Podcast Healio Rheuminations by Adam J. Brown, MD Episodes

Explore every episode of the podcast Healio Rheuminations

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	Title	Pub. Date	Duration
	NSAIDs, Part 3: The rise, fall and rise again of COX-2 inhibition	29 Aug 2024	00:37:44
In the third episode of the NSAIDs saga, we focus on COX-2 inhibition! Did the hopes and dreams of selective COX-2 inhibition pan out? What can the rise and fall of VIOXX teach us about physiology? Intro 0:11 Recap of part 1 & 2 0:28 In this episode 1:44 Cyclooxygenase 2 (COX-2) and the rat experiment 3:12 What do we know about the prostaglandins? And what about COX-2 7:54 What does prostacyclin do? 10:33 The first COX-2 inhibitor: VIOXX 10:56 What is COX-2 doing?: Pfizer and Merck 12:15 Two more NSAID studies: colon cancer, Alzheimer’s disease and COX-2 inhibitors 18:41 VIOXX: Why is myocardial infarction risk occurring? 22:34 Animal models and the Goldilocks theory of thromboxane and prostacyclin 23:49 PRECISION trial 30:25 Rheum + Boards 37:14 Thanks for listening 37:32 We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Anderson GD, et al. J Clin Invest. 1996;doi:10.1172/JCI118717. Funk CD, et al. J Cardiovasc Pharmacol. 2007;doi:10.1097/FJC.0b013e318157f72d. Hennan JK, et al. Circulation. 2001;doi:10.1161/hc3301.092790. Krumholz HM, et al. BMJ. 2007;doi:10.1136/bmj.39024.487720.68. Nissen SE, et al. N Engl J Med. 2016;doi:10.1056/NEJMoa1611593. Disclosures: Brown reports no relevant financial disclosures.
	NSAIDs, Part 2: The Dawn of the Anti-Inflammatories	26 Jun 2024	00:46:59
In this episode, we dive into the story of aspirin and the development of ibuprofen, ending with the experiments that showed the mechanism of how aspirin actually works. Intro 0:12 Review of part 1 0:28 In this episode *1:04* Blocking prostaglandins and willow leaves 2:26 Edward Stone 3:45 Johann Andreas Buchner 4:16 The chemical structure of salicylic acid and creating the synthetic compound 4:44 Dr. TJ MacLagan: The first trial in 1876 and treating acute rheumatism 5:16 Felix Hoffmann: manipulating salicylic acid and aspirin 8:47 How widespread was the use of aspirin for rheumatoid arthritis? *12:04* 1938: problems with aspirin and endoscopies 14:58 1950s: long-term use of aspirin and chronic renal impairment 17:12 Dr. Lawrence Craven: the use of aspirin to treat myocardial infarction 18:13 Overview of what we’ve learned so far 20:48 Stewart Adams: the development of ibuprofen 21:40 A paper lost to time 23:29 How do you test if a drug is anti-inflammatory? 25:25 How do you make better aspirin? 26:55 1960: a trial comparing ibuprofen, baby aspirin and prednisone in patients with rheumatoid arthritis 30:03 Aspirin, ibuprofen and other NSAIDs 32:49 Nobel Prize winner Dr. John Vane 33:40 Dr. Vane: what triggered prostaglandin production? 35:42 Another guinea pig experiment 37:37 Nobel Prize winner Dr. Bengt Samuelsson 39:00 Interesting tidbits: early studies looking at the side effects of NSAIDs *40:01* 1968: gastric ulcer formation and prostaglandins in rats *40:25* 1973: renal blood flow and prostaglandins in dogs 41:53 1974: aspirin vs ibuprofen vs indomethacin for the heart 44:03 Aspirin vs ibuprofen vs indomethacin 44:20 On the next episode 46:09 Thanks for listening 46:37 We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Adams SS. Inflammopharmacology. 1999;doi:10.1007/s10787-999-0002-3. https://www.aspirin-foundation.com/history/the-aspirin-story/. Buchanan WW, et al. J Rheumatol. 2002;29(6):1321-3. Cryer B, et al. Gastroenterology. 1999;doi:10.1016/s0016-5085(99)70545-7. Desborough MJR, et al. Br J Haematol. 2017;doi:10.1111/bjh.14520. Halford GM, et al. Platelets. 2012;doi:10.3109/09537104.2011.632032. Harris SC, Fosdick LS. Theoretical considerations of the mechanisms of antipyretic analgesia. NWU Bull. 1952;53: 6–9. Jasani MK, et al. Ann Rheum Dis. 1968;doi:10.1136/ard.27.5.457. Robert A, et al. Gastroenterology. 1968;55(4):481-7. Disclosures: Brown reports no relevant financial disclosures.
	The Environment and Autoimmunity, Part 1	12 Jul 2023	00:38:00
This episode delves into the history of the hygiene hypothesis. What do we know about different exposures changing risk for asthma and allergies, and do these exposures have the same protection for autoimmunity? · Intro *0:12* · In this episode *0:18* · Hygiene hypothesis *0:33* · Allergic rhinitis (or Hay fever) *2:32* · Pollen and the allergy skin test *8:58* · Exposure and cleanliness *10:22* · Allergic rhinitis and Cree Native Americans *11:51* · Appendicitis *13:10* · Family size and asthma *14:36* · Rural versus urban populations *17:41* · Dust *18:31* · Children, day care and infections *22:43* · The “old friends” theory *28:29* · Farming and allergies *30:07* · The Amish and the Hutterites *33:02* · Mice, dust and asthma *34:47* · Thanks for listening *37:40* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Emanuel MB. Clin Exp Allergy. 1988;doi:10.1111/j.1365-2222.1988.tb02872.x. Flohr C, et al. Clin Exp Allergy. 2010;doi:10.1111/j.1365-2222.2009.03346.x. Genuneit J. Pediatr Allergy Immunol. 2012;doi:10.1111/j.1399-3038.2012.01312.x. Karvonen AM, et al. J Allergy Clin Immunol. 2019;doi:10.1016/j.jaci.2019.07.035. Perkin MR, et al. Front Allergy. 2022;doi:10.3389/falgy.2022.1051368. Rantala AK, et al. Epidemiol. 2020;doi:10.1097/EDE.000000000001163. Sangrador CO, et al. Allergol Immunopathol (Madr). 2018;doi:10.1016/j.aller.2018.03.006. Stein MM, et al. N Engl J Med. 2016;doi:10.1056/NEJMoa1508749. Strachan DP. BMJ. 1989;doi:10.1136/bmj.299.6710.1259. Weber J, et al. Am J Respir Crit Care Med. 2015;doi:10.1164/rccm.201410-1899OC.
	An Afternoon with the Glaucomfleckens: On hypermobility and physician burnout	28 Jun 2023	00:46:01
On this special episode of Rheuminations, I interview comedian and ophthalmologist William Flanary, MD, and Kristin Flanary, also known as the Glaucomfleckens, on hypermobility and physician burnout. Kristen Flanary highlights what it's like to live with hypermobility, and Dr. William Flanary discusses his thoughts on physician burnout and using their podcast, Knock Knock, Hi, as comedy relief. · Intro *0:11* · In this episode *0:45* · Interview with Dr. William and Kristin Flanary, also known as Doctor and Lady Glaucomflecken *2:49* · Rheumatology and ophthalmology overlap *3:11* · Can you tell me a few things about yourselves? *7:48* · Kristin Flanary, MA: when did you notice your hypermobility and when did you start having complications from it? *12:19* · Do you ever fully dislocate or do you kind of feel like you’re about to? *19:53* · Chest compressions and William Flanary *25:23* · Have you done any bracing? *26:24* · Dr. Linda Bluestein, @hypermobilityMD, on the Glaucomfleckens podcast *30:24* · William Flanary, MD: can you talk about your experience with physician burnout? And are you optimistic about AI solving the physician burnout problem? *31:16* · Artificial Intelligence with Cardiologist Dr. Eric Topol \| Knock Knock, Hi with the Glaucomfleckens, @EricTopol *37:01* · Can you tell us more about your podcast, Knock Knock, Hi? *41:06* · Thank you *44:59* Disclosures: Brown and the Flanarys report no relevant financial disclosures. William E. Flanary, MD, is an ophthalmologist and part-time comedian, also known as Dr. Glaucomflecken. You can follow him on Twitter @DGlaucomflecken. Kristin Flanary, MA, is a marketing and communications specialist, also known as Lady Glaucomflecken. You can follow her on Twitter @LGlaucomflecken. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.
	The Black Death and Autoimmunity	03 Apr 2023	00:31:45
Was your psoriasis caused by the Black Death? Learn more than you might have wanted to know about the Black Death and delve into the data on the immunologic/autoimmune ramifications of wiping out nearly half of Europe. · Intro *0:11* · In this episode *1:09* · The Black Death *1:24* · The History of IV Immunoglobulin episode *2:07* · How the Black Death happened *4:07* · How many people died from the Black Death? *6:49* · Record keeping *6:53* · The modern immune system, the Black Death and HIV *8:43* · What is CCR5? *8:55* · Current data on autoimmune diseases *10:35* · ERAP2 *15:55* · How yersinia pestis kills you *21:04* · The inflammasome *22:03* · The Inflammasome for Dunces episode *22:09* · Mediterranean fever and mouse model *24:49* · Takeaways *30:20* · Summary *30:59* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Wheelis M. Emerg Infect Dis. 2002;doi:10.3201/eid0809.100536. Ratner D, et al. PLoS Pathog. 2016;doi:10.1371/journal.ppat.1006035. Park YH, et al. Nat Immunol. 2020;doi:10.1038/s41590-020-0705-6. Patin E. Nat Immunol. 2020;doi:10.1038/s41590-020-0724-3. Galvani AP, et al. Proc Natl Acad Sci USA. 2003;doi:10.1073/pnas.2435085100.
	Vascular Ehlers Danlos Syndrome for the Rheumatologist, Pt 2: Extra-Cellular Matrix Reloaded	28 Feb 2023	00:41:57
In this episode we explore ways in which the extracellular matrix can be manipulated, including the story of doxycycline, TGF-beta in Marfan syndrome and whether beta blockers can reduce vascular events in vascular EDS. · Intro *0:12* · Review of previous episode *0:28* · In this episode *2:26* · The pressure against the vessels *4:06* · The pressure against the wall *8:44* · Matrix metalloproteinases *10:16* · Tadpole study – collagen breakdown *10:35* · Tetracycline antibiotics *14:05* · Rat model – periodontal disease and hydroxyproline *14:24* · Chemically modified tetracyclines *20:14* · Mouse model – tetracycline use *22:00* · Tetracyclines and other autoimmune conditions *23:22* · Marfan syndrome *24:45* · Fibrillin and Marfan syndrome *28:48* · TGF-beta *29:36* · Mouse model – Marfan syndrome and fibrillin *31:14* · ARBs and TGF-beta *33:51* · TGF-beta and vascular EDS *37:25* · Back to the mouse model *38:38* · Protein kinase C *39:56* · Summary *40:26* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Bowen CJ, et al. J Clin Invest. 2020;130:686-698. Brooke BS. Lancet. 2010;doi:10.1016/S0140-6736(10)61155-5 Dietz HC, et al. Am J Med Genet C Semin Med Genet. 2005;doi:10.1002/ajmg.c.30068. Dubacher N, et al. Cardiovasc Res. 2020;116:457-465. Golub LM, et al. SAGE. 1998;doi:10.1177/08959374980120010501. Gross J, et al. PNAS. 1962;doi:10.1073/pnas.48.6.1014 Habashi JP, et al. Science. 2006;312:117-121. Morissette R, et al. Circ Cardiovasc Genet. 2014;7:80-88. Mullen M, et al. Lancet. 2019;394:2263-2270. Neptune ER, et al. Nat Genet. 2003;33:407-411.
	Vascular Ehlers-Danlos Syndrome, Part 1	31 Jan 2023	00:36:38
Dive into vascular Ehlers-Danlos syndrome. What is it? How does it present? Get clues to its diagnosis and learn more about collagen than you ever wanted to know. Intro *0:12* In this episode *0:17* Why vascular Ehlers-Danlos syndrome? *0:28* Case study: Dr. Mories *2:20* What can we learn about vascular Ehlers-Danlos syndrome? *05:02* Collagen and elastin *05:57* Collagen: horses and glue *07:07* More about collagen *10:35* Why is it a problem to miss a little bit of collagen? *14:14* The problem in vascular Ehlers-Danlos syndrome *15:06* The history of vascular EDS *15:41* How is vascular Ehlers-Danlos syndrome diagnosed? *16:36* A vascular Ehlers-Danlos syndrome diagnosis *22:33* Mouse models *23:29* Clinical and genetic features of vascular Ehlers-Danlos syndrome *24:39* Question of vasculitis *25:55* The skin: the most common symptom of vascular EDS *28:00* Family history, de novo mutations and pregnancy *29:43* Surgery or vascular intervention *31:39* How do patients do in the long-term? *32:54* Summary *34:00* Preview of part 2 *35:42* Thanks *36:25* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Barabas AP. J Cardiovasc Surg (Torino). 1972;13(2):160-7. Chow MJ, et al. Biophys J. 2014;doi:10.1016/j.bpj.2014.05.014. Liu X, et al. Proc Natl Acad Sci USA. 1997;doi:10.1073/pnas.94.5.1852. Mories A. Scott Med J. 1960;5:269-72. Pepin M, et al. N Engl J Med. 2000;doi:10.1056/NEJM200003093421001. Pepin MG, et al. Genet Med. 2014;doi:10.1038/gim.2014.72. Piez KA. Matrix Biol. 1997;doi:10.1016/s0945-053x(97)90037-8. Pope FM, et al. Proc Natl Acad Sci USA. 1975;doi:10.1073/pnas.72.4.1314. Wagenseil JE, et al. J Cardiovasc Transl Res. 2012;doi:10.1007/s12265-012-9349-8. Zilocchi M, et al. AJR Am J Roentgenol. 2007;doi:10.2214/AJR.07.2370.
	Making Sense of Sensory Ganglionopathies, Part 2	18 Jan 2023	00:29:24
In this episode, Dr. Benjamin Claytor walks us through his approach to suspected sensory ganglionopathies. I also cover other neurologic complications of Sjogren’s syndrome and some interesting history on vitamin B6. Intro *0:12* In this episode *0:46* Neurologic complications of Sjogren’s Syndrome *1:55* Intro of Dr. Benjamin Claytor *6:00* The interview *6:49* Case study: process of diagnosis *7:17* Dorsal root ganglion in Sjogren’s *10:46* Facial numbness in sensory ganglionopathies *11:42* Dorsal root ganglion biopsies *13:36* Prognosis of sensory ganglionopathies vs other distal neuropathies *14:03* Sensory loss and weakness *15:51* Sensory ataxia *16:24* Attacks on the dorsal root ganglion *18:25* Loss of fibers in the dorsal root ganglion and regrowth *19:21* Treating cancer and sensory ganglionopathies *20:03* Idiopathic patients and treatments *20:45* Interview wrap-up *21:43* Pearls of wisdom from the interview *22:11* History of sensory ganglionopathies *23:35* Thanks *29:09* Disclosures: Brown and Claytor report no relevant financial disclosures. Benjamin Claytor, MD, is assistant professor of neurology at the Neuromuscular Center at Cleveland Clinic. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Antopol W, et al. J Neuropathol Exp. 1942;doi:10.1097/00005072-194207000-00006. Pavlakis PP, et al. J Autoimmun. 2012;doi:10.1016/j.jaut.2012.01.003. Schaumburg H, et al. N Engl J Med. 1983;doi:10.1056/NEJM198308253090801.
	Making Sense of Sensory Ganglionopathies and Sjogren’s Syndrome	15 Dec 2022	00:37:36
A sensational (or lack thereof) series on the signs and symptoms of the spellbinding sensory ganglionopathies. Intro *:12* Today’s episode *:16* Anatomy review *1:32* Large fiber vs. small fiber nerves *4:47* Case presentation *6:11* Neurologic examination of patient *8:31* What is pseudoathetoid posturing? *10:11* What does it mean to be length independent? *14:30* What is sensory ganglionopathy? *16:19* How did the differential evolve throughout history? *18:50* How do things get out of the synovium? *23:19* Why does rheumatology get involved? *26:12* Case series of patients with Sjogren’s syndrome and sensory ganglionopathy *28:20* How do we treat it? *32:48* Summary *34:09* Thank you *36:59* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Amato AA, et al. N Engl J Med. 2020;doi:10.1056/NEJMra2023935. Denny-Brown D. J Neurol Neurosurg Psychiatry. 1948;doi:10.1136/jnnp.11.2.73. Griffin JW, et al. Ann Neurol. 1990;doi:10.1002/ana.410270313. Malinow K, et al. Ann Neurol. 1986;doi:10.1002/ana.410200416.
	Long COVID: Some facts, unanswered questions and implications for rheumatology – Part 2	10 Oct 2022	00:24:19
In part two, Leonard Calabrese, DO, discusses the symptoms of long COVID and the role that rheumatologists play in diagnosing and treating patients with long COVID. Brought to you by Tremfya. Intro *1:06* Calabrese introduction *1:11* In this episode *1:36* Defining long COVID *1:49* Reviewing symptoms of long COVID *2:51* Long COVID fatigue *3:44* Studies and research on fatiguability *4:38* Phenomena of post-exertional malaise *6:18* Chronic fatigue syndrome *7:25* Neurocognitive dysfunction *7:52* Co-factors of intercurrent mood disorders and neurocognitive dysfunction *9:30* Pandemic-related sequelae *10:30* What about pain? *10:53* Long COVID pain and criteria for fibromyalgia *11:40* Pandemic-related long COVID *13:16* Diagnoses of long COVID *14:46* Immunopathogenesis *15:27* What about infections and autoimmunity? *17:50* What about treatments for long COVID? *19:28* Validation of long COVID *20:52* What do rheumatologists have to do with long COVID? *21:56* Wrap up *21:13* Thanks *24:02* Disclosures: Calabrese reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum
	Long COVID: Some facts, unanswered questions and implications for rheumatology – Part 1	30 Sep 2022	00:21:21
In this episode, Leonard Calabrese, DO, reviews the history and controversies of post-infection sequelae, as well as the facts and epidemiology of long COVID. Intro *:12* Calabrese introduction *:15* COVID-19 and the history of modern medicine *:48* In this episode *1:39* The course of COVID-19 *2:05* COVID-19 vaccines and immunity *2:50* Controversy, facts, fascination, long COVID *3:16* The history of post-acute sequelae *3:59* Post-infectious sequelae *10:15* What is long COVID and how do we define it? *11:02* How common is long COVID? *13:50* The epidemiology of long COVID *15:32* What are protective factors? *16:53* Preview of Part 2 *17:36* Shoutout to rheumatologists *18:46* Conclusion *19:08* Wrap up of Part 2 preview *20:11* Thanks *21:02* Disclosures: Calabrese reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum
	The Story of the Synovium	25 Aug 2022	00:35:11
How is the synovial fluid produced? Who figured it out? It’s a ripping yarn involving corpses, cats, anti-hypertensives, steroids and streptococcus. Brought to you by Tremfya. Intro *:11* Today’s episode *:15* Synovium 101 *:22* Overview of the synovium and synovial fluid *2:06* How they figured it out? Dr. Marian Ropes *5:37* Investigating synovial fluid *7:46* Cows experiment and where synovial fluid comes from *11:25* Clinical review of synovial fluid *14:57* What’s inside the fluid? *18:54* What makes up the fluid? *20:51* How do things get out of the synovium? *23:19* How are things absorbed into the synovium? *27:21* How well do steroids get picked up systemically? *29:39* Summary *32:30* Thank you *34:59* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Edwards JC. J Anat. 1994;184:493-501. Rhinelander FW, et al. J Clin Invest. 1939;doi:10.1172/JCI101011. Shaffer MF, et al. J Exp Med. 1939;doi:10.1084/jem.70.3.293. Stout A, et al. PM R. 2019;doi:10.1002/pmrj.12042.
	The Discovery of Non-Steroidal Anti-inflammatory Drugs (NSAIDs), Part 1	16 May 2024	00:38:05
Humans have had an insatiable appetite for inhibiting production of prostaglandins for centuries! This series delves into the history of aspirin and NSAIDs, looking at the understanding of the prostaglandin pathway. · Intro *0:12* · In this episode *0:23* · What are NSAIDs? *0:53* · Prostaglandins *5:50* · What are prostaglandins? *7:19* · Where do prostaglandins come from? *8:45* · So, what do we do with prostaglandins? *13:15* · How did they figure out prostaglandins? *13:55* · Naming the prostaglandin *21:25* · Phospholipids *24:46* · Arachidonic acid *25:28* · Arachidonic acid into prostaglandins: how do you prove it? *26:32* · How does arachidonic acid turn into prostaglandins? *27:27* · Cyclo-oxygenase *28:36* · mRNA and COX-2 *32:50* · On the next episode *35:55* · Summary *36:38* · Thanks for listening *37:49* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Botting RM. Pharmacol Rep. 2010;doi:10.1016/s1734-1140(10)70308-x. Flower RJ. Br J Pharmacol. 2006;doi:10.1038/sj.bjp.0706506. Flower RJ. Br J Pharmacol. 2019;doi:10.1111/bph.14588. Kurzrok R, et al. Exp Biol Med. 1930;doi:10.3181/00379727-28-5265. https://www.nobelprize.org/prizes/medicine/1970/euler/biographical/. von Euler US. J Physiol. 1936;doi:10.1113/jphysiol.1936.sp003433.
	SAPHO Part 2: An Abundance of Acronyms (AAOA)	26 Jul 2022	00:44:07
What does the PAPA spectrum disorder teach us about SAPHO? Is SAPHO an autoinflammatory condition or part of the SpA spectrum? Why have antibiotics been used to treat this condition? Find out in this episode! Brought to you by Tremfya. Intro *:01* Welcome to another exciting episode of Rheuminations *:11* About today’s episode *:17* A summary of SAPHO Part 1 *:24* What to expect in this episode *1:28* Earlier long-term data *2:27* A more recent paper from Italy *6:47* Therapeutics in detail *12:17* Summary so far *21:39* IL-1 inhibition in SAPHO 22:32 Monogenic pediatric conditions *33:58* Why can’t we check the genes in SAPHO? *40:00* Episode summary *41:55* We went through a lot in this paper *45:29* Thanks for listening *43:53* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum and be sure to check out Rheum + Boards – your destination for rheumatology education and quizzes! References: Agak GW, et al. J Invest Dermatol. 2014;134:366-373. Aksentijevich I, et al. N Engl J Med. 2009;360:2426-2437. Assmann G, Simon P. Best Pract Res Clin Rheumatol. 2011;25:423-434. Boursier G, et al. J Invest Dermatol. 2021;141:1141-1147. Cai R, et al. Front Cell Dev Biol. 2021;doi:10.3389/fcell.2021.643644. Colina M, et al. Arthritis Rheum. 2009;61:813-821. Daoussis D, et al. Semin Arthritis Rheum. 2019;48:618-625. Eun IS, et al. J Clin Neurosci. 2021;92:153-158. Ferguson PJ, El-Shanti H. Biomolecules. 2021;11:367. Grosse J, et al. Blood. 2006;107:3350-3358. Guignard S, et al. Joint Bone Spine. 2002;69:392-396. Hayem G, et al. Semin Arthritis Rheum. 1999;29:159-171. Holzinger D, Roth J. Curr Opin Rheumatol. 2016;28:550-559. Hurtado-Nedelec M, et al. J Rheumatol. 2010;37:401-409. Liao HJ, et al. Rheumatology (Oxford). 2015;54:1317-1326. Lindor NM, et al. Mayo Clin Proc. 1997;72:611-615. Nguyen MT, et al. Semin Arthritis Rheum. 2012;42:254-265. Trimble BS, et al. Agents Actions. 1987;21:281-283. Yeon HB, et al. Am J Hum Genet. 2000;66:1443-1448. You H, et al. J Clin Immunol. 2021;41:565-575.
	SAPHO Part 1	20 May 2022	00:47:16
What is SAPHO? What does the ‘H’ stand for, again? This episode explores some basics about the condition and delves into the history of how this disease came to be. Intro *:01* Welcome to another exciting episode of Rheuminations *:11* About today’s episode *:17* What does the acronym ‘SAPHO’ stand for? *:37* How do you define this condition? *2:35* So, what is SAPHO syndrome? *4:59* Are any of the letters specific for SAPHO syndrome? *15:20* How the puzzle pieces were put together *15:48* Over the next ensuing decades, when did we start realizing that patients could have dermatologic manifestations? *23:00* So, what about hyperostosis? 30:46 Why isn’t the Sonozaki group getting the credit? *39:22* So, how did we get SAPHO? *40:26* How did they get 85 patients? *42:50* We went through a lot in this paper *45:29* Next episode preview *46:29* Thanks for listening *47:03* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum and be sure to check out Rheum + Boards – your destination for rheumatology education and quizzes! References: Chamot AM, et al. Rev Rheum Mal Osteoartic. 1987;54:187-196. Giedion A, et al. Ann Radiol (Paris) 1972;15:329-342. Köhler H, et al. Ann Intern Med. 1977;87:192-194. Nguyen MT, et al. Semin Arthritis Rheum. 2012;42:254-265. Raposo I, Torres T. Am J Clin Dermatol. 2016;17:349-358. Romani M, et al. Clin Podiatr Med Surg. 2021;38:541-552. Sonozaki H, et al. Ann Rheum Dis. 1981;40:547-553. Windom RE, et al. Arthritis Rheum. 1961;4:632-635.
	The Glucocorticoid Toxicity Index with John Stone, MD, MPH	16 Mar 2022	00:36:11
Glucocorticoids can do a lot of harm over time. In this episode, John Stone, MD, MPH, walks us through the Glucocorticoid Toxicity Index (GTI), a validated tool to measure steroid toxicity over time that we’ll be seeing more of in the future. Intro *:11* Stone introduction *:26* About the GTI *1:13* Professional development opportunities for rheumatologists 2:32 The interview *4:27* What is the GTI, how did it come about and how do you think rheumatologists now and in the future will be utilizing it? *5:28* What are the difficulties in measuring steroid toxicities in trials? *10:58* How did you go about putting this instrument together? *13:04* What makes up the GTI? *19:11* Can you explain the Cumulative Worsening Score and the Aggregate Improvement Score? *20:53* Walk us through a patient coming in and being evaluated for the GTI *25:49* What's the future of the GTI in your opinion? *30:32* Do you think the GTI is going to be something that can eventually be used in day-to-day clinical practice? *33:42* Thank you, Dr. John Stone *34:43* John Stone, MD, MPH, is director of clinical rheumatology at Massachusetts General Hospital. Disclosures: Brown reports no relevant financial disclosures. Stone is one of the experts who developed the Glucocorticoid Toxicity Index. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum
	A Cat in Wolves' Clothing, Part 3: An ID Perspective	11 Feb 2022	00:21:37
In this episode, Cassandra Calabrese, DO, dual-boarded in infectious disease and rheumatology, walks us through when to suspect Bartonella (it’s not always a house cat!), how to diagnose and how to treat. Intro *:01* Welcome to another exciting episode of Rheuminations *:11* About today’s episode *:17* 10th Annual Basic and Clinical Immunology for Busy Clinicians starts 2/26 *2:18* A look at upcoming episodes *3:00* Check out Healio’s Rheum + Boards – new questions coming soon! *3:15* The interview with Dr. Cassandra Calabrese *4:08* Is there always a cat exposure? *5:19* Are there other animals to look out for? Or other scenarios? *6:15* Endocarditis and Bartonella – consider these when things aren’t adding up 7:20 What about Bartonella quintana, do you always treat it? *9:43* It seems Bartonella can be more subtle than other infectious endocarditis, is that true? *10:49* When suspicious, how do we test for Bartonella? *11:57* Titer is important *13:57* How do you treat this? *14:43* What are long-term outcomes like? *16:38* Thank you, Dr. Calabrese *17:35* Warthan-Starry stain 17:54 Thanks for listening *21:24* Cassandra Calabrese, DO, is associate staff in the department of rheumatic and immunologic disease and the department of infectious disease at Cleveland Clinic Foundation. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum Disclosures: Brown and Calabrese report no relevant financial disclosures. References: Wright JR. Arch Pathol Lab Med. 2021;145:1297-1306.
	A Cat in Wolves' Clothing, Part 2: The History of Bartonella	10 Dec 2021	00:37:52
Is this episode clinically relevant? No. Is it important? I think so! The story of Bartonella features a cast of characters, including a medical student who died trying to understand the disease, as well as some scientists with some less than ethical experiments. Enjoy! Intro *:01* Welcome to another exciting episode of Rheuminations *:11* About today’s episode *1:12* More discussion of Bartonella quintana *2:52* How did we figure out the lice were actually the problem? *7:32* When do we figure out what this infection organism is? *11:51* A quick refresher of Koch’s postulates *12:58* How did they get the volunteers to do this? *13:33* The story of how Bartonella got its name *17:00* What is Bartonella bacilliformis? 17:38 Who is Richard Strong? *26:29* How do we finally prove that Carrion’s disease is what Carrion had proven? *28:25* About Bartonella henselae *32:21* Recapping the episode *36:39* Thanks for listening *37:24* We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. Disclosure: Brown reports no relevant financial disclosures. References: Anstead GM. Lancet Infect Dis. 2016;16:e164–172. Salinas-Flores D. Revista de la Facultad de Medicina, Universidad Nacional de Colombia. 2016;64:517. Schultz MG. Am J Trop Med Hyg. 1968;17:503-515. Vinson JW, et al. Am J Trop Med Hyg. 1969;18:713-22.
	A Cat in Wolves’ Clothing: Bartonella and the Rheumatologist	11 Nov 2021	00:29:21
Bartonella is an important mimic of a variety of autoimmune diseases, and it can be subtle. This episode tackles the ways in which this strange organism can present to a rheumatologist. Brought to you by Genentech Intro *:01* Today’s episode *:15* Overview of Bartonella *1:57* Inspiration for this episode *4:17* Bartonella, what are you? *7:24* About Bartonella quintana *12:32* Take-away so far *16:07* Core symptoms and rheumatologic aspects *17:15* About serologies *24:51* Key takeaways from this episode *28:09* Check out Rheum + Boards on Healio at com/rheumandboards *28:31* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum and be sure to check out Rheum + Boards – your destination for rheumatology education and quizzes! References: Aslangul E, et al. J Rheumatol. 2014;doi:10.3899/jrheum.130150. Beydon M, et al. Rheumatology (Oxford). 2021;doi:10.1093/rheumatology/keab691. Im JH, et al. Vector Borne Zoonotic Dis. 2018;18:291-296. Jacobs RF, Schutze GE. Clin Infect Dis. 1998;26:80-84. Maman E, et al. Clin Infect Dis. 2007;45:1535-1540. Raybould JE, et al. Infect Dis Clin Pract (Baltimore). 2016;24:254-260. Zangwill KM, et al. N Engl J Med. 1993;329:8-13.
	Paget's and the Rheumatologist: Why Haven't I Seen This Yet?	18 Aug 2021	00:45:04
What is Paget’s? Why is it declining across much of the globe? Find out, plus hear an interview with the head of the center for osteoporosis and metabolic bone disease at Cleveland Clinic, Chad Deal, MD. Brought to you by GSK. Intro *:11* Today’s episode *:27* What is Paget’s? *1:07* The history of Paget’s *5:35* How often is this symptomatic? *9:30* The epidemiology of Paget’s *13:22* The data on viruses and Paget’s disease *21:08* An interview with Dr. Chad Deal25:09 The numbers are showing a decline in Paget’s disease, are you seeing that? *26:03* Identifying Paget’s disease … who’s picking this up? *27:01* Can you walk us through those studies again? *27:58* Can you tell us a little bit about hypervascularity found in these patients? *30:32* Can you walk us through the history of how the treatments have changed? *31:37* Paget’s kind of just doesn’t go anywhere … is that what you’ve seen in your practice? *35:05* What if the patient has poor or borderline kidney function? Do they have other options? *37:07* Have you seen familial cases? Are people more prone to get it if someone in the family has it? *38:32* A discussion on osteosarcoma *39:55* Dr. Deal, thank you so much for your time and your knowledge about metabolic bone *42:46* Episode summary *42:52* I hope you learned something and thanks for listening! *44:47* Disclosure: Brown reports no relevant financial disclosures. Healio was unable to confirm relevant financial disclosures for Deal at the time of publication. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Cundy T. Metabolism. 2018;80:5-14. Haddaway MJ, et al. Br J Radiol. 2007;80:523-526. Poór G, et al. J Bone Miner Res. 2006;21:1545-1549. Renier JC, Audran M. Rev Rhum Engl Ed. 1997;64:35-43. Shaw B, et al. Proc Natl Acad Sci USA. 2019;10463-10472. Singer FR. Nat Rev Endocrinol. 2015;11:662-671. Wermers RA, et al. J Bone Miner Res. 2008;23:819-825. Music by Lesfm from Pixabay.
	A Sickness in the Serum, Part 3: The Search for Immune Complexes	29 Jul 2021	00:32:28
The final episode in this trilogy delves into the advancement in laboratory techniques that allowed for more accurate measurements of immune complexes, leading to studies in the ‘50 and ‘60s that clearly demonstrated the potential pathogenicity of immune complex-mediated disease. Brought to you by GSK. Intro *:20* Recap and in this episode *:40* The precipitant reaction *3:29* The antibody story *11:25* Frank Dixon *18:20* When did people start using these techniques? *20:15* On the quest to see if immune complexes are pathogenic *24:09* Frank Dixon’s findings using radioactive iodine tagging *28:22* Episode wrap-up *29:00* Thanks for listening! *32:11* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Germuth FG Jr, et al. Johns Hopkins Med J. 1967;120:225-251. Kano K, Milgrom F. Vox Sanguinis. 1980;38:121-137. McCluskey RT, et al. J Exp Med. 1960;111:181-194. Waksman BH. Medicine (Baltimore). 1962;41:93-141.
	A Sickness in the Serum, Part 2: The Birth of Immune Complex Disease	08 Jul 2021	00:29:41
The second episode in the series delves into the experiments and observations of Dr. Clemens (Baron) von Pirquet who first proposed that antibodies and antigens join forces to wreak havoc. Brought to you by GSK. Intro *:10* Today’s episode *:26* A recap of the previous episode *:43* About Baron von Pirquet *4:40* What’s going on in the study of infectious disease and immunology in the early 1900s? *6:41* Writing the paper, “Serum Sickness” *13:13* What are the antibodies doing at that time? *19:10* What happened to Dr. Pirquet? *20:44* Pirquet’s medical student, Bela Schick *25:35* Episode wrap-up *27:27* The next episode *27:56* Thanks again for listening! *29:17* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Shulman ST. J Pediatric Infect Dis Soc. 2017;6:376-379. Silverstein AM. Nat Immunol. 2000;1:453-455.
	A Sickness in the Serum, Part 1: Serum Sickness and the Rheumatologist	16 Jun 2021	00:29:00
This episode delves into the clinical presentation of serum sickness along with a dash of Arthus reaction, to boot! Brought to you by GSK. Intro *:10* Today’s episode *:26* Let’s get into some cases *4:11* The Arthus reaction *6:06* What is another example of the same thing happening but on a systemic level? *7:25* Breaking down the clinical features of serum sickness *14:20* How confident are we that the compliment levels always drop? *16:26* How common is serum sickness? *19:45* The mechanistics of rituximab *21:36* A preview of parts two and three *27:37* Episode wrap-up *28:38* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Bayer G, et al. Eur J Intern Med. 2019;67:59-64. Karmacharya P, et al. Semin Arthritis Rheum. 2015;35-334-340. Lawley TJ, et al. J Invest Dermatol. 1985;85:129s-132s.
	Urticarial Vasculitis, Part 2: Walking the Balance Beam of Allergy and Rheumatology	18 Apr 2024	00:35:59
This episode digs into the pathophysiology of urticaria vasculitis from anti-C1q to the story of bradykinin. · Intro *0:11* · In this episode *0:22* · Review of episode 83 *1:23* · Listen to previous episode, The Complement System for Dunces *4:09* · Anti-C1q antibodies *6:26* · Lupus, anti-C1q and lupus nephritis *9:33* · What happens when you inject anti-C1q in a mouse? *12:56* · The allergy component: anti-C1q, urticaria and angioedema *17:36* · Bradykinin-mediated angioedema and C1q deficiency *24:20* · What is the kinin kallikrein system? *26:21* · French researchers in 1909: human urine injected in dogs *27:30* · How is this relevant to urticarial vasculitis? *31:08* · SERPING1 gene mutation *31:23* · Summary *32:06* · COPD association with urticarial vasculitis *33:51* · Coming up in episode 85 *35:28* · Thanks for listening *35:45* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Busse P, et al. J Allergy Clin Immunol Pract. 2022;doi:10.1016/j.jaip.2021.11.011. Davis MDP, et al. J Allergy Clin Immunol Pract. 2018;doi:10.1016/j.jaip.2018.05.006. Dorn JM, et al. Ann Allergy Asthma Immunol. 2023;doi:10.1016/j.anai.2023.06.014. Marzano AV, et al. J Allergy Clin Immunol. 2022;doi:10.1016/j.jaci.2022.02.007. Siegert CE, et al. Clin Immunol Immunopathol. 1993;doi:10.1006/clin.1993.1066. Stojan G, et al. Lupus. 2016;doi:10.1177/0961203316645205. Venzor J, et al. Clin Rev Allergy Immunol. 2002;doi:10.1385/CRIAI:23:2:201. Wisnieski JJ, et al. Medicine. 1995;doi:10.1097/00005792-199501000-00003.
	The Iron Fist, Part 2: Iron and Bone	01 Jun 2021	00:31:36
Why is hemochromatosis so common? What is iron actually doing to the joint? Does phlebotomy help? What’s going on with iron and Popeye? These are the questions we tackle in the second episode of hemochromatosis: Iron and Bone! Brought to you by GSK. Intro *:19* Today’s episode *:29* Why is hemochromatosis so common? *1:06* The history of Popeye the Sailor Man *3:37* Treatment with phlebotomy *8:35* Why doesn’t join pain improve? *12:03* What is Kashin-Beck disease? *14:18* Mouse studies from the 1970s *19:45* What about histology? *25:36* Episode wrap-up *28:34* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Adams PC, et al. Hepatology. 1997;25:162-166. Adams PC, et al. N Engl J Med. 2005;352:1769-1778. Brighton CT, et al. Arthritis Rheum. 1970;13:849-857. Heiland GR, et al. Ann Rheum Dis. 2010;69:1214-1219. Hiyeda, K. Jap Med Sci. 1939;4:91-106. Powell LW, et al. Lancet. 2016;388:706-716. Rametta R, et al. Int J Mol Sci. 2020;21:3505. Sella EJ, Goodman AH. J Bone Joint Surg Am. 1973;55:1077-1081. Sutton M. Internet Journal of Criminology. 2010;1-34.
	The Iron Fist, Part 1: Hemochromatosis and the Rheumatologist	13 May 2021	00:23:37
In this episode, we dig into hemochromatosis to better understand what it is, how it affects the joints, available screening methods, as well as clues to presentation and physical exam findings. Brought to you by GSK. Intro *:10* Today’s episode *:26* What is hemochromatosis? *1:42* What does the iron do? *3:03* How much iron is in the body? *5:30* When do you suspect it? *7:46* What do we want to know about the joints? *9:33* About Ralph Schumacher Jr., MD, and his work *12:15* How have Schumacher’s observations held up? *14:42* What about radiographs … can they help? *16:09* What about hand OA and the gene mutation? *16:44* So, what about people with undiagnosed hemochromatosis? What do their hands look like? *18:09* What about chondrocalcinosis? *19:13* Tune in next time for part two *21:59* Episode wrap-up *22:25* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Bulaj ZJ, et al. N Engl J Med. 2000;343:1529-1535. Carroll GJ, et al. Arthritis Care Res. 2012;64:9-14. Hamilton EB, et al. Q J Med 1981;199:321–329. Jordan JM. Curr Opin Rheumatol. 2004;16:62-66. Rametta R, et al. Int J Mol Sci. 2020;21:3505. Ross JM, et al. J Rheumatol. 2003;30:121-5. Schumacher HR. Arthritis Rheum. 1964;7:41–50. Timms AE, et al. Ann Rheum Dis. 2002;61:745–747. Ulvik RJ. Tidsskr Nor Laegeforen. 2016;136:2017-2021.
	VEXAS	04 May 2021	00:58:16
In this episode, I interview the NIH team who brought you VEXAS! Hear different points of view of this disease, how it was discovered, clinical presentations, as well as where this research could lead. Then, we wrap up with Dr. Kastner’s historical take on autoinflammatory disorders! Intro *:11* In this episode *:12* Big thanks to Peter Grayson, MD, MSc *2:07* About our guests *2:30* The interview *5:10* How did VEXAS come about? *5:37* You had an idea of where to start looking? *6:58* What should rheumatologists know about ‘somatic mutation’? *12:31* Do you think this could be a clue to other conditions? *13:37* Can you tell us about some of the unique aspects that we see in these patients with MDS that make them atypical? *17:14* How’s the clinician going to see or note the vacuoles? *18:53* Do we have kind of a pathway for how the vacuoles are forming based on what we know about ubiquitization or is that unclear? *20:51* What’s going to raise the antenna that this isn’t “run of the mill x disease”? *23:33* How, in your experience, have patients responded to diagnoses being changed? *37:15* Where does everyone see the therapy going for this condition in the future? *41:15* Do we think that with this approach that this is going to “reshuffle the deck” of what we call certain diseases from multiple different specialties over the next decade? *44:02* Would you mind walking us through a little bit about FMF and how the different variants you saw led to further discoveries? *49:46* What was known about IL1 at the time? How did that knowledge of IL1 come along? *52:53* It’s such a true honor to have you all on *57:42* David Beck, MD, PhD, is a genetics fellow at the NIH. He can be reached at david.beck@nih.gov. Marcella A. Ferrada, MD, is Lawrence Shulman scholar at NIAMS. She can be reached at ferradama@mail.nih.gov. Peter Grayson, MD, MSc, is head of the Vasculitis Translational Research Program at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and associate director of the NIAMS fellowship program. He can be reached at peter.grayson@nih.gov. Dan Kastner, MD, PhD, is an NIH distinguished investigator in the Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch; director in the Division of Intramural Research; and head of the Inflammatory Skin Disease Section at the National Human Genome Research Institute. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum Disclosures: Beck, Brown, Ferrada, Grayson and Kastner report no relevant financial disclosures.
	Parvovirus B19: The Other 19	01 Apr 2021	00:28:45
In this episode, we delve into Parvovirus B19: What does it do? How does it affect the joints? How was it discovered? Does it only infect young female schoolteachers? Find out! Brought to you by Actemra Intro *:12* Shout out to Cleveland Clinic Biologic Therapies Summit *1:22* In this episode *2:11* An overview of the virus *3:46* What causes the aplastic crisis? *6:16* What does the virus do in humans? *11:46* A two-phase trial on young adults *14:29* A summary of studies *18:55* So, what happens to these patients? *22:59* How about a long-term study? *24:39* Summing up Parvovirus 19 *26:42* The big takeaway from this episode *27:33* The next episode *28:06* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Anderson MJ, et al. J Infect Dis. 1985;152:257-265. Chorba T, et al. J Infect Dis. 1986;154:383-393. Moore TL. Curr Opin Rheumatol. 2000;12:289-294. Mortimer PP. Nature. 1983;302:426-429. Ogawa E, et al. J Infect Chemother. 2008;14:377-382. Potter CG. J Clin Invest. 1987;79:1486-1492. Reid DM, et al. Lancet. 1985;1:422-425. Speyer I, et al. Clin Exp Rheumatol. 1998;16:576-578. Takahashi Y, et al. Proc Natl Acad Sci USA. 1998;95:8227-8232. White DG, et al. Lancet. 1985;1:419-421. Young N, et al. J Clin Invest. 1984;74:2024-2032. Young NS, Brown KE. N Engl J Med. 2004;350:586-597.
	The Birth of a Disease: The Story of Psoriatic Arthritis	11 Mar 2021	00:22:13
This episode details how psoriatic arthritis and the spondyloarthropathies came to be recognized as a distinct clinical entity after decades of nerdy arguing. Brought to you by Actemra. Intro *:10* Shout out to Cleveland Clinic Biologic Therapies Summit *:30* In this episode *1:29* A 30,000-foot view *2:34* When did PsA separate from rheumatoid arthritis? *3:34* Mary Stults Sherman *7:11* Verna Wright and Dr. John Moll put PsA on the map *9:09* Recognizing PsA as a disease *15:20* An anecdote about Wright *16:18* Putting the SpA puzzle pieces together *18:19* The severity of disease *19:08* Episode wrap-up *20:46* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Ankylosing Spondylitis, Churchill Livingstone, Edinburgh, London, Melbourne, New York, 1980. Espinoza LR, Helliwell P. Clinical Rheumatology. 2014;33:1335-1336. Gladman DD, et al. Q J Med. 1987;62:127-141. Kane D, et al. Rheumatology. 2003;42:1460-1468. Moll JMH. Reumatismo. 2007;59 Suppl 1:13-18. Moll JM, Wright V. Semin Arthritis Rheum. 1973;3:55-78. Seronegative polyarthritis, North-Holland Pub. Co., New York, Amsterdam, 1976. Sound effects obtained from https://www.zapsplat.com Wright V. Am J Med. 1959;27:454-462. Wright V. Ann Rheum Dis. 1956;15:348-356. Wright V. BMJ. 1994;309:1739-1740.
	ANCA Vasculitis and the Complement System, Part 2: On to the Humans	23 Feb 2021	00:37:31
The final episode summarizes the human data on complement in ANCA vasculitis, with a quick discussion of the trials of C5a receptor antagonism. Brought to you by Actemra. Intro *:10* Welcome *:21* Recap of previous episodes *:22* In this episode *2:12* Let’s start with neutrophil data *5:24* Studies in humans *11:54* A summary of the data so far *21:20* What does all this amount to? *25:41* Trials of avacopan *28:25* Side effect profile *36:25* Thanks for listening *37:06* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Augusto JF, et al. PLoS One. 2016;https://doi.org/10.1371/journal.pone.0158871. Bekker P, et al. PLoS One. 2016;https://doi.org/10.1371/journal.pone.0164646. Chen SF, et al. Arthritis Res Ther. 2015;https://doi.org/10.1186/s13075-015-0656-8. Falk RJ, et al. Proc Natl Acad Sci USA. 1990;87:4115-4119. Gou SJ, et al. Clin J Am Soc Nephrol. 2013;8:1884-1891. Gou SJ, et al. Kidney Int. 2013;83:129-137. Jayne DRW, et al. J Am Soc Nephrol. 2017;28:2756-2767. Jayne DRW, et al. N Engl J Med. 2021;384:599-609. Merkel PA, et al. ACR Open Rheumatol. 2020;2:662-671. Schreiber A, et al. J Am Soc Nephrol. 2009;20:289-298. Xiao H, et al. Am J Pathol. 2007;170:52-64.
	ANCA Vasculitis and the Complement System, Part 1: The Mouse’s Tale	03 Feb 2021	00:31:06
This episode walks us through the initial research that paved the way for a game changing therapeutic in ANCA vasculitis, as well as the story of how host Adam J. Brown, MD, finally learned how to spell complement. Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. Intro *:10* Welcome *:21* Today’s episode *:24* So how did we get there? *4:18* How do we start teasing apart the effect of the complement in ANCA vasculitis? *8:13* Discussing and simplifying the mouse model *9:00* Quickly reviewing the complement cascade *12:06* Brought to you by GSK. Consider the long-term impact of disease activity flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com. Taking the puzzle pieces away in the mouse model *17:04* What about the next steps? *22:05* What happens when you block C5a? *25:12* CCX168: Summing up the mouse tale *28:44* In the next episode *30:20* Thanks for listening *30:46* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Brilland B, et al. Autoimmun Rev. 2020;19:102424. Freeley SJ, et al. J Pathol 2016;240:61-71. Haas M, Eustace JA. Kidney Int 2004;65:2145-2152. Huugen D, et al. Kidney Int 2007;71:646-654. Marder SR, et al. Arg. J Immunol. 1985;134:3325-3331. Schreiber A, et al. J Am Soc Nephrol. 2009;20:289-298. Xiao H, et al. Am J Pathol. 2007;170:52-64. Xiao H, et al. J Clin Invest 2002;110:955–963. Xiao H, et al. J Am Soc Nephrol, 2014;25:225–231.
	The Complement System for Dunces	21 Jan 2021	00:33:43
Here I break down the confusing system that is the ire of medical learners who aim to memorize it, only to forget it later. Join me on a medieval journey that will help you visualize this complex system in a way that will stay with you. Brought to you by GSK. Consider the long-term impact of disease activity flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com. Intro *:10* Welcome *:24* How do you explain the complement system? *:44* What is the complement system? *1:39* How does it complement the adaptive immunity? *3:43* Two major aspects of the complement system *4:50* Formation of the membrane attack complex *5:21* Why is this pathway so confusing? *5:55* Why do I have to memorize all of this? *8:33* Let’s talk about the cascades themselves *11:15* Breaking down the three pathways *12:55* Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. The alternative pathway – walking to the beat of its own drum *16:15* A medieval tale of the classic and lectin pathway *22:36* The tale of the alternative pathway *28:00* Summary *31:55* In the next episode *32:40* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Music: The Medieval Banquet by Shane Ivers - https://www.silvermansound.com
	COVID-19 and the Rheumatologist: The Good, the Bad and the Ugly	08 Jan 2021	00:21:52
We end the year with Leonard Calabrese, DO, giving us a summary of what we’ve learned about COVID-19 from the perspective of a rheumatologist. Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. Intro *:10* Calabrese introduction *:24* In this episode *:43* Nobody has complete control of the literature on COVID-19 *1:39* What was ugly about COVID-19? *2:16* What was bad about COVID-19? *4:05* What good came from the COVID-19 pandemic? *7:07* Brought to you by GSK. Consider the long-term impact of disease activity flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com. The good things continued *10:20* JAK inhibitors *11:30* The best outcomes: Vaccines *14:15* Pertinent questions for the rheumatology community *16:45* Recap *20:12* Conclusion *21:41* Disclosures: Calabrese reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum
	Infectious Endocarditis for the Rheumatologist, Part 3: The Immune System Behaving Badly	18 Dec 2020	00:34:25
The completion of the Endocarditis for the Rheumatologist trilogy! This episode focuses on the glomerulonephritis of endocarditis as well as the immunologic abnormalities you can see on labs. Brought to you by GSK. Consider the long-term impact of disease activity flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com. Intro *:11* In this episode *:22* Recap of previous episodes *:39* About episode three *1:00* How labs can give a clue to endocarditis being a culprit *1:23* The immune complex nature of infective endocarditis *6:30* How do you measure immune complex? *9:10* What are the effects of immune complex formation on the organ systems? *12:37* Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. Cryoglobulins and rheumatoid factor in infective endocarditis *15:12* The kidneys and infective endocarditis *16:45* Glomerulonephritis and infective endocarditis *24:15* ANCA-positive vasculitis and infective endocarditis *29:09* A summary of infective endocarditis *32:21* Takeaways *33:28* A preview of next episode *33:48* Conclusion *34:12* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Bayer AS, et al. N Engl J Med. 1976;295:1500-1505. Boils CL, et al. Kidney Int. 2015;87:1241-1249. Forte WC, et al. Arq Bras Cardiol. 2001;76:43-52. Hurwitz D, et al. Clin Exp Immunol. 1975;19:131-141. Langlois V, et al. Medicine (Baltimore). 2016;95:e2564. Levy RL, Hong R. Am J Med. 1973;54:645-652. Ma T-T, et al. PLoS One. 2014;9: https://doi.org/10.1371/journal.pone.0097843. Messias-Reason IL, et al. Clin Exp Immunol. 2002;127:310-315. Petersdorf RG. N Engl J Med. 1976;295:1534-1535. Spain DM, King DW. Ann Intern Med. 1952;36:1086-1089. Williams Jr RC, Kunkel HG. J Clin Invest. 1962;41:666-675. Tire squealing sound effect by Mike Koenig.
	Urticarial Vasculitis: Attack of the Nettles, Part 1	28 Feb 2024	00:26:07
Is it an allergy or an autoimmune vasculitis, or a little of both? Find out the story of urticarial vasculitis, how this disease was recognized and eventually sorted out from other types of urticaria. · Intro *0:12* · In this episode *0:21* · Case study *1:22* · Chronic spontaneous urticaria, hives and nettles *7:57* · Dermatographism and witchcraft? *10:15* · Causes of urticaria *11:17* · Theory of inflammation and histamines *11:40* · Urticaria and treatments with histamines *12:09* · Types of urticaria *13:02* · Mayo Clinic study *13:39* · Chronic urticaria as a manifestation of necrotizing venulitis *16:10* · Connection between types of urticaria and leukocytoclastic vasculitis *20:02* · More case studies *20:38* · What do we know about treatments? *22:23* · In conclusion *24:15* · Coming up in part two *25:08* · Thanks for listening *25:47* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Czarnetzki BM. Int J Dermatol. 1989;doi:10.1111/j.1365-4362.1989.tb01314.x. Kolkhir P, et al. J Allergy Clin Immunol. 2019;doi:10.1016/j.jaci.2018.09.007. McDuffie FC, et al. Mayo Clin Proc. 1973;48(5):340-8. Natbony SF, et al. J Allergy Clin Immunol. 1983;doi:10.1016/0091-6749(83)90096-9. Soter NA. N Engl J Med. 1977;doi:10.1056/NEJM197706232962505.
	Endocarditis for the Rheumatologist, Part 2: What You Might See in the Clinic	09 Dec 2020	00:44:19
This episode focuses on the clinical aspects of endocarditis you can catch in the exam room, emphasizing the joint and skin manifestations, along with some interesting historical insights on Osler nodes and Janeway lesions. Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. Intro *:11* In this episode *:22* About episode two *2:28* Rheumatologic manifestations of infectious endocarditis *4:28* Musculoskeletal manifestations of infectious endocarditis in the back *5:55* The lack of patterns for infectious endocarditis causing joint pain *9:48* Myalgias and the connection with endocarditis *12:48* The skin and its connection with endocarditis *15:37* What are Janeway lesions *17:13* What are Osler nodes? *19:28* Brought to you by GSK. Consider the long-term impact of disease activity flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com. What causes these lesions? *21:24* Differentiating Osler’s nodes and Janeway lesions *25:20* What are splinter hemorrhages? *28:08* Petechiae and its association to infective endocarditis *31:43* What about leukocytic vasculitis? *33:17* Other puzzle pieces to look for *37:18* A preview of next episode *40:30* Conclusion *42:12* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Chahoud J, et al. Cardiol Rev. 2016;24:230-7. Farrior JB, Silverman ME. Chest. 1976;70:239-43. Godeau P, et al. Rev Med Interne. 1981;2:29-32. Gunson TH, Oliver GF. Australas J Dermatol. 2007;48:251-5. Heffner JE. West J Med. 1979;131:85-91. Loricera J, et al. Clin Exp Rheumatol. 2015;33:36-43. Koslow M, et al. Am J Med. 2014;S0002-9343(14)00188-0. Murillo O, et al. Infection. 2018;46. Meyers OL, Commerford PJ. Ann of the Rheum Dis. 1977;36:517-519. Parikh SK, et al. J Am Acad Dermatol. 1996;35:767-8. Young J. et al. J R Coll Physicians Lond. 1988;22:240-3.
	Endocarditis for the Rheumatologist, Part 1: A Bit of Background	20 Nov 2020	00:35:25
Infectious endocarditis can present with rheumatic features in 15% to 25% of cases. This series focuses on what a rheumatologist should know about the clinical puzzle of endocarditis. Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com Intro *:11* In this episode *:22* About episode one *2:33* How did people diagnose infectious endocarditis back in the day? *5:15* What is a Gulstonian Lecture? *6:25* So, who was Dr. Emanuel Libman? *13:33* Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. How Gustav Mahler’s endocarditis diagnosis was made *19:15* The evolution of diagnosing endocarditis *20:45* The story of Alfred S. Reinhart and his self-diagnosis of endocarditis *21:45* Clinical signs and symptoms of endocarditis and how they hold up today *28:00* Recap and a preview of next episode *33:20* Conclusion *35:15* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Flegel KM. CMAJ. 2002;167:1379-1383. Harrison's Principles of Internal Medicine, Nineteenth edition, McGraw-Hill Education, New York, 2015. Levy D. Br Med J (Clin Res Ed). 1986;293:1628-1631. Libman E, Celler HL. Am J Med Sci. 1910;140. Osler W. Br Med J. 1885;1:467-470. Parsons WB Jr, et al. J Am Med Assoc. 1953;153:14-16. Pelletier LL Jr, Petersdorf RG. Medicine (Baltimore). 1977;56:287-313. Ramin S. Hektoen International. 2013;5.
	Inflammatory Bowel Disease for the Rheumatologist	03 Nov 2020	00:30:04
How common is asymptomatic bowel involvement in patients with peripheral or axial SpA? Can we use NSAIDs in these patients? What’s the difference between sulfasalazine and mesalamine? Listen to hear what a rheumatologist should know about IBD! Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. Intro *:11* In this episode *:20* Let’s start with some basics of IBD *4:11* If a patient has axSpA, what are the chances they’ll develop IBD? *5:14* What about silent disease? *7:32* When should we send our SpA patients to a GI specialist? *11:22* Two medications: budesonide and mesalamine *13:33* Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com This category of drugs – 5-ASA *16:26* NSAIDs *20:02* A look at COX inhibitors *23:06* Selective inhibition with COX-2 seems to be an attractive option for IBD *28:47* Conclusion *29:10* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Altomonte L, et al. Clin Rheumatol. 1994;13:565-570. Dougados M, et al. Joint Bone Spine. 2011;78:598-603. de Winter JJ, et al. Arthritis Res Ther. 2016;18:196. El Miedany Y, et al. Am J Gastroenterol. 2006;101:311-317. Long MD, et al. J Clin Gastroenterol. 2016;50:152-160. Mayberry J. J Gastrointestin Liver Dis. 2013;22:375-377. Miao X-P, et al. Curr Ther Res Clin Exp. 2008;69:181-191. Mielants H, et al. J Rheumatol. 1995;22:2273-2278. Morris AJ, et al. Lancet. 1991;doi: https://doi.org/10.1016/0140-6736(91)91300-J. Redfern JS, Feldman M. Gastroenterology. 1989;96:596-605. Sandborn WJ, et al. Clin Gastroenterol Hepatol. 2006;4:203-211. Stolwijk C, et al. Ann Rheum Dis. 2015;74:65-73. Svartz N. Acta Medica Scandinavica. 1942;doi: https://doi.org/10.1111/j.0954-6820.1942.tb06841.x. Takeuchi K, et al. Clin Gastroenterol Hepatol. 2006;4:196-202. Tanaka K, et al. Eur J Pharmacol. 2008;603:120-132. Van Praet L, et al. Ann Rheum Dis. 2013;72:414-417.
	Part 4, The Story of the Antibody: Two Arms and a Stick	15 Oct 2020	00:25:27
The last episode in the series highlighting how the structure of the antibody was discovered, as well as how a chicken butt was critical in understanding B cell biology. Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com Intro *:11* In this episode *:15* Recap: What we know about the antibody so far *1:12* Discovering the structure of the antibody *3:34* What else can we learn about the light chain *7:04* An understanding of what these proteins were *9:49* Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. A story about a chicken butt *11:40* Backtracking to 1898 – where do antibodies come from? *16:49* An important paper in 1945 argues the lymphocyte is the antibody maker *18:59* Where is the bursa of Fabricius in humans? *20:46* A study from Australia *21:48* The bone marrow is what did it 23:00 Thanks for listening! *24:48* Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Black CA. Immunol Cell Biol. 1997;doi: 10.1038/icb.1997.10. Coons AH, et al. J Exp Med. 1955;102:49-60. Cooper MD. Nat Rev Immunol. 2015;191-197. Edelman GM. J Am Chem Soc. 1959;81:3155-3156. Ehrich WE, Harris TN. Science. 1945;101:28-31. Fagraeus A. J Immunol. 1948;58:1-13. Glick B, et al. Poultry Sci. 1956;35:224-225. Osmond DG, Nossal GJ. Cell Immunol. 1974;13:132-145. Porter RR. Biochem J. 1959;73:119-126. Ryser JE, Vassalli P. J Immunol. 1974;113:719-728.
	Part 3: The History of IV Immunoglobulin	02 Oct 2020	00:27:57
Learn about the discovery of immunodeficiencies leading to the use of pooled immunoglobulin as therapy, the struggle to use it intravenously and the eventual use in autoimmune disease. Intro *:11* In this episode *:15* Splitting Part 3 into two episodes *:26* Part A of the history of IV Ig and the antibody *:53* A recap on Cohn fractionation *2:40* The history and uses of IV Ig *4:30* What led to the recognition and research of primary immunodeficiencies *7:08* How Charles Janeway Sr. paved the way for IV Ig from intramuscular Ig *9:01* What are protein aggregates? *12:54* Understanding the various mechanisms of Ig reactions *15:49* Managing patients with low IgA and anti-IgA antibodies *18:36* How to go from treating immunodeficiency to treating autoimmunity *21:40* The modern understanding and mystery of IV Ig *25:30* Quick summary *26:05* Thanks for listening! *27:30* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Barandun S, et al. Vox Sang. 1962;7:157-174. Eibl MM. Immunol Allergy Clin North Am. 2008;28:737-764, viii. Furusho K, et al. Lancet. 1983;2:1359. Gallagher PE, Buckley RH. J Allergy Clin Immunol. 1982;69:120. Guo Y, et al. Front Immunol. 2018;9:1299. Imbach P, et al. Lancet. 1981;1:1228-31. Intravenous Immunoglobulin: Prevention and Treatment of Disease. NIH Consens Statement Online. 1990;8:1-23. Kustiawan I. PLoS ONE. 2018;13: e0195729. https://doi.org/10.1371/journal.pone.0195729. MRC Working Party on Hypogammaglobulinaemia. Hypogammaglobulinaemia in the United Kingdom. London: Her Majesty’s Stationery Office; 1971. Oransky I. Lancet. 2003;362:409. Sandler SG, et al. Transfus Med Rev. 1995;9:1-8.
	Part 2: The History of Convalescent Serum and the Story of the Antibody	18 Aug 2020	00:45:22
Part 2 of this series explores how we began to measure antibody levels and how serotherapy evolved and was used to investigate multiple diseases (I’m looking at you, pneumonia). We’ll also learn how advances in laboratory techniques like electrophoresis paved the way for a better understanding of the antibody. Intro *:11* In this episode *:15* Recap of Part 1 *:22* In this episode *:53* The mechanism of action was theoretical *2:30* The story of convalescent serum *6:22* Pneumonia: “The captain of the men of death” *6:58* How culturing was done then *10:56* A big break: Isolating the antibody *14:26* A 30,000-foot look at pneumonia *17:13* Type 1 pneumonia trials *20:20* 1918 influenza pandemic *23:31* Measles *27:59* The story of the antibody *30:30* More fun naming conventions 35:25 Cone fractionation *38:35* Quick summary *42:20* Thanks for listening! *44:27* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Black CA. Immunol Cell Biol. 1997;doi: 10.1038/icb.1997.10. Bullowa JGM. JAMA. 1928;90:1354-1358. Cecil RL, Sutliff WD. JAMA. 1928;91:2035-2042. Felton LD. Boston Med Surg J. 1924;190:819-825. Hooper JA. LymphoSign Journal. 2015;2 181-194. Luke TC, et al. Ann Intern Med. 2006;145:599-609. McGuire LW, Redden WR. Am J Public Health. 1918. 741-744. McKhann CF, Chu FT. Am J Dis Child. 1933;45:475-479. Podolsky SH. Am J Public Health. 2005;95:2144-2154. Podolsky SH. J R Soc Med. 2009;102:203-207. Tiselius A, Kabat EA. J Exp Med. 1939;69:119-131.
	The History of Convalescent Serum and the Story of the Antibody, Part 1	15 Jul 2020	00:40:41
COVID-19 has brought up the use of the old remedy convalescent serum. What is it? Did it work? This series walks us through the history of the serum, how it was discovered, how it was first used, and how it inspired the field of immunology. Intro *:11* In this episode *:15* A quick tale *:20* Outline of these three episodes *2:51* Quick definitions *3:50* How it all began *7:16* A solo paper on diphtheria *12:57* A trial of children *17:07* Giving fluids from a horse *21:57* What happened with tetanus? *25:12* Switching gears to our understanding of antibodies *27:09* The next target: snakes *29:17* The plague *32:00* Summary of Part 1, what’s next *39:05* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Butler T. Clin Microbiol Infect. 2014;20:202-209. Crum FS. Am J Public Health. 1917;7:445. Eibl MM. Immunol Allergy Clin North Am. 2008;28:737-764, viii. Graham BS, Abrosino DM. Curr Opin HIV AIDS. 2015;10:129-134. Grundbacher FJ. Immunol Today. 1992;13:188-190. Hawgood BJ. Toxicon. 1999;37:1241-1258. Kantha SS. Keio J Med. 1991;40:35-39. Kaufmann SHE. mBio. 2017;8:e00117-17. Klass, Perri. “An Apocryphal Christmas Miracle.” The New York Times, The New York Times, 23 Dec. 2019, www.nytimes.com/2019/12/23/well/family/diphtheria-antitoxin-Christmas-miracle.html. Lindenmann J. Scand J Immunol. 1984;19:281-285. Meyer KF, et al. Ann N Y Acad Sci. 1952;55:1228-1274. Ramon G. Bull Soc Centr Med Vet. 1925;101:227-234. von Behring, Emil. Geschichte der Diphtherie (mit besonderer Berücksichtigung der Immunitätslehre). Leipzig, Germany, Thieme, 1893. von Behring E. Ueber das Zustandekommen der Diphtherie-Immunität und der Tetanus-Immunität bei Thieren. German Medical Weekly; 1890.
	Glucocorticoids in the Setting of Active Infection	22 Jun 2020	00:35:57
With COVID-19 and the question of whether glucocorticoids could be beneficial, this episode digs into the data on the use of glucocorticoids in the setting of infections, from pneumonia and septic arthritis, to meningitis and septic shock. Intro *:11* In this episode *:25* The first published case series of patients with serious infection *6:45* Otolaryngologic infections *7:43* Pneumonia, malaria and flu *8:26* Cortisone in strep throat *9:22* Major severe infections *11:26* A review article *12:12* Specific organ systems *13:25* Dexamethasone for bacterial meningitis *25:28* Septic shock *26:19* Dearth of data on glucocorticoids for influenza *32:10* Summary and take-home *35:19* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Annane D, et al. JAMA. 2002;288:862-871. Annane D, et al. N Engl J Med. 2018;378:809-818. Bennett IL, et al. JAMA. 1963;183:462-465. Blum CA, et al. Lancet. 2015;385:1511-1518. de Gans J, van de Beek D. N Engl J Med. 2002;347:1549-1556. Dellinger RP, et al. Crit Care Med. 2013;41:580-637. Fogel I, et al. Pediatrics. 2015;136:e776. Hahn EO, et al. J Clin Invest. 1951;30:274-281. Hartman FA, Merle Scott WJ. Proc Soc Exp Biol and Med. 1931;28:478-479. Hinshaw LB, et al. J Surg Res. 1980;28:151-170. Nedel WL, et al. World J Crit Care Med. 2016;5:89-95. Odio CM, et al. Pediatr Infect Dis J. 2003;22:883-888. Perla D, Marmorston J. Endocrinology. 1940;27:368-374. Stern A, et al. Cochrane Database Syst Rev. 2017;12:doi:10.1002/14651858.CD007720.pub3 Venkatesh B, et al. N Engl J Med. 2018;378:797-808. Wenner WF, Cone AJ. Arch Otolaryngol. 1934;20:178-187. Whitehead KW, Smith C. Proc Soc Expert Biol and Med. 1932;29:672-673. Wysenbeek AJ, et al. Ann Rheum Dis. 1998;57:687–690. Zhou Y, et al. Sci Rep. 2020;10:https://doi.org/10.1038/s41598-020-59732-7.
	The History of Whipple's Disease	09 Jun 2020	00:26:09
This episode delves into the history of Whipple’s disease — from its initial description, to the lengthy process of proving it’s an infectious disease. Intro *:11* In this episode *:12* The initial case report *1:35* How I fit into the history of Whipple’s *4:46* Back to the case report *6:56* Bodies in the intestines *10:12* More about George Hoyt Whipple *10:50* Whipple may not have been the first to identify this condition *14:19* First treatment with antibiotics *15:55* Personality change after antibiotics *19:12* Whipple’s disease intestines have positive staining *20:20* Using the electron microscope in Whipple’s disease *21:18* Summary and take-home *25:19* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Bayless, TM. Adv intern Med. 1970;16:171-189. Black-Schaffer B. Proc Soc Exp Biol Med. 1949;72:225-227. Fenollar F, et al. N Engl J Med. 2007;356:55‐66. Hendrix JP, et al. Arch Intern Med (Chic).1950;85:91-131. Morgan AD. Gut. 1961;2:370-372. Paulley JW. Gastroenterology. 1952;22:128-133. Raoult D, et al. N Engl J Med. 2000;342:620-625. Relman DA, et al. N Engl J Med. 1992;327:293-301. Whipple GH. Bull Johns Hopkins Hosp. 1907;18:382-391.
	Whipple’s Disease: When Should a Rheumatologist Take a Whiff of Whipple’s?	20 May 2020	00:47:26
This episode dives into the rare Whipple’s disease, focusing on the articular manifestations of this infectious masquerader and when a rheumatologist should consider it in the differential. Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. Intro *:20* In this episode *:28* Background on the organism *5:25* An important point when making the diagnosis *7:48* Who gets infected? *8:55* What is Whipple’s disease? *11:48* This disease is fatal *15:53* A look at the joints *16:28* What happens when you give these patients immunosuppression? *26:36* How to diagnose *28:38* Summary so far *31:00* Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com Other organ manifestations of Whipple’s disease *32:08* Summary and take-home *44:36* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Bousbia S, et al. Emerg Infect Dis. 2010;16:258-63. Chan RY, et al. Ophthalmology. 2001;108:2225-2231. Dobbins 3rd WO, et al. Arthritis Rheum. 1987;30:102-105. Durand DV, et al. Medicine (Baltimore). 1997;76:170-84. Fenollar F, et al. BMC Infect Dis. 2011;11:171. Feurle GE, et al. Eur J Clin Invest. 1979;9:385-389. Geissdörfer W, et al. J Clin Microbiol. 2012;50:216-22. Guérin A, et al. Elife. 2018;7:e32340. Heffner DK. Lancet. 2007;370:738-9; author reply 739. Keita AK, et al. PLoS Negl Trop Dis. 2011;5:e1403. Lagier JC, et al. Medicine (Baltimore). 2010;89:337-345. Lozupone C, et al. Am J Respir Crit Care Med. 2013;187:1110-7. McAllister Jr. HA, Fenoglio Jr. JJ. Circulation. 1975;52:152-6. O’Duffy JD, et al. Arthritis Rheum. 1999;42:812-817. Puéchal X. Joint Bone Spine. 2016;83:631-635. Puéchal X, et al. Arthritis Rheum. 2002;46:1130-1132. Puéchal X, et al. Arthritis Rheum. 2007;56:1713-1718. Raheja AA, et al. Clin Imaging. 2010;34:143-147. Ramos JM, et al. J Med Case Rep. 2015;9:165. Raoult D, et al. Emerg Infect Dis. 2010;16:776-82. Schöniger-Hekele M, et al. Appl Environ Microbiol. 2007;73:2033-2035. Stein A, et al. Am J Respir Crit Care Med. 2013;188:1036-7. Additional resource: Neurosigns.org’s video on oculomasticatory myorhythmia can be viewed at: https://www.youtube.com/watch?v=Zwb5bt749Jo
	COVID-19, long COVID and the rheumatologist with Leonard Calabrese, DO	04 Jan 2024	00:29:04
What should rheumatologists know about what we've learned about COVID-19 and long COVID in 2023? Hosted by Dr. Leonard Calabrese. · Intro *0:11* · In this episode *0:21* · 2023: current status and controversies *0:35* · What is going on with COVID-19? *01:53* · What do we know about vaccine responses? What should we be telling our patients about vaccines in our immunocompromised population? *2:58* · Lancet Rheumatology MELODY study summary *3:08* · What about patients within the rheumatic and autoimmune disease space? *4:15* · Who is immunocompromised and why does it matter? *5:11* · What is the immunosuppression we are giving them? *6:39* · What to tell patients about getting vaccinated *8:56* · Long COVID *10:09* · What is long COVID? *10:26* · JAMA Network Open study on prevalence and characteristics associated with post-COVID conditions *14:19* · In the clinical arena, what should rheumatologists be thinking about? *16:38* · What about pathogenesis? What do we know about the controversies in this area? *18:58* · Autoimmunity: COVID-19 and autoimmune response *20:45* · What about therapies? *22:22* · The next generation of rheum agents: Immunomodulation with neonatal Fc receptor targeting? *24:40* · A question for the rheumatology community: do patients with immune mediated diseases get more long COVID than the control population? *25:40* · In conclusion *27:37* · Thanks for listening *28:38* Leonard H. Calabrese, DO, is the chief medical editor, Healio Rheumatology, and professor of medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer chair of clinical immunology at the Cleveland Clinic. Disclosures: Calabrese reports professional relationships with AbbVie, AstraZeneca, Bristol Myers Squibb, Galvani, Genentech, GlaxoSmithKline, Janssen, Novartis, Regeneron, Sanofi and UCB.. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.
	The History of Cryoglobulinemic Vasculitis: Dry Humors, Part 3	23 Apr 2020	00:38:13
This episode explores the history of cryoglobulinemic vasculitis, from the first person who froze a tube of blood and noticed something strange happened, to the discovery of hepatitis C. We also throw in how the lab test for cryoglobulins is performed and some of the data we have on therapy. Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com Intro *:20* In this episode *:45* How is this test done? *1:30* What is the first description of cryoglobulins? *4:15* The first time “cryoglobulins” is used *10:26* Hepatitis C is discovered and linked to cryoglobulinemia *16:28* What do we know about the pathophysiology? *19:38* Why does HCV do this? *22:12* Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. What’s in the blood as a result of immune complex? *24:52* What do we know about autoimmune diseases and the prevalence of cryoglobulins? *26:03* What about treatment? 28:25 Summary of this three-part series *36:16* Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Brouet JC, et al. Am J Med. 1974;57:775-788. Cacoub P, et al. Clin Gastroenterol Hepatol. 2019;17:518-526. De Vita S, et al. Arthritis Rheum. 2012;64:843-853. Fuentes A, et al. Curr Rheumatol Rep. 2019;21:doi:10.1007/s11926-019-0859-0. Lerner AB, Watson CJ. Am J Med Sci. 1947;214:410-415. Lospalluto J, et al. Am J Med. 1962;32:142-147. Meltzer M, Franklin EC. Am J Med. 1966;40:828-836. Pascual M, et al. J Infect Dis. 1990;162:569-570. Ragab G, Hussein MA. J Adv Res. 2017;8:99-111. Tzioufas AG, et al. Arthritis Rheum. 1986;29:1098-1104. Wintrobe MM, Buell, MV. Bull. Johns Hopkins Hosp. 1933;52:156-165.
	Dry Humors, Part 2	08 Apr 2020	00:53:41
In Part 2, I sit down with nephrologist Ali Mehdi, MD, and neurologist Ghulam Abbas Kharal, MD, MPH, to discuss their different specialty perspectives on working up patients with suspected cryoglobulinemic vasculitis. Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. Intro *:20* Introduction of Ali Mehdi, MD *:45* Interview with Dr. Mehdi *2:02* Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com Introduction of Ghulam Abbas Kharal, MD, MPH 25:01 Interview with Dr. Kharal *26:37* To hear more of my interview with Abbas, keep listening 44:47 Thank you, Dr. Kharal *53:07* Ghulam Abbas Kharal, MD, MPH, is a Partners Neurology Resident at Massachusetts General Hospital, Brigham & Women's Hospital, Harvard School of Medicine. Ghulam Abbas Kharal, MD, MPH, is a staff neurologist at Cleveland Clinic. Kharal did his training in a combined program at Massachusetts General Hospital and Brigham & Women's Hospital, Harvard School of Medicine. Ali Mehdi, MD, is a Nephrology Fellow at the Cleveland Clinic. Mehdi did his Internal medicine residency and chief year at the Cleveland Clinic. We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum
	Dry Humors, Part 1	27 Mar 2020	00:38:38
Try your hand at this medical mystery, which is followed by some didactics on a fascinating disease which will hopefully make sense of this inscrutable title. Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com Intro *:22* What to expect in each episode *:30* The case: A 75-year-old man with Sjogren’s and MALT lymphoma presents with recurrent cerebral infarcts of multiple territories *1:10* Rheumatology is consulted *6:11* Decreased sensation in toes occurs between strokes *7:14* What’s going on with this patient? *8:36* What additional labs can we perform? *9:36* We spin the urine *11:10* What kind of vasculitis are Sjogren’s and lymphoma associated with? *12:22* C3 and C4 had already been performed *13:00* An overall picture of this patient *13:54* What about the strokes? *14:19* Should we do more imaging? *15:57* At this point we can make a clinical decision *16:33* Why make a decision so quickly vs. waiting for biopsy? *18:18* Two things you must check before moving forward with a cryoglobulinemic vasculitis *19:46* Spoiler alert: The patient is doing really well *20:16* Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. What is cryoglobulinemic vasculitis? *21:00* What are these immunoglobulins? There are three types of cryoglobulins *22:55* Usually driven by another identifiable disease *25:18* What is making these immunoglobulins? *26:49* We don’t know why these immunoglobulins behave this way *27:18* How do you explain the kidneys? *28:28* What’s occurring at the tissue level? *29:35* How does type 1 present? *30:50* Type 2 and type 3 *31:12* What other organ systems are involved? *33:11* I hope you enjoyed this patient presentation *36:00* What we’ll discuss in episodes 2 and 3 *36:05* Thanks for listening *38:03* Coming soon from Healio, Unmasking COVID-19, a podcast hosted by Gitanjali Pai, MD, infectious disease physician at Memorial Hospital and Physicians’ Clinic in Stilwell, Oklahoma. In this timely new show, Dr. Pai will explore COVID-19’s impact on vulnerable patient populations by answering questions from experts in various medical fields, including oncology, endocrinology and rheumatology. To submit your question for Dr. Pai, email covid19podcast@healio.com. We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum @LCalabreseDO @CCalabreseDO Disclosure: Brown reports no relevant financial disclosures. References: Fuentes A, et al. Current Rheumatology Reports. 2019;21:60. Silva F, et al. J Autoimmun. 2019;105:102313.
	The Rheumatologist, Cancer and the Breakthrough, Part 2	11 Mar 2020	00:33:49
In this episode, Leonard H. Calabrese, DO, is joined by his colleague and daughter Cassandra Calabrese, DO, as they discuss specifics of irAEs, including unusual toxicities, rheumatic conditions associated with checkpoint inhibitors and the rheumatologist’s role in this new area of medicine. Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. Intro *:22* Recap of Part 1 *:40* An interview with Cassandra Calabrese, DO *2:02* The number of patients with irAEs will grow *2:22* How many people actually experience irAEs? *3:40* Any examples of unusual toxicities? *5:49* What’s the timeline? *6:51* Have you seen patients with delayed onset? *8:10* Most of our patients have had one irAE or another beforehand *9:04* Who’s the captain of this ship? *10:15* What about inflammatory arthritis? *10:55* What about polymyalgia rheumatica? *13:48* Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com What about sicca, is it Sjogren’s? *16:22* Can you tell us about myositis in this context? *18:38* An overview of the guidelines *21:47* Check out our article in March Current Opinions in Rheumatology *24:12* What about patients with preexisting autoimmunity? *24:33* Are you worried about blunting tumor response? *27:10* Are there any biomarkers to predict this? *28:30* How have you been working with oncologists to manage/educate? *29:42* What about meetings? *31:04* Rheumatologists have a special place in this new area of medicine *31:45* We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum @LCalabreseDO @CCalabreseDO Disclosure: Brown and Cassandra Calabrese report no relevant financial disclosures. Leonard Calabrese reports serving as an investigator and a consultant to Horizon Pharmaceuticals. Cassandra Calabrese, DO, is associate staff member in the department of rheumatic and immunologic disease and department of infectious disease at the Cleveland Clinic. Leonard H. Calabrese, DO, is chief medical editor of Healio Rheumatology and director of the RJ Fasenmyer Center for Clinical Immunology at the Cleveland Clinic.

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