Healio Rheuminations – Details, episodes & analysis

To celebrate 101 episodes, I sit with Leonard H. Calabrese, DO, to discuss his unique career in Rheumatology, spanning immunology, HIV, MECFS, IRES, CNS vasculitis and more. We also discuss how medical history shaped our careers. 

·        Intro 0:12

·        Welcome Leonard H. Calabrese, DO 3:11

·        A quick friendship begins over medical history 4:14

·        How Healio Rheuminations began and where the show is now 5:38

·        How Dr. Calabrese got interested in medical history 7:11

·        Serotherapy 10:52

·        Why patients get certain diseases 12:33

·        Dr. Calabrese's career trajectory 14:43

·        One day in 1981… 17:52

·        A few things happened in the 90's 20:20

·        Tell us about CNS vasculitis 21:53

·        Don't be afraid to reinvent yourself 24:30

·        Checkpoint inhibitors 25:09

·        How do you keep up? 26:43

·        Placebo science 28:25

·        Do you think we'll ever be able to answer where diseases come from? 29:33

·        Thank you, Dr. Calabrese 31:01

·        Thanks for listening 31:26

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.

What does a goiter and syphilis have in common with the first descriptions of giant cell arteritis? Join us as we dive into the history of the most common type of vasculitis!

• Intro 0:13
• GCA at ACR 2025 00:30
• How Brown has approached framing this episode 1:01
• A primer leading us to GCA 3:15
• Let's get to the story 4:02
• The man who couldn't wear a hat 4:57
• Dr. Bayard Horton's 7:40
• A tangent on cluster headaches 8:27
• Let's get back to GCA 13:16
• The first temporal artery biopsy 14:28
• Vision loss and other puzzle pieces of GCA 16:27
• What about jaw claudication? 21:15
• Could GCA be transmissible? Injecting ground temporal arteries into healthy volunteers 24:13
• Oxygen? Histamines? Adrenal cortical extract? Looking for GCA treatments 26:55
• Steroids and GCA 28:40
• A quote from the 1959 Mayo Clinic Board of Governors 32:24
• Extracranial involvement in GCA 33:24
• When did we recognize aorta involvement? Syphilis enters the picture 35:08
• A recap of the history of GCA 41:25
• Thanks for listening 42:19

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:

Boes CJ, Cephalalgia. 2007;doi:10.1111/j.1468-2982.2007.01238.x

Cummer CL, et al. JAMA. 1912;doi:10.1001/jama.1912.04270080101004

Horton BT, Proc Cent SOC Clin Res. 1946

Sproul EE, et al. Am J Pathol. 1937;PMID: 19970328

Disclosures: Brown reports no relevant financial disclosures.

In part 2, we dig into the history of pulmonary hypertension. How did this strange diagnosis first get recognized, what does it have to do with cows with thick necks and urinary catheters in the heart?

• Intro 0:11
• In this episode 0:17
• Recap of part 1 0:26
• How was pulmonary hypertension discovered? 2:38
• 1891 3:51
• 1901 5:07
• 1935 7:02
• Hilar dance 12:58
• Cardiac catheterization: 1929 15:03
• When did cardiac catheterization become relevant? 20:10
• 1965: Aminorex 24:40
• World Health Organization: 1975 26:37
• 1980s: toxic oil syndrome of Spain 28:20
• Preview of part 3 33:15 
• Back to cardiac catheterization 34:08
• Briskets disease 35:45
• 1947 37:56
• Pulmonary physiology and prostaglandin therapies (in the next episode) 38:41
• Schistosomiasis outbreaks in Egypt 1938 40:26
• Chronic thromboembolism 45:03
• Thanks for listening 48:16

We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Barst RJ. Ann Thorac Med. 2008;doi:10.4103/1817-1737.37832.

Bodo R. J Physiol. 1928;doi:10.1113/jphysiol.1928.sp002447.

Dresdale DT, et al. Am J Med. 1951;doi:10.1016/0002-9343(51)90020-4.

Egypt. Stanford.edu. Published 2015. https://schisto.stanford.edu/pdf/Egypt.pdf.

Hewes JL, et al. Pulm Circ. 2020;doi:10.1177/2045894019892801.

Johnson S, et al. Am J Respir Crit Care Med. 2023;doi:10.1164/rccm.202302-0327SO.

Newman JH. Am J Respir Crit Care Med. 2005;doi:10.1164/rccm.200505-684OE.

Weir EK, et al. Circulation. 1996;doi:10.1161/01.cir.94.9.2216.

Disclosures: Brown reports no relevant financial disclosures.

In this series, we dive into what rheumatologists should know about pulmonary hypertension, starting an interview with Joseph Parambil, MD, where we learn about the disease, when to suspect and how to work up!

• Intro 0:11
• In this episode 0:16
• Preview of the four-part series 4:46
• Interview with Joseph Parambil, MD 6:27
• How did you become interested in pulmonary hypertension? 7:02
• Brown and Parambil discuss the histology of pulmonary hypertension. 10:13
• Brown and Parambil discuss a case of pulmonary hypertension. 12:26
• What is pulmonary hypertension and what does that mean for a rheumatologist? Where is pulmonary hypertension happening? 13:25
• Describe the different groups of pulmonary hypertension. 19:51
• A note about Dr. Chatterjee 20:25
• Brown and Parambil discuss the groups of pulmonary hypertension. 23:35
• What should we know about evaluating patients with pulmonary hypertensions? 26:51
• Brown and Parambil discuss bendopnea and other signs of pulmonary hypertension. 29:58
• What about the heart sound? 33:06
• What should we look for in patients who we suspect to have pulmonary hypertension? 36:52
• What should we look for in the tricuspid jet? 38:18
• Brown and Parambil discuss the use of echocardiograms in pulmonary hypertension. 39:28
• Tell us about the threshold of diagnosis. 40:47
• What is the difference between the mean pressure and the wedge pressure? 41:41
• What about the role of the pulmonary function test? 43:55
• Summary 46:41
• Do you think the pulmonary hypertension in scleroderma and lupus are different entities? 48:37
• Brown and Parambil discuss the connection of autoimmune disease and pulmonary hypertension. 50:49
• Coming up in episode 91 51:50
• Thanks for listening 52:25

Disclosures: Brown and Parambil report no relevant financial disclosures.

Joseph Parambil, MD, is a staff member in the Respiratory Institute and the director of the HHT Center of Excellence and the Vascular Anomalies Center at the Cleveland Clinic. He is associate professor of medicine at Cleveland Clinic's Lerner College of Medicine. He is certified by the American Board of Internal Medicine with additional specialty certification in pulmonary medicine and critical care medicine.

We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

On this episode, hear the 2024 updates on COVID-19, long COVID and the latest developments in research in rheumatology. Hosted by Dr. Leonard Calabrese.

• Intro 0:12
• In this episode 0:21
• Coming up on Healio Rheuminations 0:56
• COVID-19, long COVID and the rheumatologist with Leonard Calabrese, DO 2:19
• Questions 3:12
• Long COVID 4:46
• Calabrese's bias 10:15
• The evidence 13:08
• Auto antibodies 14:54
• Why does the body develop auto antibodies? 17:47
• COVID-19 and epidemiologic association 22:25
• New clinical entity 26:40
• Therapeutic implications 31:00
• In conclusion 32:00
• Thanks for listening 33:18

Leonard H. Calabrese, DO, is the chief medical editor, Healio Rheumatology, and professor of medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer chair of clinical immunology at the Cleveland Clinic.

Disclosures: Calabrese reports professional relationships with AbbVie, AstraZeneca, Bristol Myers Squibb, Galvani, Genentech, GlaxoSmithKline, Janssen, Novartis, Regeneron, Sanofi and UCB.

We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

It's that time of year again, everyone rolling up their sleeves to get a flu shot. This throwback episode dives into the history of the struggles pinning down the causative agent of flu and the journey to the vaccine!

• Intro 0:40
• In this episode 1:11
• The history of the flu: 1892 1:41
• What do we know about viruses? 6:29 
• Rabies and dead virus 11:17
• A Sickness in the Serum, Part 2 14:43
• 1918 16:44
• Vaccines and trials 19:13
• Pig influenza 23:12
• Influenza: a filterable agent we can't see 27:01
• The trials of 1942 33:02
• PS: 1918 influenza 38:57
• Thanks for listening 47:42

Disclosures: Brown reports no relevant financial disclosures.

We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Hicks DJ, et al. Clin Exp Immunol. 2012;doi:10.1111/j.1365-2249.2012.04592.x.

Rosenau MJ. Experiments Upon Volunteers to Determine the Cause and Mode of Spread of Influenza, Boston, November and December, 1918. https://quod.lib.umich.edu/f/flu/3750flu.0016.573. Published February 1921. Accessed December 6, 2023.

Rosenau MJ, et al. JAMA. 1925;doi:10.1001/jama.1925.02670070040019.

Taubenberger JK, et al. Antivir Ther. 2007;12(4 Pt B):581-91.

Tobin J. The first flu shot. https://heritage.umich.edu/stories/the-first-flu-shot/. Accessed December 6, 2023.

In the third episode of the NSAIDs saga, we focus on COX-2 inhibition! Did the hopes and dreams of selective COX-2 inhibition pan out? What can the rise and fall of VIOXX teach us about physiology?

• Intro 0:11
• Recap of part 1 & 2 0:28
• In this episode 1:44
• Cyclooxygenase 2 (COX-2) and the rat experiment 3:12
• What do we know about the prostaglandins? And what about COX-2 7:54
• What does prostacyclin do? 10:33
• The first COX-2 inhibitor: VIOXX 10:56
• What is COX-2 doing?: Pfizer and Merck 12:15
• Two more NSAID studies: colon cancer, Alzheimer's disease and COX-2 inhibitors 18:41
• VIOXX: Why is myocardial infarction risk occurring? 22:34
• Animal models and the Goldilocks theory of thromboxane and prostacyclin 23:49
• PRECISION trial 30:25
• Rheum + Boards 37:14 
• Thanks for listening 37:32

We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Anderson GD, et al. J Clin Invest. 1996;doi:10.1172/JCI118717.

Funk CD, et al. J Cardiovasc Pharmacol. 2007;doi:10.1097/FJC.0b013e318157f72d.

Hennan JK, et al. Circulation. 2001;doi:10.1161/hc3301.092790.

Krumholz HM, et al. BMJ. 2007;doi:10.1136/bmj.39024.487720.68.

Nissen SE, et al. N Engl J Med. 2016;doi:10.1056/NEJMoa1611593.

Disclosures: Brown reports no relevant financial disclosures.

In this episode, we dive into the story of aspirin and the development of ibuprofen, ending with the experiments that showed the mechanism of how aspirin actually works.

• Intro 0:12
• Review of part 1 0:28
• In this episode 1:04
• Blocking prostaglandins and willow leaves 2:26
• Edward Stone 3:45
• Johann Andreas Buchner 4:16
• The chemical structure of salicylic acid and creating the synthetic compound 4:44
• Dr. TJ MacLagan: The first trial in 1876 and treating acute rheumatism 5:16
• Felix Hoffmann: manipulating salicylic acid and aspirin 8:47
• How widespread was the use of aspirin for rheumatoid arthritis? 12:04
• 1938: problems with aspirin and endoscopies 14:58
• 1950s: long-term use of aspirin and chronic renal impairment 17:12
• Dr. Lawrence Craven: the use of aspirin to treat myocardial infarction 18:13
• Overview of what we've learned so far 20:48
• Stewart Adams: the development of ibuprofen 21:40
• A paper lost to time 23:29
• How do you test if a drug is anti-inflammatory? 25:25
• How do you make better aspirin? 26:55
• 1960: a trial comparing ibuprofen, baby aspirin and prednisone in patients with rheumatoid arthritis 30:03
• Aspirin, ibuprofen and other NSAIDs 32:49
• Nobel Prize winner Dr. John Vane 33:40
• Dr. Vane: what triggered prostaglandin production? 35:42
• Another guinea pig experiment 37:37
• Nobel Prize winner Dr. Bengt Samuelsson 39:00
• Interesting tidbits: early studies looking at the side effects of NSAIDs 40:01
• 1968: gastric ulcer formation and prostaglandins in rats 40:25
• 1973: renal blood flow and prostaglandins in dogs 41:53
• 1974: aspirin vs ibuprofen vs indomethacin for the heart 44:03
• Aspirin vs ibuprofen vs indomethacin 44:20
• On the next episode 46:09
• Thanks for listening 46:37

We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Adams SS. Inflammopharmacology. 1999;doi:10.1007/s10787-999-0002-3.

https://www.aspirin-foundation.com/history/the-aspirin-story/.

Buchanan WW, et al. J Rheumatol. 2002;29(6):1321-3.

Cryer B, et al. Gastroenterology. 1999;doi:10.1016/s0016-5085(99)70545-7.

Desborough MJR, et al. Br J Haematol. 2017;doi:10.1111/bjh.14520.

Halford GM, et al. Platelets. 2012;doi:10.3109/09537104.2011.632032.

Harris SC, Fosdick LS. Theoretical considerations of the mechanisms of antipyretic analgesia. NWU Bull. 1952;53: 6–9.

Jasani MK, et al. Ann Rheum Dis. 1968;doi:10.1136/ard.27.5.457.

Robert A, et al. Gastroenterology. 1968;55(4):481-7.

Disclosures: Brown reports no relevant financial disclosures.

Humans have had an insatiable appetite for inhibiting production of prostaglandins for centuries! This series delves into the history of aspirin and NSAIDs, looking at the understanding of the prostaglandin pathway.

·       Intro 0:12

·       In this episode 0:23

·       What are NSAIDs? 0:53

·       Prostaglandins 5:50

·       What are prostaglandins? 7:19

·       Where do prostaglandins come from? 8:45

·       So, what do we do with prostaglandins? 13:15

·       How did they figure out prostaglandins? 13:55

·       Naming the prostaglandin 21:25

·       Phospholipids 24:46

·       Arachidonic acid 25:28

·       Arachidonic acid into prostaglandins: how do you prove it? 26:32

·       How does arachidonic acid turn into prostaglandins? 27:27

·       Cyclo-oxygenase 28:36

·       mRNA and COX-2 32:50

·       On the next episode 35:55

·       Summary 36:38

·       Thanks for listening 37:49

Disclosures: Brown reports no relevant financial disclosures.

We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Botting RM. Pharmacol Rep. 2010;doi:10.1016/s1734-1140(10)70308-x.

Flower RJ. Br J Pharmacol. 2006;doi:10.1038/sj.bjp.0706506.

Flower RJ. Br J Pharmacol. 2019;doi:10.1111/bph.14588.

Kurzrok R, et al. Exp Biol Med. 1930;doi:10.3181/00379727-28-5265.

https://www.nobelprize.org/prizes/medicine/1970/euler/biographical/.

von Euler US. J Physiol. 1936;doi:10.1113/jphysiol.1936.sp003433.

This episode digs into the pathophysiology of urticaria vasculitis from anti-C1q to the story of bradykinin.

·       Intro 0:11

·       In this episode 0:22

·       Review of episode 83 1:23

·       Listen to previous episode, The Complement System for Dunces 4:09

·       Anti-C1q antibodies 6:26

·       Lupus, anti-C1q and lupus nephritis 9:33

·       What happens when you inject anti-C1q in a mouse? 12:56

·       The allergy component: anti-C1q, urticaria and angioedema 17:36

·       Bradykinin-mediated angioedema and C1q deficiency 24:20

·       What is the kinin kallikrein system? 26:21

·       French researchers in 1909: human urine injected in dogs 27:30

·       How is this relevant to urticarial vasculitis? 31:08

·       SERPING1 gene mutation 31:23

·       Summary 32:06

·       COPD association with urticarial vasculitis 33:51

·       Coming up in episode 85 35:28

·       Thanks for listening 35:45

Disclosures: Brown reports no relevant financial disclosures.

We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Busse P, et al. J Allergy Clin Immunol Pract. 2022;doi:10.1016/j.jaip.2021.11.011.

Davis MDP, et al. J Allergy Clin Immunol Pract. 2018;doi:10.1016/j.jaip.2018.05.006.

Dorn JM, et al. Ann Allergy Asthma Immunol. 2023;doi:10.1016/j.anai.2023.06.014.

Marzano AV, et al. J Allergy Clin Immunol. 2022;doi:10.1016/j.jaci.2022.02.007.

Siegert CE, et al. Clin Immunol Immunopathol. 1993;doi:10.1006/clin.1993.1066.

Stojan G, et al. Lupus. 2016;doi:10.1177/0961203316645205.

Venzor J, et al. Clin Rev Allergy Immunol. 2002;doi:10.1385/CRIAI:23:2:201.

Wisnieski JJ, et al. Medicine. 1995;doi:10.1097/00005792-199501000-00003.