New RCT in a new disease with a new drug! But is it as shiny as one would hope? Interesting discussion today about what a trial means, how it will affect practice, and how we could do better as a field. Happy holidays everyone! 

Reading one of my recent newsletters this week, this one about PMR tapers. Be sure to subscribe at ebrheum.com if you want access to the visuals and upcoming editions! 

Quick methodology episode this week discussing the concept of "fragility" in randomized controlled trials of lupus. Really enjoyed discussing this paper and was grateful to have been a part of it. Get the text here: https://lupus.bmj.com/content/lupusscimed/11/1/e001068.full.pdf

Today I'm taking another twitter discussion into the podcast realm! Dr. Bhaskar Dasgupta has published hundreds of papers about polymyalgia rheumatica and giant cell arteritis, including a recent publication in Nature Reviews: Rheumatology that piqued my interest (https://www.nature.com/articles/s41584-023-00976-8). 

In this podcast we discuss screening for GCA among patients with PMR, what it means to have a diagnosis, the role of novel IL-6 inhibitors, and many other topics. Have a listen and follow me @ebrheum and Dr. Dasgupta @profbdasgupta

Interesting topic and interesting paper this year, including discussion of observational biases, positive and negative controls, and interpreting data as it comes. 

Paper: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2810259

Important trial on the podcast this week! I take a deep dive into the recently published SAPHYR study, which evaluated the use of the IL6 inhibitor sarilumab for patients with PMR. A few aggravating quibbles but overall a very useful trial and an important step forward for patients with PMR.

Article: https://www.nejm.org/doi/full/10.1056/NEJMoa2303452

This week I took a twitter disagreement from the impersonal world of twitter to the podcast world of a back and forth conversation. Really enjoyed talking to Dr. Len Calabrese about monoclonal antibodies, FDA regulatory pathways, and life in general. 

Excited to share an editorial that I wrote along with Cody Bruggemeyer and Desh Nepal, two trainees with me at the Medical College of Wisconsin. We discussed what I believe to be a pervasive (but seldom discussed) issue in rheumatology RCTs: unblinding. I suspect many of our studies suffer from this. Have a listen! 

Happy to share the FIRST randomized trial in CPPD today. It's kind of a weird study but worth a quick discussion. 

https://www.sciencedirect.com/science/article/pii/S2665991323001650

This week I dive into the health related quality of life measures that were reported in the ADVOCATE study. I found them overall somewhat convincing and they have affected my practice. Have a listen and be sure to follow along. Find my work at ebrheum.com 

Quick episode this week from a recent Perspective piece I had published in the New England Journal. Have a listen or a read!

https://www.nejm.org/doi/full/10.1056/NEJMp2304828

Podcast this week discussing key opinion leaders (KOLs) and pharmaceutical companies. Please subscribe to my newsletter (ebrheum.com) and be sure to share the podcast with friends! 

Quick rundown of an important rheumatology RCT this week, discussing the IL-5 inhibitor benralizumab for the treatment of relapsing/refractory EGPA. 

MANDARA Study: https://www.nejm.org/doi/full/10.1056/NEJMoa2311155

Nice quick RCT rundown this week, covering the ALLHEART study, a pragmatic RCT of urate lowering therapy to reduce cardiovascular disease. Quick listen for a useful teaching point! 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01657-9/fulltext

Today I cover the recently published long-COVID study from Norway. It's a great paper that challenges much of the prevailing wisdom. I think there are some interesting limitations, but anyone who sees post COVID patients (aka all of us) would do well to read it. Or have a listen here! 

PDF: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802893

Fun study this week from JAMA Network Open and the French Vasculitis Study Group. They used a target trial emulation (one of my favorites) to ask whether RTX > CYC in AAV (another one of my favorites). I tried to use this to compare between observational and randomized data. 

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799018 

This week I hope to debunk one of rheumatology's "paradoxes." We love to talk about these and subject our fellows to memorizing them for the boards. We often use them to guide clinical practice, but I suspect that many "paradoxes" are actually the result of shoddy epidemiology. Todays' paper from JAMA dermatology covers one that I have heard frequently, which is that steroids cause psoriasis flares. I hope you enjoy!

Follow me @ebrheum and check out my newsletter where I cover more of these (links on ebrheum.com) 

Today I'll be reading one of my recent newsletters! It's kind of a fun run-down of my anti-azathioprine stance. As I say in the piece, some patients may benefit from azathioprine and I am not saying it is an entirely useless drug or that nobody should ever prescribe it. Rather, I am just saying that it is likely the worst option for nearly every indication for which it could be prescribed.

Please subscribe AND JOIN my newsletter if you would like to support my writing and podcasting! https://t.co/RIzRvWnSfv

Today I review a recent large meta analysis of randomized controlled trials of statin use. Super interesting findings that have changed my clinical practice. Check out the paper here and listen to the episode! 

Paper: https://www.thelancet.com/article/S0140-6736(22)01545-8/fulltext

"Internet driven cult" editorial: https://pubmed.ncbi.nlm.nih.gov/28738422/

Change of pace today! I interviewed Jason Liebowitz and Phil Seo about their new book entitled "Clinical Innovation in Rheumatology: Past, Present, and Future." I thoroughly enjoyed the book and had a great time interviewing them about some of their "futuristic" topics. Grab the book (or better yet, have your division get some copies) at the link below and be sure to share the podcast with friends! 

https://www.routledge.com/Clinical-Innovation-in-Rheumatology-Past-Present-and-Future/Liebowitz-Seo/p/book/9781032074917

Quick episode this week to share an editorial I recently wrote with Jay Patel and Anisha Dua. We cover one of my least phrases in medicine, the "diagnosis of exclusion." 

Hope you enjoy! Find the original paper here: https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keac278/6584804

Exciting (negative) results from a large RCT on the podcast this week as well as a (mini) rant about how we should be spending our time as rheumatologists and the false security of ineffective treatments. 

Let me know what you think on twitter @ebhruem

https://www.nejm.org/doi/full/10.1056/NEJMoa2202106

Interesting case-crossover study today evaluating the association between HCQ dosing and risk of SLE flares. Super worth your time to read the paper or listen to this episode! 

https://jamanetwork.com/journals/jama/article-abstract/2796634

Important methodology podcast this week, covering a lot of ground with expert epidemiologist Rishi Desai. Really enjoyed our conversation and glad to be publishing today! 

**House Keeping Note: we actually recorded this ~15 months ago but I somehow lost the audio... which somehow re-appeared! #technology 

STAR-RA: https://pubmed.ncbi.nlm.nih.gov/35027405/

Podcast is back! This week I discuss a pivotal RCT in dermatomyositis. Check it out and be sure to subscribe to my newsletter at ebrheum.com! 

Mixing it up again this week to discuss an editorial by Miguel Hernan and a systematic review of target trials in rheumatology. It's kind of a fun free-form stream of consciousness. Hope you enjoy! Links: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5888052/

https://pubmed.ncbi.nlm.nih.gov/32381560/

Quick episode today. I wanted to share an editorial that was recently published in Rheumatology, where I and co-authors (Shannon Tai and Natalie Anumolu) discuss lessons from recent trials in AAV and SLE. 

Link to editorial: https://pubmed.ncbi.nlm.nih.gov/35438142/ 

After some delay, I finally get around to discussing ORAL-Surveillance, a post-marketing safety study of tofacitinib for rheumatoid arthritis. It's an incredibly important trial that will likely affect how all of us practice for the foreseeable future. Link to paper: 

https://www.nejm.org/doi/full/10.1056/NEJMoa2109927

After a winter hiatus, the podcast is back! Today I wanted to dive into a 'hotbutton' issue - the question of whether (or not) COVID-19 vaccines "work" for patients with rheumatic diseases. My answer is an emphatic "yes," albeit with a few caveats. Here are the papers I discuss: 

https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(22)00034-0/fulltext

https://pubmed.ncbi.nlm.nih.gov/35441151/

Hello again! Snappy episode this week about the exciting LoVAS trial, which compared a reduced dose steroid taper for ANCA vasculitis. Be sure to drop by my website at ebrheum.com to subscribe to my newsletter! 

In this episode, I talk with Dr. Andy Abril, Chair at the Division of Rheumatology at the Mayo Clinic in Jacksonville Florida.  Dr. Abril is one of the lead authors for the 2021 ACR Guidelines on  Takayasu’s arteritis.

This project was done in partnership with the Vasculitis Foundation. To review the complete guidelines, visit https://dev.vasculitisfoundation.org/2021-acr-vf-vasculitis-guidelines/ or vasculitisfoundation.org. You can find them on Twitter @vasculitisfound and I am @ebrheum. Thanks for listening! 

In this episode, I talk with Dr. Jason Springer, Co-Director of the Vanderbilt Vasculitis Center, about the guidelines for PAN  He is one of the lead authors for the ACR/VF Guidelines for Polyarteritis Nodosa.

This project was done in partnership with the Vasculitis Foundation. To review the complete guidelines, visit https://dev.vasculitisfoundation.org/2021-acr-vf-vasculitis-guidelines/ or vasculitisfoundation.org. You can find them on Twitter @vasculitisfound and I am @ebrheum. Thanks for listening! 

On today's episode I discuss GCA with Dr. Mehrdad Maz.  He is the Division Director of the Kansas University Allergy, Clinical Immunology and Rheumatology Section and served on the Steering Core Committee of the ACR-VF Vasculitis Treatment Guidelines. We cover a lot of great topics!

This project was done in partnership with the Vasculitis Foundation. To review the complete guidelines, visit https://dev.vasculitisfoundation.org/2021-acr-vf-vasculitis-guidelines/ or vasculitisfoundation.org. You can find them on Twitter @vasculitisfound and I am @ebrheum. Thanks for listening! 

In today's episode, I talk with Dr. Mehrdad Maz about the newly published guidelines for giant cell arteritis (GCA).  Dr. Maz is the Division Director of the Kansas University Allergy, Clinical Immunology and Rheumatology Section. He serves on the Steering Core Committee of the ACR-VF Vasculitis Treatment Guidelines. 

This project was done in partnership with the Vasculitis Foundation. To review the complete guidelines, visit https://dev.vasculitisfoundation.org/2021-acr-vf-vasculitis-guidelines/ or vasculitisfoundation.org. You can find them on Twitter @vasculitisfound and I am @ebrheum. Thanks for listening! 

Exciting podcast this week about the upcoming / impending use of CAR-T in rheumatology. Highly recommend rheumatologists learn about this now; it's going to be a big thing for many years to come. In a future episode I will lay out my case for skepticism, but for now I think a good run down of the first big published series will be enough! 

NEJM CAR-T Case Series: https://www.nejm.org/doi/full/10.1056/NEJMoa2308917

Nature Review Article: https://www.nature.com/articles/s41584-024-01139-z

The guidelines have finally arrived!  I'm kicking off the series today with a conversation about the ANCA vasculitis guidelines.  My guest is Dr. Sharon Chung, the director of the UCSF Vasculitis Clinic and the lead investigator on the ACR/Guideline committee. She provided a LOT of great insights; have a listen and let us know what you think! 

This project was done in partnership with the Vasculitis Foundation. To review the complete guidelines, visit https://dev.vasculitisfoundation.org/2021-acr-vf-vasculitis-guidelines/ or vasculitisfoundation.org. You can find them on Twitter @vasculitisfound and I am @ebrheum. Thanks for listening! 

Hopping in this week to round out my thoughts on ADVOCATE (avacopan in AAV) and covering the recently published AURORA trial for SLE nephritis. Back to the Vasculitis Guidelines Podcast after as soon as they are released! 

In this episode we'll be introducing the process by which the 2021 ACR/VF guidelines were produced.  My guest is Dr. Sharon Chung.  She's the director of the UCSF Vasculitis Clinic and the lead investigator on the guideline committee.  Please follow along with future episodes - you can find me @ebrheum and the Vasculitis Foundation is at @vasculitisfound and their website vasculitisfoundation.org.

Welcome to the first episode of the Vasculitis Guidelines Podcast! In Episode 1, I interview Joyce  Kullman, Executive Director of the Vasculitis Foundation, about collaborating with the ACR in updating these guidelines, and how patients with vasculitis will ultimately benefit from them. We discuss the complex process of updating these critical guidelines involve years of input from researchers, physicians, and patient themselves.

Quick update on a new series! 

Steroid free remission! Or is it? This week I discuss a really exciting trial in ANCA vasculitis.  

I stole some time to tackle a pressing issue for rheumatologists - to hold or not to hold immunosuppression in patients who are receiving a COVID19 vaccination.  We obviously don't have any data on this, but I have always loved this study on influenza vaccination.  PDFs at ebrheum.com/twts and follow me on twitter @ebrheum! 

We have a great show for you this week!  Anisha Dua will be moderating a debate between myself and Max Konig on this motion: "Hydroxychloroquine levels should be monitored in patients with SLE."  I learned a ton and thoroughly enjoyed it.  Be sure to vote on the post-debate twitter poll to decide the winner! 

This week I cover another of my meta-research projects, this one on systematic review and meta analysis (SRMA) growth as compared to randomized clinical trial (RCT) growth.  Short and to the point - hope you enjoy! I highly recommend checking out the associated graphs - just take a quick peek at some point while listening. Find them on my twitter handle @ebrheum 

Active comparator trial! Always my favorite.  Lots of fun topics in this one, including noninferiority trials, crafty endpoints, and PROs.  Check it out and let me know what you think! @ebrheum 

This week's podcast will be a quick read of one of my newsletters. The title basically speaks for itself! Find the newsletter and my other work at ebrheum.com 

Another day, another lupus trial, another round of endpoint shenanigans.  Why does that matter? How big is the benefit from belimumab in SLE nephritis? Will this save lives and prevent ESRD / RRT? I try to tackle these issues this week and (hopefully) avoid getting myself in trouble.  Hope you enjoy the episode!  Let me know what you think @ebrheum on twitter! 

Great paper to discuss this week - one that may be too good to believe? I highly recommend checking out the pdf first (ebrheum.com/twts) - their graphics are wonderful and do a great job of conveying their message.  Also, check out the "2-5-10" rule that I referenced!  This is required reading for anyone who rotates with me - easily one of the most useful EBM papers I have ever read. 

Quick podcast this week that expands on issues I discuss in Episode 55.  Go back and listen to that one first if you have time!  I think this is an important issue and it's one I'd like to highlight.  Let me know what you think @ebrheum and please share with friends! 

The podcast is back!  I tune in briefly here to explain where I've been, what I'm doing, and where this will be headed. Feel free to skip right ahead if you'd rather just dig back in!