out about this and more in today's PeerDirect Medical News Podcast.

Tra inquinamento atmosferico e salute delle ossa potrebbe esserci una relazione molto stretta. Questo è quanto suggerisce uno studio pubblicato sugli Annals of the Rheumatic Diseases che commentiamo a Obiettivo Salute con il prof. Andrea Giustina, primario dell'Unità di Endocrinologia dell'IRCCS Ospedale San Raffaele di Milano e professore Ordinario di Endocrinologia e Malattie del Metabolismo all'Università Vita-Salute San Raffaele di Milano

Join Professor Peter Nash from the Griffith University in Brisbane, as well as Professors Andrew Cope, Professor of Rheumatology and Head of the Centre for Rheumatic Diseases at Kings College London, Professor Paul Emery, Clinical Professor and Director of the Leeds Biomedical Research Centre, and Professor John Isaacs, Professor of clinical immunology and Director of Newcastle Biomedicine Versus Arthritis Experimental Arthritis Treatment Centre. Together they discuss the recent paper ‘Abatacept in individuals at high risk of rheumatoid arthritis (APIPPRA): a randomised, double-blind, multicentre, parallel, placebo-controlled, phase 2b clinical trial', published in The Lancet on 13th February 2024.

In this podcast in our wellbeing series aimed at helping people who have rheumatic conditions with aspects of symptom self-management and wellbeing, Mel Brooke, Patient and Public Engagement Programme Director (BIRD) invites Professor Emma Dures to talk about the impact of rheumatic disease on people's mental health. Useful Links: Please visit the ⁠⁠BIRD website ⁠⁠ for more podcasts including Social Prescribing NHS Talking Therapies Tips from NRAS Versus Arthritis: Arthritis and Depression Please note: All content for BIRD's PPE podcasts are created for information purposes only and not intended to be a substitute for individual medical advice, diagnosis, or treatment. Always seek the advice of your physician or health provider with any questions you may have about your medical condition. Reliance on any information provided by BIRD or any of the expertpodcast guests is solely at your own risk. The Patient and Public Engagement Programme is supported by hands-off sponsorships from Eli Lilly and Company Limited, UCB and Amgen -all of whom have provided grant funding but who have had no involvement in the development, content or editorial control of this podcast, nor the subsequent review and approval of these materials or general running of the patient and public engagement programme. We would also like to thank The Arnold Clark Community Fund, The Cumber Family Charitable Trust, Medlock Charitable Trust, The Ray Harris Charitable Trust and The Hospital Saturday Fund. Thank you to all our sponsors for helping us to bring you information that supports you and helps to increase your knowledge of rheumatic diseases. To find out more about BIRD and the PPE Programme visit:  ⁠⁠⁠⁠The Bath Institute for Rheumatic Diseases⁠⁠⁠⁠ Please sign up to our mailing list if you would like to stay in touch and be notified about future podcasts via admin@birdbath.org.uk

Join Pierre and Barbara as they interview Prof. Yukinori Okada about his groundbreaking study on immune diversity in rheumatic disorders through immunophenotyping. Be inspired by his career journey and discover the exciting prospects of using big data to enhance rheumatology outcomes. Don't miss it – tune in now! Editorial Team: Dr Bayram Farisogullari, Dr Renske Meijer, Dr Olivier Fakih, Dr Mrinalini Dey

Join us for the latest axSpA podcast brought to you by the CSF! This month Dr Sofia Ramiro, consultant rheumatologist and senior researcher at Leiden University Medical Centre and Zuyderland Medical Centre, is joined once again by experts with a wealth of clinical knowledge. Joining her is Hideto Kameda, Professor of Internal Medicine at Toho University as well as Atul Deodhar, Professor of Medicine and Medical Director of Rheumatology Clinics in the Division of Arthritis & Rheumatic Diseases at Oregon Health & Science University in Portland, USA. Also joining this insightful group is Xenofon Baraliakos, Professor of Internal Medicine and Rheumatology at the Ruhr-University in Bochum, and Medical Director of the rheumatology centre Rheumazentrum Ruhrgebiet in Herne, Germany In the first paper discussed, the authors compared the efficacy and safety of bimekizumab with biologic/targeted synthetic disease-modifying antirheumatic drugs in nr-axSpA and AS. Our second paper then goes on to identify distinct clinical clusters based on patient demographics and baseline clinical indicators from the clinical development programme of secukinumab in patients with a variety of rheumatological conditions.

Arthritis can impact quality of life, and really affects day to day living when you are in a flare. What types of arthritis are there? What happens when an individual is in a flare with their arthritis? How do they cope through the day? Are there ways to eat that help symptoms? Are there specific foods that can make arthritis pain worse or better? What types of nutrients are helpful and are there any supplements to consider for someone living with the pain and heat of arthritis? All these questions are discussed (and more) on today's lively episode, as Sandra and Rob interview guest expert, dietitian Samantha Holmgren, RD, who has been living with arthritis for over a decade and helps sufferers with living a life with more intention and self-management to help take control of their condition. ⁠⁠Samantha Holgren, RD⁠⁠ has a course for sufferers with all types of arthritis pain "Anti-inflammatory Path to Wellness"⁠⁠ Study mentioned by Samantha:⁠⁠ ⁠⁠Omega-3 Fatty Acids in Rheumatic Diseases⁠⁠, Journal of Clinical Rheumatology Magic School Bus: https://youtu.be/M4N_JVaGgx4?si=0nQUBJJw1dT76AWi Enjoying the show? Consider leaving a 5 star review (if you loved it!), and/or sharing this episode with your friends and family :) Don't forget to visit our social media pages as well. You can find us on Facebook, Instagram, and YouTube. Your support helps fuel the stoke and keeps the show going strong every week. Thanks! Website: www.mywifethedietitian.com Email: mywifetherd@gmail.com

CME credits: 4.25 Valid until: 31-10-2024 Claim your CME credit at https://reachmd.com/programs/cme/pulmonary-hypertension-in-rheumatic-diseases-part-2/16329/ This year's West Regional PH Summit occurred on September 9, 2023, in Los Angeles, CA. Over a dozen regional faculty presented key topics impacting clinical practice and PH patient outcomes. The following topics were discussed at the event: Important advancements and updates across the PH disease spectrum The latest ERS/ESC guidelines for diagnosing and treating PH Critical advancements in screening, diagnosis, and treatment of CTEPH/CTED, lung disease-associated PAH, and CTD-associated PAH Real-world examples and data related to all discussion topics

CME credits: 4.25 Valid until: 31-10-2024 Claim your CME credit at https://reachmd.com/programs/cme/pulmonary-hypertension-in-rheumatic-diseases-part-1/16328/ This year's West Regional PH Summit occurred on September 9, 2023, in Los Angeles, CA. Over a dozen regional faculty presented key topics impacting clinical practice and PH patient outcomes. The following topics were discussed at the event: Important advancements and updates across the PH disease spectrum The latest ERS/ESC guidelines for diagnosing and treating PH Critical advancements in screening, diagnosis, and treatment of CTEPH/CTED, lung disease-associated PAH, and CTD-associated PAH Real-world examples and data related to all discussion topics

Professor Hideto Kameda, Professor of Internal Medicine at Toho University in Japan, is joined by Professor Xenofon Baraliakos, Professor of Internal Medicine and Rheumatology at the Ruhr-University in Bochum, and a senior consultant and scientific coordinator of the rheumatology centre Rheumazentrum Ruhrgebiet in Herne, Germany, Dr Sofia Ramiro, consultant rheumatologist and senior researcher at Zuyderland Medical Centre and Leiden University Medical Centre in the Netherlands as well as, Atul Deodhar Professor of Medicine and Medical Director of Rheumatology Clinics in the Division of Arthritis & Rheumatic Diseases at Oregon Health & Science University in Portland, USA, to discuss the safety and efficacy of Upadacitinib. The first paper evaluated the 52-week safety, tolerability, and efficacy of updacitinib in the SELECT-AXIS 2 study in patients with AS and an inadequate response to bDMARDs and the second paper then goes on to describe, via a narrative review, the safety and efficacy of updacitinib in axSpA

Dr Sofia Ramiro, consultant rheumatologist and senior researcher at Zuyderland Medical Centre and Leiden University Medical Centre in the Netherlands, is joined by Professor Hideto Kameda, Professor of Internal Medicine at Toho University and Atul Deodhar, Professor of Medicine and Medical Director of Rheumatology Clinics in the Division of Arthritis & Rheumatic Diseases at Oregon Health & Science University in Portland, USA to discuss the Efficacy and Safety of Ixekizumab & Tildrakizumab. In the first paper discussed, it describes the safety and efficacy of ixekizumab treatment in patients with r-axSpA and nr-axSpA for up to 156 weeks. The second study discussed goes on to assess the safety and efficacy of tildrakizumab in patients with active AS.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, the precise cause of which is still unclear. Professor Shunichi Shiozawa from Kobe University, Japan, uncovers the underlying cellular and molecular mechanisms of systemic autoimmunity and identifies a novel key player. Shiozawa demonstrates that overstimulation of the host's immune system by an immunogenic pathogen kickstarts the generation of new T lymphocytes, which induce SLE and could be a future target of SLE cell therapies.Read more in Research Outreach: doi.org/10.32907/RO-136-4710684972Read the original research: doi.org/10.1016/j.isci.2021.103537

Episode 146: RA vs OA    Future Dr. Magurany explains how to differentiate rheumatoid arthritis from osteoarthritis.  Written by Thomas Magurany, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.1. Etiology: Rheumatoid Arthritis (RA): RA is an autoimmune disease wherein the immune system mistakenly attacks healthy tissues, particularly the synovial joints, usually between the ages of 30-50. Genetic predisposition, environmental factors such as smoking or infections, hormonal imbalances, and lower socioeconomic status have been associated with an increased risk of developing RA(1).Osteoarthritis (OA): OA primarily arises due to mechanical stress on the joints over time. Factors contributing to OA include age, obesity, joint injury or trauma, repetitive joint use or overuse, genetic abnormalities in collagen structure, and metabolic disorders affecting cartilage metabolism (2).The greatest risk factor for the development of OA is age with most patients presenting after 45 years of age. The greatest modifiable risk factor for OA is weight. People with a BMI >30 were found to have a 6.8 times greater risk of developing OA. (3) Primary OA is the most common and is diagnosed in the presence of associated risk factors such as: older age, female gender, obesity, anatomical factors, muscle weakness, and joint injury (occupation/sports activities) in the absence of trauma or disease. Secondary OA occurs alongside a pre-existing joint deformity including trauma or injury, congenital joint disorders, inflammatory arthritis, avascular necrosis, infectious arthritis, Paget disease, osteopetrosis, osteochondritis dissecans, metabolic disorders (hemochromatosis, Wilson's disease), Ehlers-Danlos syndrome, or Marfan syndrome.2. Pathogenesis:Rheumatoid Arthritis (RA):In some patients, RA is triggered by some sort of environmental factor in a genetically predisposed person. The best example is tobacco use in a patient with HLA-DRB1. The immune response in RA starts at sites distant from the synovial joints, such as the lung, gums, and GI tract. In these tissues, modified proteins are produced by biochemical reactions such as citrullination. (4)In RA, an abnormal immune response leads to chronic inflammation within the synovium lining the joints. The inflammatory cytokines released cause synovitis and lead to the destruction of articular cartilage and bone erosion through pannus formation. Immune cells infiltrate the synovium causing further damage. (4) In summary: formation of antibodies to citrullinated proteins, these antibodies begin attacking wrong tissues.Osteoarthritis (OA):The primary pathological feature of OA is the degeneration of articular cartilage that cushions the joints causing surface irregularity, and focal erosions. These changes progress down the bone and eventually involve the entire joint surface. Mechanical stress triggers chondrocyte dysfunction, leading to an imbalance between cartilage synthesis and degradation that cause cartilage outgrowths that ossify and form osteophytes. This results in the release of enzymes that degrade the extracellular matrix, leading to progressive cartilage loss. As more of the collagen matrix is damaged, chondrocytes undergo apoptosis. Improperly mineralized collagen causes subchondral bone thickening; in advanced disease, bone cysts infrequently occur (5). In summary: Osteophytes formation and cartilage loss.3. Clinical Presentation:Rheumatoid Arthritis (RA):The most common and predominant symptoms include joint pain and swelling, usually starting insidiously over a period of weeks to months. RA typically affects multiple joints symmetrically, commonly involving small joints of the hands, wrists, feet and progresses to involve proximal joints if left untreated. Morning stiffness lasting more than an hour is a characteristic feature. The affected joint will be painful if pressure is applied to the joint or on movement with or without joint swelling. Synovial thickening with a "boggy" feel on palpation will be noted. The classical physical findings of ulnar deviation, metacarpophalangeal joint subluxation, swan neck deformity, Boutonniere deformity, and the "bowstring" sign (prominent and tight tendons on the dorsum of the hand) are seen in advanced chronic disease. (4) Around ¼ of patients with RA may present with rheumatoid noduleswhich are well demarcated, flesh-colored subcutaneous lumps. They are usually described as being doughy or firm and are not typically tender unless they are inflamed. They are usually found on areas susceptible to repeated trauma or pressure and include the elbows, fingers and forearms. Osteoarthritis (OA):OA primarily affects weight-bearing joints such as knees, hips, spine, and hands. Symptoms include joint pain aggravated by activity and relieved with rest, morning stiffness lasting less than 30 minutes, joint swelling due to secondary inflammation, and occasionally the formation of bony outgrowths called osteophytes (6). Tenderness may be present at joint lines, and there may be pain upon passive motion. Classic physical exam findings in hand OA include Heberden's nodes (posterolateral swellings of DIP joints), Bouchard's nodes (posterolateral swellings of PIP joints), and “squaring” at the base of the thumb (first Carpal-Metarcapal or CMC joints), bony enlargement, crepitus, effusions (non-inflammatory), and a limited range of motion. Patients may also experience bony swelling, joint deformity, and instability (patients complain that the joint is “giving way” or “buckling,” a sign of muscle weakness). (5)4. Lab findings:Rheumatoid Arthritis: Laboratory testing often reveals anemia of chronic disease (increased ferritin, decreased iron and TIBC) and thrombocytosis. Neutropenia may be present if Felty syndrome is present. RF is present in 80-90% of patients with a sensitivity of 69%. In patients who are asymptomatic or those that have arthralgias, a positive RF and especially CCP predicts the onset of clinical RA. Patients with RA with RF, ACPA, or both are designated as having seropositive RA. About 10% of RA patients are seronegative. ESR and levels of CRP are usually elevated in patients with active disease and can be used to assess disease activity. The synovial fluid in RA will also reveal low C3 and C4 levels despite elevated serum levels.(4) Some non-specific inflammatory markers such as ESR, CRP can help you guide your diagnosis of RA.Osteoarthritis:Lab findings are not significant. Clinical diagnosis if the following are present: 1) pain worse with activity and better with rest, 2) age more than 45 years, 3) morning stiffness lasting less than 30 minutes, 4) bony joint enlargement, and 5) limitation in range of motion. Blood tests such as CBC, ESR, rheumatoid factor, ANA are usually normal but usually ordered to rule out an inflammatory process. Synovial fluid should show a white blood cell count less than 2,000/microL, predominantly mononuclear cells (non-inflammatory). X-rays of the affected joint can show findings consistent with OA, such as marginal osteophytes, joint space narrowing, subchondral sclerosis, and cysts; however, radiographic findings do not correlate to the severity of the disease and may not be present early in the disease. (5)5. Treatment Approaches:Rheumatoid Arthritis (RA):There is no cure for RA.The goal of treatment in RA is inducing remission and optimizing quality of life. This is initially done by beginning DMARDs, include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide. Methotrexate is the initial DMARD of choice. Anti-TNF-alpha inhibitors include etanercept, infliximab, adalimumab, golimumab, and certolizumab may be used if DMARDs fail. NSAIDs are used to control joint pain and inflammation. Corticosteroids may be used as a bridge therapy to DMARDs in a newly diagnosed patient with a very active disease. (7) Coronary artery disease has a strong association with RA. RA is an independent risk factor for the development of coronary artery disease (CAD) and accelerates the development of CAD in these patients. Accelerated atherosclerosis is the primary cause of morbidity and mortality. There is increased insulin resistance and diabetes mellitus associated with RA and is thought to be due to chronic inflammation. When treated with specific DMARDs such as hydroxychloroquine, methotrexate, and TNF antagonists, there was a marked improvement in glucose control in these patients. (8) RA is not just a disease of the joints, it is able to affect multiple organ systems.Osteoarthritis (OA):OA treatment aims at reducing pain and improving joint function through a combination of non-pharmacological interventions like exercise programs tailored to strengthen muscles around affected joints, weight management strategies, and assistive devices like braces or walking aids if required (9). Medications including analgesics or nonsteroidal anti-inflammatory drugs may be prescribed for pain relief when necessary. Duloxetine has modest activity in relieving pain associated with OA. Intraarticular glucocorticoid joint injections have a variable response but are an option for those wanting to postpone surgical intervention. In severe cases where conservative measures fail, surgical options like joint replacement may be considered (9). Weight loss is a critical intervention in those who have overweight and obesity; each pound of weight loss can decrease the load across the knee 3 to 6-fold. (5) Summary: Medications (NSAIDs, topical, duloxetine), weight loss, PT, intraarticular injections of corticosteroids, and joint replacement.________________________________Conclusion: Now we conclude episode number 146, “RA vs. OA.” Future Dr. Magurany explained that rheumatoid arthritis is an autoimmune disease that presents with joint pain and inflammation, mostly on hands and small joints, accompanied by morning stiffness longer than 1 hour. The rheumatoid factor and ACPA may be positive in a percentage of patients but not always. The base of treatment is early treatment with disease-modifying antirheumatic drugs to induce remission of the disease. OA affects weight-bearing joints with little to no inflammation, treatment is mainly lifestyle modifications, analgesics, intraarticular injections, and joint replacement.This week we thank Hector Arreaza and Thomas Magurany. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Myasoedova E, Crowson CS & Gabriel SE et al. (2010). Is the incidence of rheumatoid arthritis rising?: Results from Olmsted County, Minnesota, 1955-2007. Arthritis and Rheumatism, 62(6), 1576-1582.Goldring MB & Goldring SR. (2007). Osteoarthritis. Journal of Cellular Physiology, 213(3), 626-634.King LK, March L, Anandacoomarasamy A. Obesity & osteoarthritis. Indian J Med Res. 2013;138(2):185-93. PMID: 24056594; PMCID: PMC3788203.Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.Sen R, Hurley JA. Osteoarthritis. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.Hunter DJ, Bierma-Zeinstra S. & Eckstein F. (2014). OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for primary hip and knee osteoarthritis: An expert consensus initiative of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) Task Force in collaboration with the Osteoarthritis Research Society International (OARSI). Osteoarthritis Cartilage, 22(7), 363-381.van Everdingen AA, Jacobs JW, Siewertsz Van Reesema DR, Bijlsma JW. Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Ann Intern Med. 2002 Jan 1;136(1):1-12. doi: 10.7326/0003-4819-136-1-200201010-00006. PMID: 11777359.Nicolau J, Lequerré T, Bacquet H, Vittecoq O. Rheumatoid arthritis, insulin resistance, and diabetes. Joint Bone Spine. 2017 Jul;84(4):411-416.Fernandes L, Hagen KB, Bijlsma JWJ et al. (2019). EULAR recommendations for non-pharmacological core management of hip and knee osteoarthritis. Annals of Rheumatic Diseases, 79(6), 715-722.Royalty-free music used for this episode: "Driving the Point." Downloaded on July 29, 2023, from https://www.videvo.net/ 

Professor Peter Nash from the Griffith University in Brisbane, is joined by Dr Mark Russell, a clinical research fellow at the Centre for Rheumatic Diseases, King's College London to discuss his recent paper 'JAK inhibitors and the risk of malignancy: a meta-analysis across disease indications'.

This episode's guest is Dr Taher Mahmud, Co-Founder and Director of London Osteoporosis Clinic. Dr Mahmud trained at King's College Hospital, St Thomas' Hospital, and Guy's Hospital, and has extensive experience as an Honorary Consultant at the Royal National Hospital for Rheumatic Diseases in Bath and as Lead for Osteoporosis and Consultant Rheumatologist at Tunbridge Wells Hospital NHS Trust. He is committed to improving patient outcomes and eradicating osteoporosis-related suffering through his interests in holistic osteoporosis treatments, bone health advocacy, and patient feedback. Dr. Mahmud's MD and MSc research focused on drug side effects and he leads LOC with compassion and innovation. Dr Irene and Dr Mahmud discuss his choice of work in Rheumatology and Osteoporosis, the importance of bone health, treatments and lifestyle changes and early diagnosis. KEY TAKEAWAYS Dr Mahmud hopes to get people to get Osteoporosis diagnosed early so effective treatments to reverse the condition can be applied. Bone health is important for all generations to consider not just the elderly. You should eat healthily, avoid smoking and drinking, maintain a healthy weight and get regular exercise to keep your bone health from degrading in the long term. Dr Mahmud concentrates on transformational care which includes not just drugs but lifestyle changes. BEST MOMENTS‘We are really hoping that people can take an interest in their bone health at an earlier age so it doesn't result in any issues so we set up a foundation called Global Osteoporosis Foundation.'-Dr Mahmud‘If you had Rheumatoid Arthritis as a diagnosis some years ago it was tantamount to having severe coronary artery disease or a severe malignancy. Now..make the diagnosis very early we have very effective treatments.'-Dr Mahmud ‘If we can come from a place of service and abundance it helps us be our purpose and if people are helped then fantastic.'-Dr Mahmud‘Our main thing is not to incur an injury. If you have an injury it causes a whole bunch of other disruption and impacts your energy and your thinking and so on. Exercise definitely. Careful exercise.'-Dr Mahmud GUEST RESOURCEShttps://www.londonosteoporosisclinic.comGlobal Osteoporosis Foundation (Sticks and Stones) VALUABLE RESOURCESJoin Patreon : http://www.patreon.com/drirenechingInstagram: irene.ching.777Tiktok: @ireneching777Youtube channel: Dr Irene ChingTwitter: @ireneching7777Clubhouse: @ireneching1 https://www.facebook.com/irene.ching.735LinkedIn : https://www.linkedin.com/in/irene-ching-742623219 ABOUT THE HOSTDr Irene Ching is a medical practitioner who specialises in Family Medicine, Wealth and Life Coach, Property/ Business Investor, Speaker, and Podcaster : Be Happy, Healthy and Wealthy. Dr Ching speaks on health, wellness and wealth in talks, workshops and events. She has her own coaching programme on money mindset - Quantum Wealth Creation Accelerator (online course with weekly coaching). She approaches health and well-being in a holistic way and encourages people to look at all the areas of their lives. In her coaching sessions, she works with emotional freedom techniques, energy works, NLP, Intuition/ Superconscious mind, Inner child healing, Timeline therapy, Self love works, behavioural change, goal settings and money attraction healing. Her motto: Reset Your Mind, Reset Your life.The podcast Be Happy Healthy and Wealthy is aimed at people who want to be high achievers who perform at their peak performance in all aspects of life. It is about how we could be happy regardless of our circumstances, and to understand the secrets to real health and wealth; especially how to live a prosperous long life. She has been interviewing successful entrepreneurs, keynote speakers, influencers and millionaires on this important subject. So stay tuned to get the deep dive on how to be happy, healthy and wealthy- the million dollar questions!

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.

Does a 4th dose of vaccine significantly reduce COVID-19 risk in patients with rheumatic diseases? Find out about this and more in today's PVRoundup podcast.

In this podcast, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the February 2023 issue of DTB. They discuss concerns over a national initiative in England to transfer people with atrial fibrillation to edoxaban from other DOACs (https://dtb.bmj.com/content/61/2/18). They review a study that examined whether the correct dose of DOAC was used in people with renal impairment (https://dtb.bmj.com/content/61/2/21). They talk about the use of empagliflozin in people with heart failure (https://dtb.bmj.com/content/61/2/22) and finish with an overview of an article that discusses prescribing for pregnancy for those with inflammatory rheumatic disease (https://dtb.bmj.com/content/61/2/24). 60th anniversary interview with Dr John Dowden: https://soundcloud.com/bmjpodcasts/dtb-60th-anniversary-podcast-interview-john-dowden Trends in direct oral anticoagulant (DOAC) prescribing in English primary care (2014–2019): https://heart.bmj.com/content/109/3/195 The contact address for the DTB team is dtb@bmj.com. Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). Thank you for listening.

Identify the most common pediatric rheumatic diseases.Review how the treatment of common pediatric rheumatic diseases impacts standard childhood healthcare.

Join the Sanders Sisters as they welcome the holidays and the last episode of their first season of Floss & FlipFlops! In this episode, the sisters discuss the 12 medical conditions on Santa's list that can indicate a bigger systemic complication, and how you can integrate your knowledge of these conditions in helping your patients achieve lifelong health! Floss and Flip-Flops with the Sanders sisters features hosts dental hygienist and speaker Katrina M. Sanders, RDH, and podiatrist Dr Elizabeth Sanders, DPM. Together, the sisters discuss the oral-systemic link and its impact—from your teeth down to your toes. The podcast is produced monthly by Dental Products Report® and Modern Hygienist®, in partnership with The Sanders sisters. For additional content for dental professionals visit DPR and MH at dentalproductsreport.com. Katrina Sanders, RDH, can be reached at:  Website: katrinasanders.com Facebook Instagram LinkedIn EPISODE 12 REFERENCES: Tattersall, M. C., et. al. (2015). Asthma Predicts Cardiovascular Disease Events: The Multi-Ethnic Study of Atherosclerosis. Arteriosclerosis, Thrombosis, and Vascular Biology, 35(6), 1520-1525. Yeh, E. T. H., & Bickford, C. L. (2009). Cardiovascular Complications of Cancer Therapy: Incidence, Pathogenesis, Diagnosis, and Management. J Am Coll Cardiol, 53(24), 2231-2247. Chaikriangkrai, K., et. a l. (2015). Additive prognostic value of coronary artery calcium score and renal function in patients with acute chest pain without known coronary artery disease: up to 5-year follow-up. Int J Cardiovasc Imaging. 31(8), 1619-1626. Liu, Y., et. al. (2014). Kidney Stones and Cardiovascular Risk: A Metaanalysis of Cohort Studies. Am J Kidney Dis, 64(3), 402-410. Uddin, S. M. I., et. al. (2018). Erectile Dysfunction as an Independent Predictor of Future Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis. Circulation. doi:10.1161/circulationaha.118.033990 Clarson, L. E., et. al. (2015). Increased risk of vascular disease associated with gout: a retrospective, matched cohort study in the UK Clinical Practice Research Datalink. Annals of the Rheumatic Diseases, 74(4), 642-647 Beckman, J., Duncan, M., et al. HIV and PAD. March 12, 2018.  Circulation; 10.1161.117.032647 van Nimwegen, F. A., et. al. (2015). Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk. JAMA Intern Med. doi: 10.1001/jamainternmed.2015.1180 Rodondi, N., et al. (2010). Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA, 304(12), 1365-1374. Larsson Susanna, C., et. al. (2019) Thyroid Function and Dysfunction in Relation to 16 Cardiovascular Diseases: A Mendelian Randomization Study. Circulation: Genomic and Precision Medicine, 0(0). doi:10.1161/CIRCGEN.118.002468 Adelborg, K., et. al. (2018). Migraine and risk of cardiovascular diseases: Danish population based matched cohort study. Bmj, 360. doi:10.1136/bmj.k 96 Chapple ILC, Potential mechanisms underpinning the nutritional modulation of periodontal inflammation.  J Am Dent Assoc. 2009; 140 (2): 178-184. Hujoel P. Dietary carbohydrates and dental-systemic diseases.  J Dental Res. 2009; 88 (6): 490-502. Lee M, et al "Current Helicobacter pylori infection is significantly associated with subclinical coronary atherosclerosis in healthy subjects: A cross-sectional study" PloS One 2018; 13(3): e0193646. Shah NH, LePendu P., Bauer-Mehren A., et al. (June 10, 2015). Proton Pump Inhibitor Usage and the risk of MI in the general population. LLoS ONE 10(6). Mercado FB, Marshall RI, Bartold PM. Inter-relationships between rheumatoid arthritis and periodontal disease. A Review. J Clin Periodontol 2003; 30: 761-772.

Advancing Telehealth in Rheumatology Dr. Cush at ACR22 Convergence in Philadelphia, PA. Artificial Intelligence in Detecting Sacroiliitis Dr. Akhil Sood discusses Abstract 0383 at ACR22 Convergence. Abstract 0383: Analysis of the Performance of an Artificial Intelligence Algorithm for the Detection of Radiographic Sacroiliitis in an Independent Cohort of axSpA Patients Including Both Nr-axSpA and r-axSpA COVID HighlightsDr. Leonard Calabrese and Dr. Cassandra Calabrese share highlights on COVID data being presented at ACR22 Convergence Abstract 0793: Autonomic Nervous System Dysfunction Common Among Patients with Long COVID: An Exploratory Evaluation Abstract L08: Breakthrough Acute COVID-19 Infection During the US Omicron Surge Following Administration of Tixagevimab/Cilgavimab in Immunocompromised Patients with Rheumatologic Disorders Impact of COVID 19 on Pregnancies in Women with RMD Dr. Cassy Sims discusses abstract 0950 at ACR22 Convergence. Abstract 0950: Obstetric Outcomes in Women with Rheumatic Disease and COVID-19 in the Context of Vaccination Status: Data from the COVID-19 Global Rheumatology Alliance Registry Photovoice: A New Visual Research Method in Lupus Dr. Bella Mehta talks with Dr. Candace Feldman about Abstract 1099 at ACR22 Convergence. Abstract 1099: Empowering Patients with Lupus Through Their Photographs: Application of the Photovoice Method to Understand Social Determinants of Health Prescribing Methotrexate in Post-Roe Era Dr. Cassy Sims reports live from ACR22 Convergence in Philadelphia, PA.3 L09: Impact on Access to Methotrexate in the Post-Roe Era Treatment Persistence and Switching Patterns of an Adalimumab Biosimilar Dr. Julian Segan discusses Abstract 1425 at ACR22 Convergence. Abstract 1425: Treatment Persistence and Switching Patterns of ABP 501 (AMGEVITA®) in German Patients with Rheumatic Diseases          

Neste episódio, contamos com a participação da Dra. Adriana Maria Kakehasi, professora associada de Reumatologia da Faculdade de Medicina da Universidade Federal de Minas Gerais. Referências: 1) SOLOMON, Daniel H.; RUDIN, Robert S. Digital health technologies: opportunities and challenges in rheumatology. Nature Reviews Rheumatology, v. 16, n. 9, p. 525-535, 2020. 2) Jiang, M., Li, Y., Jiang, C. et al. Machine Learning in Rheumatic Diseases. Clinic Rev Allerg Immunol (2020). 3) GUAN, Yuanfang et al. Arthritis & Rheumatology, v. 71, n. 12, p. 1987-1996, 2019. 4) Stafford, I.S., Kellermann, M., Mossotto, E. et al. A systematic review of the applications of artificial intelligence and machine learning in autoimmune diseases. npj Digit. Med. 3, 30 (2020). 5) STOEL, Berend. Use of artificial intelligence in imaging in rheumatology–current status and future perspectives. RMD open, v. 6, n. 1, 2020. 6) HÜGLE, Maria et al. Applied machine learning and artificial intelligence in rheumatology. Rheumatology Advances in Practice, v. 4, n. 1, p. rkaa005, 2020.

Neste episódio, contamos com a participação da Dra. Adriana Maria Kakehasi, professora associada de Reumatologia da Faculdade de Medicina da Universidade Federal de Minas Gerais. Referências: 1) SOLOMON, Daniel H.; RUDIN, Robert S. Digital health technologies: opportunities and challenges in rheumatology. Nature Reviews Rheumatology, v. 16, n. 9, p. 525-535, 2020. 2) Jiang, M., Li, Y., Jiang, C. et al. Machine Learning in Rheumatic Diseases. Clinic Rev Allerg Immunol (2020). 3) GUAN, Yuanfang et al. Arthritis & Rheumatology, v. 71, n. 12, p. 1987-1996, 2019. 4) Stafford, I.S., Kellermann, M., Mossotto, E. et al. A systematic review of the applications of artificial intelligence and machine learning in autoimmune diseases. npj Digit. Med. 3, 30 (2020). 5) STOEL, Berend. Use of artificial intelligence in imaging in rheumatology–current status and future perspectives. RMD open, v. 6, n. 1, 2020. 6) HÜGLE, Maria et al. Applied machine learning and artificial intelligence in rheumatology. Rheumatology Advances in Practice, v. 4, n. 1, p. rkaa005, 2020.

This episode is a Step 2 - put the topic on the table for the 1st time - in our 6 Step Patient-Led Problem Solving Process   In this episode Tiffany, Deb, and Bridget talk about personalized therapy, or complimentary, non-pharmacologic options, that are being researched and added to new recommendations for full disease management. We often talk about the importance of Precision Medicine (which involves finding the best pharmacologic treatment for each person's individual needs), but as we, as patients, identify what works best for our unique needs, we have to consider all options (both pharmaceutical and non-pharmaceutical). Just as with our biologics and other disease modifying treatments - where one works for one person and not the other - we need to think about alternative therapies the same way. For example, just because you “tried diet”, did you try all the diets? We all need to find our own right combination of therapy - but what does that look like to you? Then we also need access to that option, which can be challenging, but together - with AiArthritis - we can fight to make access a reality!   *All main episodes that air on the 1st Sunday of each month are either Step 2 in our 6 step problem solving process (first time the topic is on the table) OR a Step 5, which is a revisit to the table. In a Step 2, we are  putting a topic on the table for the first time to open conversation - and continue break out conversations (360its) to further explore what is most important to patients. Make sure your voice is counted!    Show Notes: Episode 75 – “The Whole Picture: Holistic, Personalized Therapy”   00:36 – Tiffany welcomes listeners. 01:05 - Tiffany is joined today by AiArthritis Voices 360 recurring co-hosts Bridget and Deb. 01:15 - Deb Constien was diagnosed with Rheumatoid Arthritis at the age of 13. 01:50 - Bridget Serrett has multiple autoimmune diseases and genetic conditions. 02:49 - Today's topic is personalized, complementary, non-pharmacologic therapies. 03:50 - In order to manage a systemic, whole-body disease, we need holistic treatment options. 05:36 - Deb is a dietitian, although she is currently medically retired. 07:00 - Deb did not have access to complementary therapies when she was younger because they are expensive and not covered by insurance. 07:41 - Deb does not have any inflammatory triggers, so she did not find relief from any particular diet. 09:09 - Always tell your doctor if you are taking any supplements because they need to know anything you are taking to manage your medications. 09:21 - Bridget has tried every complementary therapy she could find. 09:38 - She also has found that most people do not have access to quality complementary therapies due to prohibitive costs. 10:47 - Tiffany has always been interested in complementary therapies, especially exercise. 13:30 - There is an access barrier for most patients to the recommended complementary therapies because most are not covered by insurance or national healthcare systems. 14:28. - Data drives access, but the voices of patients about their need for access are also. Important to eliminating barriers to these therapies. 15:21 - Tiffany explains clinical practice guidelines. 16:28 - Clinical practice guidelines provide justification for access to insurance companies and national health programs. 17:07 - Deb is on the panel for the American College of Rheumatology to develop clinical practice guidelines for holistic, complementary therapies. 17:15 - Deb and Tiffany explain the ACR panel process for developing clinical guidelines. 23:53 - Many people have a limited amount of covered physical therapy sessions per year, which can lead to difficult choices about how to prioritize health needs. 26:35 - Personalized treatments are unique to the individual, so what works for one patient may not work for another. 29:01 - The elimination diet requires a lot of discipline and consistency to even find out if it works for someone. 30:52 - Access is important, and having the ability to find the combination of therapies that work for a patient is critical to successful treatment. 32:10 - Tiffany discusses the AiArthritis initiative in partnership with FORWARD National Databank for Rheumatic Diseases to collect patient information and conduct research to try and improve early detection / intervention and patient individuality as it relates to precision medicine and personalized therapies. 35:39 - Even Dr. Al Kim who is very invested in holistic guidelines does not spend much time during patient appointments on complementary therapies because the subject is currently very nebulous and inaccessible. 37:18 - There is some concern that unethical actors may take advantage of vulnerable patients when we incorporate providers that are not part of the traditional medical field. 40:17 - Chronic pain is getting its own code in the healthcare coding system. 40:43 - Tiffany explains the ICD-11 coding system and how this will help patients. 42:33 - Deb attended a EULAR session called “Not Another Pill: Integrative Pain Management Approaches” at the 2022 EULAR Conference in June. 43:40 - The Biopsychosocial Model is the gold standard for addressing chronic pain and includes a requirement that providers believe their patients and value them. 47:23 - Being dismissed by doctors causes significant delays in diagnosis and access to treatments, which contributes directly to poorer patient outcomes. 49:23 - Having a code for chronic pain may help eliminate barriers to treatment options that result from doctors being afraid their licenses will be in jeopardy with government regulating authorities for prescribing controlled substances too often. 50:51 - When patients go to a doctor who doesn't believe them it can cause PTSD within the aiarthritis patient community. 52:24 - Sometimes when patients believe they are receiving treatments in blind placebo trials, they report improvement even though they are not really receiving any medication, which is called the placebo effect.  52:41 - Researchers wonder if the placebo effect could help uncover a mind-body connection that could help treat chronic pain. 53:15 - For more information on the mind-body connection research, check out our YouTube channel for a video on this topic. 53:55 - Complementary therapies are necessary because we need options for people who want to use fewer or no pharmacologic treatments. 55:40 - We need to hear from you on this topic! Email us at podcast@aiarthritis.org or find us on social media @IFAiArthritis on all platforms. 56:03 - Visit our website (aiarthritisvoices.org) to join our AiArthritis Voices program. 58:20 - For more information on medical cannabis or to get involved in advocating for legal access to medical cannabis, you can connect with Bridget on Facebook @cprcofcolorado (new website coming soon). 1:00:38 - To continue this conversation, donate to support the show, or for information on any of our initiatives, please visit us @ aiarthritis.org.       Patient Voices and All Other Stakeholders - Join our AiArthritis Voices Program and Connect to Opportunities to Have Your Voice Counted If you are a patient, a parent of a juvenile patient, or any other stakeholder (doctor, nurse, researcher, industry representative, or other health services person) - are you ready to join the conversation? It's your turn to pull up a seat. Join our new AiArthritis Voices program, where people living with AiArthritis diseases and other stakeholders who we need 'at the table' to solve problems that impact education, advocacy, and research sign up to have a voice in our initiatives. By signing up, you'll get notified of opportunities to be more involved with this show - including submitting post-episode comments and gaining insider information on future show topics. Patients and all other stakeholders are encouraged to join so we can match you with opportunities to pull up a seat and TOGETHER - as equals - solve the problems of today and tomorrow. JOIN TODAY! AiArthritis Voices 360 is produced by the International Foundation for Autoimmune and Autoinflammatory Arthritis. Visit us on the web at www.aiarthritis.org/talkshow. Find us on Twitter, Instagram, TikTok, or Facebook (@IFAiArthritis) or email us (podcast@aiarthritis.org).  Be sure to check out our top-rated show on Feedspot! 

Prof Catherine Nelson-Piercy and Dr Lizemarie Wium join guest host Dr Puja Mehta to discuss the importance and challenges of obstetric medicine in rheumatic diseases. 

A-t-on découvert de nouvelles maladies auto-inflammatoires de l'adulte ? Quelle actualité sur les antipaludéens de synthèse dans le lupus ? Quelles implications pratiques sur la fatigue dans la polyarthrite rhumatoïde débutante ?   Le Pr Thierry Schaeverbeke, chef du service de Rhumatologie du CHU de Bordeaux, répond à vos questions.   [1]   Wang J, Ye Q, Zheng W, et al. Low-ratio somatic NLRC4 mutation causes late-onset autoinflammatory disease. Annals of the Rheumatic Diseases. 2022 April. doi: 10.1136/annrheumdis-2021-221708. [2]   Ionescu D et al. First Description of Late‐Onset Autoinflammatory Disease Due to Somatic NLRC4 Mosaicism. Arthritis & Rheumatology. 2022 Apr;74(4):692-699. doi: 10.1002/art.41999. [3]   Almeida-Brasil CC, Hanly JG, Urowitz M, et al. Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Annals of the Rheumatic Diseases. 2022;81:370-378. doi: 10.1136/annrheumdis-2021-221295. [4]   Holten K, Paulshus Sundlisater N, Lillegraven S, et al. Fatigue in patients with early rheumatoid arthritis undergoing treat-to-target therapy: predictors and response to treatment. Annals of the Rheumatic Diseases. 2022;81:344-350. doi: 10.1136/annrheumdis-2021-220750.   Invité : Pr Thierry Schaeverbeke – CHU de Bordeaux – Hôpital Pellegrin https://www.chu-bordeaux.fr/Les-services/Service-de-rhumatologie/  Le Pr Schaeverbeke déclare ne pas avoir de lien d'intérêt en rapport avec le sujet traité.   L'équipe :
 Comité scientifique : Pr Jérémie Sellam, Pr Thao Pham, Dr Catherine Beauvais, Dr Sophie Hecquet, Dr Céline Vidal Animation :  Pyramidale Communication Production : Pyramidale Communication Soutien institutionnel : Pfizer   Crédits : Pyramidale Communication, Sonacom

In this episode, we'll clarify some common misconceptions about exercise for people with rheumatic diseases, we'll discuss tips and strategies to increase physical activity for people of all ages, explore who would benefit from physical or occupational therapy. We'll discuss bracing, taping, and other strategies that people may use to reduce pain and improve function. 

Hosts Gregg Masters and Fred Goldstein again meet with Atul Deodhar, MD, Professor of Medicine and Medical Director of Rheumatology clinics, Division of Arthritis & Rheumatic Diseases at Oregon Health & Science University returning for part 2 of their discussion on his research. They also hear key takeaways from The American College of Rheumatologists (ACR) Convergence, 2021, including the latest updates in rheumatology research, treatments and developments in basic & clinical science. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Hosts Gregg Masters and Fred Goldstein meet Atul Deodhar, MD, Professor of Medicine and Medical Director of Rheumatology clinics, Division of Arthritis & Rheumatic Diseases at Oregon Health & Science University. They discuss key takeaways from The American College of Rheumatologists (ACR) Convergence, 2021, including the latest updates in rheumatology research, treatments and developments in basic & clinical science. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play HealthcareNOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Dr. Thomas Bush joins guest host Dr. Lola Falasinnu to discuss climate change and the potential adverse health effects of climate hazards for patients with rheumatic diseases. 

Marcela, Pedro e Fred discutem 7 armadilhas sobre a crise de gota. Pode usar alopurinol na crise? Precisa puncionar toda monoartrite? Colchicina, AINEs ou corticoide, qual é o melhor? Essas armadilhas e mais algumas são discutidas nesse episódio. Referências: Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2016. Hill EM, et al. Does Starting Allopurinol Prolong Acute Treated Gout? A Randomized Clinical Trial. JCR - Journal of Clinical Rheumatology Apr 2015. Vol21 Issue 3. Taylor TH. Initiation of Allopurinol at First Medical Contact for Acute Attacks of Gout: A Randomized Clinical Trial. The American Journal of Medicine. Vol 125, Issue 11. Nov 2012.  Xin Feng, Yao Li, Wei Gao. Significance of the initiation time of urate-lowering therapy in gout patients: A retrospective research. Joint Bone Spine Volume 82, Issue 6, December 2015.  Park Y, Park Y, Lee S, et al. Clinical analysis of gouty patients with normouricaemia at diagnosisAnnals of the Rheumatic Diseases 2003;62:90-92.  LOGAN JA, MORRISON E, McGILL PE. Serum uric acid in acute goutAnnals of the Rheumatic Diseases 1997;56:696-697.  FitzGerald, J. D., Dalbeth, N., Mikuls, T., Brignardello‐Petersen, R., Guyatt, G., Abeles, A. M., ... & Neogi, T. (2020). 2020 American College of Rheumatology guideline for the management of gout. Arthritis care & research, 72(6), 744-760. Ragab, Gaafar, Mohsen Elshahaly, and Thomas Bardin. "Gout: An old disease in new perspective–A review." Journal of advanced research 8.5 (2017): 495-511. Janssens, H. J., Janssen, M., Van de Lisdonk, E. H., van Riel, P. L., & van Weel, C. (2008). Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. The Lancet, 371(9627), 1854-1860. Parperis, K. (2021). Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care. Annals of the Rheumatic Diseases, 80(12), e202-e202. Barthélémy, I., Karanas, Y., Sannajust, J. P., Emering, C., & Mondié, J. M. (2001). Gout of the temporomandibular joint: pitfalls in diagnosis. Journal of Cranio-Maxillofacial Surgery, 29(5), 307-310. Terkeltaub, R. A., Furst, D. E., Bennett, K., Kook, K. A., Crockett, R. S., & Davis, M. W. (2010). High versus low dosing of oral colchicine for early acute gout flare: twenty‐four–hour outcome of the first multicenter, randomized, double‐blind, placebo‐controlled, parallel‐group, dose‐comparison colchicine study. Arthritis & Rheumatism, 62(4), 1060-1068. Lumezanu, E., Konatalapalli, R., & Weinstein, A. (2012). Axial (spinal) gout. Current rheumatology reports, 14(2), 161-164. Kienhorst, Laura BE, et al. "The validation of a diagnostic rule for gout without joint fluid analysis: a prospective study." Rheumatology 54.4 (2015): 609-614. Clebak, Karl T., Ashley Morrison, and Jason R. Croad. "Gout: Rapid evidence review." American family physician 102.9 (2020): 533-538. Robin, F., et al. "External validation of Gout-calculator performance on a cohort of acute arthritis (SYNOLACTATE) sparing distal joints such as hallux and midfoot. A cross-sectional study of 170 patients." Clinical Rheumatology 40.5 (2021): 1983-1988. Ma, Lingling, Ann Cranney, and Jayna M. Holroyd-Leduc. "Acute monoarthritis: what is the cause of my patient's painful swollen joint?." Cmaj 180.1 (2009): 59-65. Yu, K. H., et al. "Concomitant septic and gouty arthritis—an analysis of 30 cases." Rheumatology 42.9 (2003): 1062-1066. NBR 6023Janssens, Hein JEM, et al. "A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis.Archives of Internal Medicine170.13 (2010): 1120-1126

Reproductive Health in Rheumatic Diseases: Drs. Bermas, Buyon and Dao

FDA 批准靶向IL-23的单克隆抗体治疗银屑病Arthritis & Rheumatol 替格瑞洛治疗后骨关节炎风险的降低JAMA 生物力学鞋对膝骨关节炎患者膝关节疼痛的影响LANCET 非布司他与别嘌醇在痛风患者中的长期心血管安全性Nature子刊 抑制MEK使CD8+ T淋巴细胞重新编码为具有潜在抗肿瘤特性的记忆干细胞替达珠单抗（tildrakizumab）替达珠单抗（tildrakizumab）是人源化IgG1x单克隆抗体，靶向IL-23的p19亚基并阻断其与IL-23受体结合，抑制细胞因子与趋化因子释放。2018年3月FDA批准替达珠单抗用于治疗成人中重度斑块型银屑病。《reSURFACE1和reSURFACE2研究52周的综合分析：替达珠单抗治疗中重度银屑病52周的疗效的3期临床研究》Journal of European Academy of Dermatology & Venereology，2019年12月 (1) reSURFACE1和reSURFACE2研究的目的是观察替达珠单抗治疗中重度银屑病的疗效，前28周的结果已经证实了替达珠单抗的疗效，这篇文章报告了随访52周的结果，旨在评价治疗对患者皮肤科生活质量评分（DLQI）和银屑病面积和严重程度指数（PASI）评分的影响。两项研究中使用替达珠单抗100 mg或200 mg治疗的1156位患者，在第28周合并，然后根据第28周时的PASI评分改善程度分为5组：0-49分、50-74分、75-89分、90-99分和100分。第28周，替达珠单抗100 mg组和200 mg组根据PASI评分改善程度分组后的患者比例分别为8.3%、14.3%、23.8%、30.4%、23.1%，和4.0%、18.1%、19.6%、29.1%、29.3%。第28周疗效较差的、PASI改善50的患者中，持续使用相同剂量的替达珠单抗至第52周，PASI评分持续改善。两种剂量都观察到了类似的结果。28周时PASI改善较好的患者中，DLQI 0/1的比例较高，且维持或改善至52周。然而，并不是所有PASI改善100患者的DLQI都为0/1。结论：替达珠单抗疗效较差的患者可在第8周确定，疗效好、PASI评分改善≥90的患者通常可在第4周确定。第28周PASI改善水平与生活质量改善相关。骨关节炎骨关节炎（osteoarthritis，OA）是最常见的关节炎。发病机制中有很多重要的因素，包括生物力学因素、促炎因子和蛋白酶等。症状主要是特征性关节组织病理改变所引起的疼痛和关节功能改变，所有的OA患者都存在关节软骨、骨骼、滑膜和软组织的病理表现。《回顾性分析：与氯吡格雷相比，替格瑞洛治疗后骨关节炎风险的降低》Arthritis & Rheumatol，2020年11月 (2)细胞外腺苷具有抗炎作用，在动物模型中可预防和治疗骨关节炎。替格瑞洛和氯吡格雷都用于冠心病患者，但只有替格瑞洛增加了细胞外腺苷水平。这项研究是为了确定治疗替格瑞洛是否与降低骨关节炎风险有关。研究纳入替格瑞洛或氯吡格雷治疗≥90天的、没有关节炎病史的、21000例患者。平均治疗天数分别为287天和284天。两组患者的平均年龄均为64岁，73%为男性。多变量Cox回归分析估计，与氯吡格雷相比，替格瑞洛治疗后发生OA的危险比为0.71(95%可信区间0.64-0.79)(P < 0.001)。结论：在5年的随访中，与氯吡格雷治疗相比，替格瑞洛治疗降低了骨关节炎发病风险达29%，这可能与我们假设接受替格瑞洛的患者中OA的减少可能部分是由于细胞外腺苷水平的增加。《软骨缺失会导致骨关节炎疼痛吗？如果会，疼痛程度是多少?》Annals of Rheumatic Disease，2020年9月 (3)虽然骨关节炎的治疗重点是软骨保护，但目前尚不清楚预防软骨损失能在多大程度上减轻关节疼痛。研究量化了骨髓病变和滑膜炎后软骨损失、和膝关节疼痛恶化之间的关系，并检查了这些因素在多大程度上介导了这种关联。研究人员在基线、12个月和24个月时，对600例膝关节MRI定量、半定量测量骨关节炎的结构特征。定量的计算了内侧软骨厚度的变化、软骨损失情况、使用西安大略和麦克马斯特大学骨关节炎指数疼痛评分（WOMAC疼痛评分）评价疼痛程度。随访24个月，软骨厚度的减少与疼痛的轻微恶化显著相关。例如，两年内软骨厚度减少0.1mm，WOMAC疼痛增加0.32。软骨厚度的减少与疼痛的关系是通过滑膜炎的改变，而不是骨髓病变的改变。亚分析结果相似。结论：软骨厚度的减少只与少量的膝关节疼痛恶化有关，这种关联部分是由滑膜炎恶化引起的。通过软骨保护减少膝盖疼痛可能是难以实现的。骨关节炎的治疗膝关节骨性关节炎的治疗方法包括非药物治疗、药物治疗和手术，旨在缓解疼痛、改善关节功能以及改变骨关节炎进展的危险因素。尽管研究很多，但改变疾病病程的疗法效果欠佳。轻度骨性关节炎着重体重管理、镇痛、局部物理治疗；中重度骨性关节炎着重情绪疏导、镇痛、关节内注射类固醇、运动（建议水中锻炼，耐受性比地面锻炼好）和手术。《VITAL研究：补充维生素D和ω-3脂肪酸对老年慢性膝盖疼痛的影响》Arthritis & Rheumatol，2020年11月 (4)膝痛是成人骨关节炎的常见病因。该研究的目的是评价维生素D、ω-3脂肪酸治疗膝关节疼痛的效果。这项双盲、安慰剂对照的研究纳入25,871名参与者，按照2x2设计随机接受维生素D或ω-3脂肪酸，随机化之前，确定了一个膝盖疼痛的亚组，这组人群共1398人，平均年龄67岁，66%为女性，根据WOMAC评分评价关节疼痛程度。基线时，WOMAC疼痛评分平均值为37，平均随访时间为5.3年后，WOMAC疼痛评分在维生素D组、ω-3脂肪酸组和安慰剂组之间没有差异。随着时间的推移，补充维生素D和ω-3脂肪酸对WOMAC功能或僵硬评分也没有显著影响。结论：在慢性膝关节疼痛的大样本中，补充维生素D和ω-3脂肪酸持续5.3年并不能减轻膝关节疼痛、或改善关节功能或僵硬。《随机、双盲、安慰剂对照试验：白细胞介素-1β抑制对髋关节和膝关节置换术发生率的影响》Annals of Internal Medicine，2020年10月 (5) 研究的目的是确定IL-1抑制卡那单抗是否减少全髋关节或膝关节置换术的发生率。研究纳入1061例CANTOS研究的参与者，随机给予安慰剂、或卡那单抗50mg、150mg或300mg ip 三个月一次。平均随访3.7年，与安慰剂相比，卡那单抗组的关节置换的风险比分别为：50mg组为0.60，150mg组为0.53，300 mg组为0.60，均有统计学意义。将治疗组数据合并，关节置换发生率为0.31/100人年，安慰剂组为0.54例/100人年（风险比 0.58，P=0.001）。结论：该随机对照试验的探索性分析结果支持进一步研究IL-1抑制治疗大型关节骨性关节炎。《随机对照研究：膝关节骨性关节炎的物理治疗与糖皮质激素注射比较》New England Journal of Medicine，2020年4月 (6)物理治疗和关节内注射糖皮质激素已被证明对膝骨关节炎有临床疗效。该研究的目的是评价这两种疗法在缓解疼痛、改善身体功能方面的短期和长期效果。这项随机试验纳入单膝或双膝骨关节炎患者共156人，平均年龄56岁，随机接受糖皮质激素注射或接受物理治疗。基线WOMAC功能或僵硬度评分平均值，糖皮质激素注射组为108.8分，物理治疗组为107.1分；1年时的平均值分别为55.8分和37.0分。组间平均差异为18.8分，物理治疗更好。结论：与接受关节内糖皮质激素注射的膝关节骨性关节炎患者相比，接受物理治疗的膝关节骨性关节炎患者在1年的疼痛和功能残疾更少。《BIOTOK研究：生物力学鞋对膝骨关节炎患者膝关节疼痛的影响》JAMA，2020年5月 (7)研究的目的是评价个体化校准的生物力学鞋疗法是否可能改善有症状性的、膝骨关节炎患者的疼痛和功能。这项随机临床试验纳入症状性膝关节骨关节炎患者220名，平均年龄65.2岁，给予生物力学鞋治疗或安慰剂治疗，随访24周。随访24周时，生物力学鞋组的标准化WOMAC疼痛评分平均值从4.3提高到1.3，对照组鞋组从4.0提高到2.6（P 50岁的、膝关节骨关节炎和软骨下骨髓病变的223名成年患者，平均年龄62岁，女性52%。随机分组，分别在试验开始时和12个月的时候静脉滴注一次5mg唑来膦酸组或100ml生理盐水作为安慰剂。随访24个月，唑来膦酸组和安慰剂组的胫股软骨体积变化无显著差异（P = 0.50）。次要结果的组间差异均无统计学意义，包括膝关节疼痛评分、WOMAC骨关节炎指数、骨髓病灶大小变化。唑来膦酸的不良事件比安慰剂更常见。结论：症状性膝骨关节炎和骨髓病变患者中，每年注射唑来膦酸并没有显著减少软骨体积损失。这些发现不支持使用唑来膦酸治疗膝骨关节炎。《随机对照研究：姜黄提取物治疗膝关节骨关节炎症状及渗出性滑膜炎的疗效观察》Annals of Internal Medicine，2020年12月 (9)研究的目的是探讨姜黄提取物对症状性、膝关节骨性关节炎和膝关节渗出性滑膜炎的疗效。这项单中心研究招募了70名参与者，连续12周，每天2粒姜黄提取物或安慰剂。12周后，与安慰剂相比，姜黄提取物改善视觉模拟疼痛（VAS）评分的幅度为-9.1mm（P = 0.039），但没有改变渗出性滑膜炎体积（3.2mL）。姜黄提取物还可改善WOMAC膝关节疼痛评分（P = 0.006），但没有改善MRI腓骨外侧软骨T2松弛时间（−0.4 ms）。两组不良事件发生率相似（P = 0.16）结论：对于膝关节疼痛，姜黄提取物比安慰剂更有效，但不影响膝关节渗出性滑膜炎或软骨成分。需要更大样本量的多中心试验来评估这些发现的临床意义。痛风痛风是尿酸单钠结晶沉积病，其生化特点是细胞外液尿酸盐浓度达到饱和，血液中表现为高尿酸血症，即血尿酸盐浓度超过400μmol/L，该水平接近于尿酸盐的溶解度极限。痛风的临床表现包括：炎症性关节炎的反复发作、慢性关节病、尿酸盐结晶累积形成痛风石沉积、尿酸性肾结石等。急性期止痛，可以使用全身或关节内糖皮质激素、NSAID、秋水仙碱，难治性痛风发作可尝试使用抑制IL-1β的生物制剂（欧盟已批准卡那单抗治疗难治性痛风发作）。缓解期降尿酸，可以使用别嘌醇、非布司他、丙磺舒、苯溴马龙或聚乙二醇重组尿酸酶。《FAST研究：非布司他与别嘌醇在痛风患者中的长期心血管安全性》LANCET，2020年11月 (10)这项前瞻性、随机、开放、非劣效研究，纳入≥60岁、已经接受别嘌醇治疗的、合并心血管危险因素的患者，共6128人。患者平均年龄71岁，85%为男性，33.4%有心血管疾病病史。被随机分配别嘌醇或非布司他治疗，中位随访时间为1467天。在非致死性心梗或急性冠脉综合征住院的发生率方面，非布司他为1·72次/100人年，低于别嘌醇2·05次/100人年（风险比 0·85，p

FDA 批准IL-23单克隆抗体用于治疗银屑病关节炎Rheumatology 幼年特发性关节炎患者的妊娠结局Ann Rheumat Dis间充质干细胞移植联合干扰素治疗RA古赛库单抗（Guselkumab）古赛库单抗（Guselkumab）是IL-23单克隆抗体，2017年被FDA批准用于治疗银屑病；2020年7月，FDA批准古赛库单抗用于治疗银屑病关节炎。《DISCOVER-1研究：古赛库单抗治疗肿瘤坏死因子α抑制剂效果不佳的、活动性银屑病关节炎的3期临床研究》Lancet，2020年4月 (1) 这项多中心、双盲、随机、安慰剂对照的3期试验中，纳入肿瘤坏死因子(TNF)α抑制剂的反应不佳的、活动性银屑病性关节炎的患者共381人，随机分入古赛库单抗q4w组、古赛库单抗q8w组或安慰剂组，共24周。古赛库单抗q4w组和q8w组的患者，相比安慰剂，24周时达到30%缓解的几率更高（59%、66% vs 22%，p均

FDA 批准卡那单抗用于治疗成人Still病Lancet 苏金单抗与阿达木单抗治疗银屑病关节炎的头对头比较Arthri & Rheumatol重组腺苷脱氨酶可改善系统性硬化症模型的纤维化卡那单抗（canakinumab）上周一的心脏科专题中，我们聊到了冠心病的抗炎治疗最新进展，目前研究热点集中在IL-1β单克隆抗体卡那单抗和秋水仙碱。今天我们来聊一聊卡那单抗在免疫科中的应用。卡那单抗（canakinumab）最初于2009年被FDA批准用于治疗Cryopyrin相关周期性综合征（CAPS）、全身型幼年特发性关节炎以及三种少见的周期性发热综合征；2020年6月，卡那单抗被FDA批准用于治疗成人Still病。《卡那单抗用于治疗成人Still病以减少关节炎的表现：2期临床试验》Annals of Rheumatic Diseases，2020年8月 (1)这项多中心、双盲、随机、安慰剂对照试验，旨在评价其治疗成人Still病的有效性和安全性。研究纳入19名多关节受累的成人Still病患者，随机给予卡那单抗和安慰剂治疗。基线时，卡那单抗组和安慰剂组的平均疾病活动评分为5.4和5.3。在卡那单抗组中，61%的患者达到30%应答率，50%的患者达到50%应答率，28%的患者达到70%应答率；而对照组仅为20%、6.7%和0%（p=0.033，0.009和0.049)。卡那单抗组的两名患者经历了严重的不良事件。结论：卡那单抗治疗可改善多项成人Still病的疗效指标。银屑病性关节炎银屑病关节炎（psoriatic arthritis，PsA）是一种与银屑病有关的炎症性肌肉骨骼疾病。主要表现为受累关节疼痛和僵硬，可同时累及周围关节和中轴关节，常呈非对称性分布。70%的关节炎就诊时有银屑病病史，80-90%伴有甲病变。实验室检查没有特征性的变化，类风湿因子（RF）、抗核抗体（ANA）和抗瓜氨酸肽抗体（ACPA）大多呈阴性。《荟萃分析：银屑病关节炎关节外表现的患病率》Rheumatology，2020年9月 (2)研究的目的是评价银屑病关节炎关节外症状的流行情况（肌腱炎、指炎、指甲疾病、葡萄膜炎和炎症性肠病），及其对纵向疾病结局的影响。研究纳入65项研究，共计163 299例银屑病关节炎患者。在进行报道的文献中，肌腱炎平均发病率为30%，指炎平均发病率为25%，甲疾病发病率为60%，葡萄膜炎为3.2%，炎症性肠病3.3%。其中，合并指炎的患者影像学进展的可能性增加。结论：银屑病关节炎患者中，常合并肌腱炎、指炎和甲病；而葡萄膜炎和炎症性肠病不常见。《真实世界：银屑病或银屑病关节炎患者严重感染的风险》Annals of Rheumatic Diseases，2020年2月 (3)研究的目的是使用IL-17、IL-12/23或肿瘤坏死因子（TNF）抑制剂，是否与银屑病或银屑病关节炎患者严重感染风险的增加有关。研究共包括11560个新的治疗事件，9264人年的随访。研究共发现190例严重感染（占治疗期的2%），IL-17和TNF抑制剂的感染发生率相似，而IL-12/23抑制剂则明显降低（风险比0.59）。在曾经使用过生物制剂的患者中，各组感染风险无差异。结论：相对于TNF和IL-17抑制剂，IL-12/23抑制剂可以降低银屑病或银屑病关节炎患者的严重感染的风险。《纵向队列研究：银屑病性关节炎的DAPSA、颈动脉斑块和心血管事件》Annals of Rheumatic Diseases，2020年11月 (4)研究的目的是评价反映银屑病关节炎炎症成分的银屑病关节炎的疾病活动评分（DAPSA）是否能够预测心血管事件，而不依赖于传统的心血管危险因素和亚临床颈动脉粥样硬化。研究纳入189例银屑病关节炎患者，平均年龄48.9岁。平均9.9年的随访后，较高的银屑病关节炎的疾病活动评分与心血管事件的风险增加显著相关（风险比 1.04， p=0.009），在多变量模型中调整所有心血管风险后，这种关联仍然有统计学意义。亚组分析中，调整其他心血管风险后，颈动脉斑块与发生CV事件的风险增加显著相关（风险比 3.42）。结论：较高的DAPSA和CP的存在可以独立预测银屑病关节炎患者的心血管事件事件，这种风险不依赖于传统的心血管疾病风险。小羽点评：银屑病性关节炎不仅累及皮肤、关节，还可能增加感染和心血管疾病的发生风险，在临床实践中，需要对银屑病关节炎的患者进行多个系统的功能进行跟踪和随访。银屑病关节炎的治疗银屑病关节炎中，外周关节炎常使用NSAID治疗；若效果不佳，常采用传统改变病情的抗风湿药物（DMARD），如甲氨蝶呤（MTX）、来氟米特（LEF）；若多个关节侵蚀及功能受限，建议使用生物性DMARD，如TNF抑制剂为一线治疗（依那西普、阿达木单抗、英夫利西单抗、塞妥珠单抗和戈利木单抗）。一种TNF抑制剂无效时，可换用另一种TNF抑制剂；两种TNF抑制剂无效时，可使用IL-17抑制剂（苏金单抗、依奇珠单抗）、IL-12/23抑制剂（优特克单抗）、T细胞共刺激调节因子（阿巴西普）、JAK抑制剂（托法替尼）。累及骶髂关节和脊柱关节、附着点炎时，通常不推荐使用传统DMARD。银屑病关节炎患者一般应避免使用糖皮质激素，因为可能增加红皮病或脓疱型银屑病的几率。《回顾性队列研究：传统合成抗风湿药治疗银屑病性关节炎中，单药保留甲氨蝶呤优于柳氮磺胺吡啶》Rheumatology，2020年8月 (5)比较传统合成抗风湿药物的疗效和使用时间的研究有限，此研究的目的是比较一线传统合成抗风湿药物单药治疗的银屑病关节炎的药物保留和药物保留的预测因子。文章回顾性的研究了首次使用传统抗风湿药物作为单一药物治疗银屑病关节炎的187例患者，主要终点是治疗失败、停止用药或添加另一个抗风湿药物的时间。患者中单药使用甲氨蝶呤共163人，单药使用柳氮磺胺吡啶共21人，平均药物保留事件为31.8个月。其中甲氨蝶呤平均使用34.5个月，柳氮磺胺吡啶平均使用12.0个月（P =0.016）。使用甲氨蝶呤的患者中，随着年龄增长药物保留率逐渐增加。治疗失败的主要原因是无效(52%)和副作用(28%)。结论：在临床实践中，甲氨蝶呤单药治疗银屑病关节炎优于柳氮磺胺吡啶。《GO-DACT研究：治疗银屑病关节炎患者的指炎方面，戈利木单抗联合甲氨蝶呤优于单用甲氨蝶呤》Annals of Rheumatic Diseases，2020年4月 (6)戈利木单抗是一种抗肿瘤坏死因子α单抗，研究的目的是评价戈利木单抗联合甲氨碘呤和单用甲氨蝶呤治疗银屑病性关节炎指炎的疗效。这个多中心、随机、双盲、安慰剂对照、平行设计的3b期试验中，银屑病关节炎伴有活动性指炎的患者被分配到戈利木单抗或安慰剂组，两者均与甲氨蝶呤联合使用。24周后，与甲氨蝶呤单药治疗相比，戈利木单抗联合甲氨蝶呤显著改善指炎的临床症状（指炎严重程度评分变化分别为5和2，p = 0.026）。联合治疗组的指炎严重程度评分改善50%或70%的患者和Leeds指炎指数改善20%、50%或70%的患者比例显著高于单用甲氨蝶呤的患者。结论：戈利木单抗联合甲氨蝶呤作为一线生物抗风湿治疗银屑病指炎优于甲氨蝶呤单药治疗。《荟萃分析：生物制剂对银屑病关节炎患者外周关节影像学进展的影响》Rheumatology，2020年11月 (7)研究的目的是确定生物制剂在预防银屑病关节炎患者、外周关节影像学进展中的有效性。研究包括11项临床试验，涉及5382名患者，9种药物和18种治疗方法。与安慰剂相比，接受生物制剂的患者更有可能实现影像学无进展（优势比2.40，其中TNF抑制剂的优势比 2.94，IL抑制剂的优势比 2.15，阿巴西普的优势比 1.54）。生物制剂显著降低了外周关节影像学进展的风险（影像学进展评分平均下降-2.16，其中TNF抑制剂下降 -2.82，IL抑制剂下降 -1.60，阿巴西普下降 -0.40。生物制剂联合甲氨蝶呤的方案，并不优于单一生物制剂治疗的效果；尤特克单抗和苏金单抗的疗效，不受先前抗TNK治疗的影响。结论：与安慰剂相比，生物制剂可能在骨侵蚀和关节间隙狭窄方面延缓银屑病关节炎患者的影像学进展。甲氨蝶呤似乎没有额外的获益；先前的抗肿瘤坏死因子治疗似乎不会影响IL抑制剂的治疗效果。上一次的节目介绍了IL-17抑制剂（苏金单抗、依奇珠单抗）最近刚刚被FDA批准用于治疗中轴型脊柱关节炎，今天来和大家聊一聊IL-17A单抗在银屑病关节炎中的应用，以及比较这两个药物和肿瘤坏死因子抑制剂阿达木单抗的头对头研究。《Future 5研究：苏金单抗治疗银屑病性关节炎的3期研究结果》Rheumatology，2020年6月 (8)研究目的是评估苏金单抗治疗银屑病性关节炎52周后患者的影像学进展。纳入的银屑病性关节炎参与者，既往没有治疗过、或者TNF-α抑制剂无效，被随机分入苏金单抗 300mg组、150mg组、150mg无负荷给药组或安慰剂组，前4周q1w负荷给药，4周后q4w给药。其中300mg组有91.8%的患者52周后，没有出现影像学进展；在150mg组和150mg无负荷给药组中，这里比例分别是85.2%和87.2%。苏金单抗 300mg组、150mg组和150mg无负荷给药组中，影像学vdH-mTSS评分的随机斜率为-0.18、0.11和-0.20。临床疗效持续稳定，52周内没有报告新的或意料之外的安全事件。结论：苏金单抗 300mg、150mg和150mg无负荷剂量组，治疗银屑病性关节炎显示出持续稳定的低进展率。《SPIRIT-P1研究：依奇珠单抗治疗活动性银屑病关节炎患者的III期临床试验3年结果》Rheumatology，2020年2月 (9)研究的目的是评估长达156周的依奇珠单抗（IL-17A单抗）治疗银屑病关节炎的安全性和有效性。银屑病关节炎患者被随机分配到安慰剂组、阿达木单抗或依奇珠单抗q2w或q4w组。在第24周时，阿达木单抗和安慰剂组的患者被重新随机分配到依奇珠单抗q2w或q4w组，并继续延长治疗至第156周，共243例患者完成了为期3年的研究。依奇珠单抗q2w组患者治疗紧急和严重不良事件的发生率分别为38.0%和5.2%，依奇珠单抗q4w组患者为38.1%和8.0%。156周时，两组患者ACR响应≥20%的比例占69.8%和62.5%；响应≥50%的比例为51.8%和56.1%，响应≥70%的比例为33.4%和43.8%。银屑病面积和严重程度指数（PASI）缓解75%的占（63.5%和69.1）；缓解90%的展51.2%和64.5；缓解100%的占43.6%和60.5%。直至156周，在q2w组中的61%和q4w组中的71%的患者，影像学进展得到抑制。结论：依奇珠单抗治疗156周后，其安全性与之前的报道保持一致，并且观察到银屑病关节炎患者症状和体征的持续改善，包括影像学进展率持续较低。《EXCEED研究：头对头比较苏金单抗与阿达木单抗治疗银屑病关节炎疗效的3b期试验》Lancet，2020年5月 (10)EXCEED研究评估了苏金单抗与阿达木单抗作为一线生物单药治疗活动性银屑病关节炎患者的安全性和有效性。这个平行、双盲、多中心、主动对照的3b阶段的研究，招募18岁以上的、活动性银屑病关节炎患者，主要终点是52周时ACR反应标准至少改善20%（ACR20）。研究过程中853例患者完成了52周的研究，研究结束后，苏金单抗组14%和阿达木单抗组24%的患者选择停止使用研究中的治疗方案。第52周时，67%的苏金单抗组患者和62%的阿达木单抗组患者达到治疗的主要终点，两组间无统计学差异。苏金单抗组2%和阿达木单抗组1%的患者出现严重感染，苏金单抗出现一例与研究药物无关的死亡，其他的安全性与之前报道一致。结论：苏金单抗与阿达木单抗的疗效没有统计学差异，但是苏金单抗的治疗保留率更高。《SPIRIT研究：头对头比较依奇珠单抗和阿达单抗治疗银屑病关节炎的疗效和安全性》Annals of Rheumatic Diseases，2020年7月 (11)SPIRIT研究头对头的比较了依奇珠单抗（IL-17A单抗）和阿达单抗治疗银屑病关节炎的有效性和安全性。 研究纳入566例银屑病关节炎的患者，将患者随机分为依奇珠单抗和阿达单抗治疗组，评价标准是24周和52周时，患者ACR反应标准改善50%（ACR50）和银屑病面积和严重度评分改善100%（PASI100）。52周时，依奇珠单抗治疗组中同时达到ACR50和PASI100的患者的比例显著高于阿达木单抗 (39% vs 26%， p

FDA 连续批准2个IL-17A单抗治疗中轴型脊柱关节炎Annals of Rheumatic Diseases 发表2篇真实世界的研究讨论TNF抑制剂在中轴型脊柱关节炎治疗中的疗效Science Advance 纳米颗粒包裹环孢素靶向治疗狼疮肾炎依奇珠单抗中轴型脊柱关节炎（axial spondyloarthritis，SpA）是慢性炎症性疾病，主要表现为背痛和进展性脊柱僵直。分成两种类型：影像学可见骶髂关节炎改变的称为强直性脊柱炎（ankylosing spondylitis，AS）；没有骶髂关节炎改变的称为影像学阴性的中轴型脊柱关节炎（nonradiographic axial spondyloarthritis，nr-axSpA）。常用的治疗药物包括非甾体类抗炎药和TNF-α抑制剂。依奇珠单抗（ixekizumab）是抗IL-17A的单克隆抗体，2016年被批准用于治疗银屑病和银屑病性关节炎；2020年6月适应症被扩展放射学阴性的中轴型脊椎关节炎、和强直性脊柱炎。《COAST-X研究：依奇珠单抗用于放射学阴性的中轴型脊椎关节炎的3期临床研究》Lancet，2020年1月 (1)COAST-X是一项52周、随机、双盲、安慰剂对照、平行组研究。共303名、活动性的、放射学阴性的中轴型脊椎关节炎的、对非甾体抗炎药效果不好的患者，被随机分配依奇珠单抗80mg q4w组，依奇珠单抗80mg q2w组或安慰剂组。第16周后，可根据情况开放标签。研究的主要终点设定为中轴型脊椎关节炎评估国际标准改善≥40%（ASAS40）。16周时，q4w组中35%的患者和q2w组中40%的患者病情缓解，安慰剂组仅19%。52周时，q4w组中30%的患者和q2w组中31%的患者病情缓解，安慰剂组仅13%。依奇珠单抗最常见的不良事件是鼻咽炎和注射部位反应，而且有1例出现严重感染。总的来说，三组的严重不良事件发生率都很低，没有肿瘤或死亡。结论：在治疗放射学阴性的中轴型脊椎关节炎方面，依奇珠单抗疗效优于安慰剂。《COAST-V和COAST-W研究：依奇珠单抗在治疗活动性强制性脊柱炎的有效性和安全性的3期临床研究》Annals of Rheumatology，2020年2月 (2)在2项3期临床研究中，旨在研究连续52周使用依奇珠单抗治疗活动性强制性脊柱炎的疗效和安全性，纳入研究的患者有的从未使用过生物抗风湿药（COAST-V），有的正在使用TNF抑制剂（COAST-W）。研究将患者随机分入依奇珠单抗q4w组，依奇珠单抗q2w组、安慰剂组或阿达木单抗组。在第16周时，安慰剂组和阿达木单抗组随机加用依奇珠单抗q2w或依奇珠单抗q4w，直至第52周。研究的主要终点设定为中轴型脊椎关节炎评估国际标准改善≥40%（ASAS40）。COAST-V研究中，在第16周和第52周达到ASAS40的比例分别为48%和53% （依奇珠单抗q4w），52%和51%（依奇珠单抗q2w），36%和51%（依奇珠单抗+阿达木单抗），19%和47%（依奇珠单抗+安慰剂）。COAST-W研究中，16周和52周达到ASAS40的比例分别为25%和34%（依奇珠单抗q4w），31%和31%（依奇珠单抗q2w），14%和39%（依奇珠单抗+安慰剂）。依奇珠单抗两种给药方案持续改善疾病活动度、患者身体功能、炎症的客观指标、生活质量、健康状况和整体功能达52周。依奇珠单抗52周安全性与16周的安全性一致。结论：对于未使用过生物制剂和曾经使用过TNF抑制剂的患者，依奇珠单抗的疗效从16周持续至52周。最初接受阿达木单抗治疗的患者换到依奇珠单抗后，有进一步改善。苏金单抗苏金单抗（secukinumab）是人源抗IL-17A的单克隆抗体。2015年被批准用于治疗银屑病和银屑病性关节炎；2020年6月适应症被扩展放射学阴性的中轴型脊椎关节炎。《苏金单抗治疗影像学阴性的中轴型脊椎关节炎的3期研究》Arthritis and Rheumatology，2020年8月 (3)研究旨在评估苏金单抗在治疗活动性、影像学阴性的中轴型脊椎关节炎的患者中的疗效。共555例患者，分别苏金单抗150mg负荷组，苏金单抗150mg无负荷组或安慰剂，前4周q1w负荷剂量给药，4周后q4w给药。20周后，允许切换到开放标签。研究的主要终点设定为国际中轴型脊椎关节炎评估国际标准改善≥40%（ASAS40）。16周时苏金单抗负荷组41.5%的患者，52周时非负荷组39.8%的患者出现病情缓解，安慰剂组仅为29.2%（P < 0.05)。没有新的安全发现报告。结论：苏金单抗治疗影像学阴性的中轴型脊椎关节炎优于安慰剂，疗效持续52周。中轴型脊柱关节炎中轴型脊柱关节炎的背痛的特点有：40岁以前出现背部不适、起病隐匿、随运动而改善、休息时无缓解、夜间痛。患者还可以伴有以下症状：交替性臀区疼痛、附着点炎导致的足跟痛、指炎、下肢非对称性关节炎、前葡萄膜炎（虹膜炎）、克罗恩病或溃疡性结肠炎、银屑病、疼痛对NSAID类药物反应良好、脊柱关节炎家族史。实验室检查包括HLA-B27阳性，和影像学骶髂关节炎。对于慢性背痛发病时3个月、后因无效而停用、并开始另一项抗风湿药物的患者，进行了一项回顾性队列研究。137例患者中，抗阿达木单抗抗体的存在并不能预测换用其他TNFi的药物反应性（敏感性/特异性 18%/75%），也不能预测非TNFi药物的反应性（敏感性/特异性 33%/70%）。阿达木单抗的血药浓度不能预测换用TNFi的药物反应性（敏感性/特异性 50%/52%），也不能预测非TNFi药物反应性（敏感性/特异性 32%/69%）。结论：对于抗阿达木单抗抗体或阿达木单抗血药浓度，作者无法找到二次使用TNFi或非TNFi药物反应的预测价值。《BSRBR-RA研究：抗TNF的早期反应预测长期获益》Rheumatology，2020年7月 (9)研究的目的是评估，类风湿关节炎患者在启动第一个抗TNF（TNF）的药物后，长期的疾病活动情况的轨迹。研究选取2001年至2013年首次使用抗TNF药物的类风湿关节炎患者，共14436例。类风湿关节炎活动评分的最低点出现在用药250天内。第180天时，已经出现了4种不同的、稳定的响应轨迹。55.3%的患者属于“适度”反应型；32.4%的患者属于“显著”反应型。其余的8.7%和3.6%分别符合“最大”和“最小”反应型。在2001-2008年和2010-2013年之间，达到“最大”反应的比例显著增加(P < 0.01)。结论：抗TNF药物使用6个月时，疾病活动的长期轨迹轮廓已经可以确定。大多数患者有持续的“适度”反应，维持中度的疾病活动；大约1/3的患者达到最大程度的缓解。《注册研究：一线TNF抑制剂与非TNF抑制剂生物制剂和靶向合成制剂在类风湿性关节炎患者中的疗效比较》Annals of Rheumatic Diseases，2020年7月 (10)本研究评估了TNF（TNF）抑制剂与非TNF抑制剂（生物疾病修饰抗风湿药物，bDMARDs）和靶向合成抗风湿药物（tsDMARDs）的疗效比较。TNF抑制剂治疗组和非TNF抑制剂治疗组在疗效评估方面无统计学差异。贫血的发生率上，TNF抑制剂组略优于非TNF抑制剂组（24.01 / 100人年，p=0.03)。结论：一线TNF抑制剂和一线非TNF抑制剂的疗效没有显著差异，支持指南中建议的“基于临床判断和考虑患者偏好的个体化治疗”。狼疮性肾炎《高效淋巴系统靶向纳米颗粒包裹的环孢霉素预防狼疮小鼠模型肾小球肾炎》Science Advance，2020年6月 (11)环孢素A是一种强大的免疫抑制剂，但由于其生物利用度低需要增加剂量，但大剂量又存在肾毒性，故它无法单独用于治疗系统性红斑狼疮。贝勒医学院的研究人员设计了一个以CD71为靶点的、生物可降解的聚酯纳米颗粒，直接向淋巴系统递送环孢素A。其中藤黄酸偶联纳米颗粒显著增加了纳米颗粒与CD3+或CD20+淋巴细胞以及肠道淋巴组织的结合率。在口服给药的小鼠模型中，经纳米颗粒包裹的环孢素A增加了4-18倍的淋巴给药量。环孢素A淋巴生物利用度的提高，与抗双链DNA抗体IgG滴度、血浆细胞因子和肾小球肾炎的缓解一致。结论：本研究证明了纳米颗粒增强淋巴组织靶向性的潜力。参考文献1.Deodhar A, van der Heijde D, Gensler LS, Kim TH, Maksymowych WP, Østergaard M, et al. Ixekizumab for patients with non-radiographic axial spondyloarthritis (COAST-X): a randomised, placebo-controlled trial. Lancet. 2020;395(10217):53-64.2.Dougados M, Wei JC, Landewé R, Sieper J, Baraliakos X, Van den Bosch F, et al. Efficacy and safety of ixekizumab through 52 weeks in two phase 3, randomised, controlled clinical trials in patients with active radiographic axial spondyloarthritis (COAST-V and COAST-W). Ann Rheum Dis. 2020;79(2):176-85.3.Deodhar A, Blanco R, Dokoupilová E, Hall S, Kameda H, Kivitz AJ, et al. Secukinumab improves signs and symptoms of non-radiographic axial spondyloarthritis: primary results of a randomized controlled phase III study. Arthritis Rheumatol. 2020.4.Renson T, Depicker A, De Craemer AS, Deroo L, Varkas G, de Hooge M, et al. High prevalence of spondyloarthritis-like MRI lesions in postpartum women: a prospective analysis in relation to maternal, child and birth characteristics. Ann Rheum Dis. 2020;79(7):929-34.5.Abdelaziz MM, Gamal RM, Ismail NM, Lafy RA, Hetta HF. Diagnostic value of anti-CD74 antibodies in early and late axial spondyloarthritis and its relationship to disease activity. Rheumatology (Oxford). 2020.6.Jones GT, Dean LE, Pathan E, Hollick RJ, Macfarlane GJ. Real-world evidence of TNF inhibition in axial spondyloarthritis: can we generalise the results from clinical trials? Ann Rheum Dis. 2020;79(7):914-9.7.Koo BS, Oh JS, Park SY, Shin JH, Ahn GY, Lee S, et al. Tumour necrosis factor inhibitors slow radiographic progression in patients with ankylosing spondylitis: 18-year real-world evidence. Ann Rheum Dis. 2020;79(10):1327-32.8.Ulijn E, den Broeder N, Wientjes M, van Herwaarden N, Meek I, Tweehuysen L, et al. Therapeutic drug monitoring of adalimumab in RA: no predictive value of adalimumab serum levels and anti-adalimumab antibodies for prediction of response to the next bDMARD. Ann Rheum Dis. 2020;79(7):867-73.9.Hamann PDH, Pauling JD, McHugh N, Hyrich K, Shaddick G. Early response to anti-TNF predicts long-term outcomes including sustained remission: an analysis of the BSRBR-RA. Rheumatology (Oxford). 2020;59(7):1709-14.10.Pappas DA, St John G, Etzel CJ, Fiore S, Blachley T, Kimura T, et al. Comparative effectiveness of first-line tumour necrosis factor inhibitor versus non-tumour necrosis factor inhibitor biologics and targeted synthetic agents in patients with rheumatoid arthritis: results from a large US registry study. Ann Rheum Dis. 2020.11.Ganugula R, Arora M, Zou D, Agarwal SK, Mohan C, Kumar MNVR. A highly potent lymphatic system–targeting nanoparticle cyclosporine prevents glomerulonephritis in mouse model of lupus. Science Advances. 2020;6(24):eabb3900.

"Ayurveda is a deep awareness of your own existence and life itself" - Dr. Ram Manohar.  Ayurveda has been plagued by various interpretations and misconceptions over the last century and has been relegated to status of alternate medicine for the longest time now.  But what is the true essence of this ancient science and how is it relevant in our lives. Join me in conversation with Dr. Ram Manohar, who has dedicated his life to the study and research in the science of Ayurveda. Listen in to his fascinating experience of the Gurukul system! Dr. P. Ram Manohar is the Research Director of Amrita School of Ayurveda and has been contributing in the field of Ayurvedic research for the last 29 years. He has to his credit more than 100 research papers published in journals. The most notable of them is a research study to scientifically evaluate the efficacy of Ayurveda in rheumatoid arthritis which was conducted in collaboration with the University of Washington, Seattle, University of California, Los Angeles and AVP, Coimbatore. The outcomes of this study were published in the Annals of Rheumatic Diseases and Journal of Clinical Rheumatology and won the prestigious Excellence in Integrative Medicine Research Award from the European Society of Integrative Medicine. He received his BAMS degree from Bharathiyar University, Coimbatore, in 1991 and MD (Ay) degree from Rajiv Gandhi University of Health Sciences, Bengaluru, in 2001. Dr. Manohar has been honored with numerous awards in this space and is also on the scientific advisory committee of the National Institute of Ayurveda AYUSH ministry, Govt of India.