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:...
Mar 16, 2022•36 min•Season 1Ep. 64
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....
Feb 11, 2022•22 min•Season 1Ep. 60
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 t...
Dec 10, 2021•38 min•Season 1Ep. 59
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 C...
Nov 11, 2021•29 min•Season 1Ep. 58
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 Deal 25:09 The numbers are showing a decline in P...
Aug 18, 2021•45 min•Season 1Ep. 57
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 c...
Jul 29, 2021•32 min•Season 1Ep. 56
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 happe...
Jul 08, 2021•30 min•Season 1Ep. 55
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 ...
Jun 16, 2021•29 min•Season 1Ep. 54
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 W...
Jun 01, 2021•32 min•Season 1Ep. 53
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 observatio...
May 13, 2021•24 min•Season 1Ep. 52
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 rheumatolog...
May 04, 2021•58 min•Season 1Ep. 51
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 pati...
Apr 01, 2021•29 min•Season 1Ep. 50
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...
Mar 11, 2021•22 min•Season 1Ep. 49
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 finan...
Feb 23, 2021•38 min•Season 1Ep. 48
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...
Feb 03, 2021•31 min•Season 1Ep. 47
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 com...
Jan 21, 2021•34 min•Season 1Ep. 46
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 Wh...
Jan 08, 2021•22 min•Season 1Ep. 45
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 b...
Dec 18, 2020•34 min•Season 1Ep. 44
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...
Dec 09, 2020•44 min•Season 1Ep. 42
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 Gul...
Nov 20, 2020•35 min•Season 1Ep. 42
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 ax...
Nov 03, 2020•30 min•Season 1Ep. 41
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...
Oct 15, 2020•25 min•Season 1Ep. 40
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 ...
Oct 02, 2020•28 min•Season 1Ep. 39
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 o...
Aug 18, 2020•45 min•Season 1Ep. 38
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 Swit...
Jul 15, 2020•41 min•Season 1Ep. 37
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 o...
Jun 22, 2020•36 min•Season 1Ep. 36
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...
Jun 09, 2020•26 min•Season 1Ep. 35
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 ...
May 20, 2020•47 min•Season 1Ep. 34
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 :...
Apr 23, 2020•38 min•Season 1Ep. 33
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-t...
Apr 08, 2020•54 min•Season 1Ep. 32
