Healio Rheuminations

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.

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.

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.

It's that time of year again, everyone rolling up their sleeves to get a flu shot. This episode dives into the history of the struggles pinning down the causative agent of flu and the journey to the vaccine! ·       Intro 0:12 ·       In this episode 0:17 ·       The history of the flu: 1892 3:10 ·       Rabies and dead virus 10:52 ·       A Sickness in the Serum, Part 2 14:31 ·       Vaccines and trials 19:13 ·       Pig influenza 23:21 ·       Influenza: a filterable agent we can’t see 27:10 ·       The trials of 1942 33:18 ·       PS: 1918 influenza 39:13 ·       Finding the 1918 influenza vaccine 39:54 ·       Thanks for listening 47:54 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.

What is silica? How does it impact your risk of developing autoimmunity if you inhale it, inject it or even snort it up your nose? Listen and find out! ·       Intro 0:12 ·       In the previous episodes 0:28 ·       The Ajax incident of 1979 1:15 ·       Silica and its association with autoimmune disease 4:11 ·       The history of silica and the health risks 5:21 ·       Rheumatoid scleroderma, etc. 8:14 ·       Cardiff pneumoconiosis medical panel 9:49 ·       Databases 12:51 ·       Silica exposure and the development of serologies 15:02 ·       What would happen if you injected silica into the veins? 16:51 ·       Anca vasculitis 18:33 ·       Thanks for listening 23:23 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: Blanc PD, et al. Am J Med. 2015;doi:10.1016/j.amjmed.2015.05.001. Boudigaard SH, et al. Int J Epidemiol. 2021;doi:10.1093/ije/dyaa287. Conrad K, et al. Lupus. 1996;doi:10.1177/096120339600500112. Hoy RF, et al. Allergy. 2020;doi:10.111/all.14202. Klockars M, et al. Br Med J (Clin Res Ed). 1987;doi:10.1136/bmj.294.6578.997. Park CG, et al. Environ Health Perspect. 1999;doi:10.1289/ehp.99107s5793. Pollard KM. Front Immunol. 2016;doi:10.3389/fimmu.2016.00097.  

In this episode, we dig through the data of lupus in Africa and speak with experts on the Lupus Gradient, the impact of malaria and what we can learn from it all. ·       Intro 0:12 ·       In the previous episode 0:30 ·       Lupus Gradient 2:01 ·       Back to Dr. Brian Greenwood 3:48 ·       Polyarthritis 4:04 ·       Rates of autoimmune diseases 6:00 ·       Malaria and mouse models 7:33 ·       Back to lupus 8:48 ·       First case of lupus 15:14 ·       Prevalence of lupus 17:15 ·       Papers on lupus 21:23 ·       Dr. Mickael Essouma 23:38 ·       Dr. Essouma, how did you conduct this study? 24:01 ·       Did you ever believe there was a gradient? 26:09 ·       Dr. Sandro Vento 30:56 ·       Dr. Vento, do you believe there was a lupus gradient? 31:51 ·       What are the connections to infectious disease? 38:51 ·       That’s a wrap! 43:04 ·       Coming up in part 4 44:55 ·       Thanks for listening 45:05 Disclosures: Brown reports no relevant financial disclosures. Healio could not confirm relevant financial disclosures for Essouma and Vento at the time of posting. Mickael Essouma, MD, is physician from Cameroon specialized in internal medicine at the University of Yaounde I in Cameroon, with a complimentary certificate on rheumatology from the EULAR online course and a certificate on lupus from the European Lupus Society (SLEuro). He is an advocate of lupus and other autoimmune diseases in Africans. Sandro Vento, MD, is the dean of faculty of medicine at the University of Puthisastra, Phnom Penh, Cambodia and a consultant and collaborating specialist at Mayo Clinic Center for Tuberculosis, WHO Collaborating Center. 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: Bae SC, et al. Arthritis Rheum. 1998;doi:10.1002/1529-0131(199812)41:12<2091::AID-ART2>3.0.CO;2-D. Bryc K, et al. Am J Hum Genet. 2015;doi:10.1016/j.ajhg.2014.11.010. Essouma M, et al. J Autoimmun. 2020;doi:10.1016/j.jaut.2019.102348. Gilkeson GS, et al. Lupus. 2011;doi:10.1177/0961203311404915. Micheletti SJ, et al. Am J Hum Genet. 2020;doi:10.1016/j.ajhg.2020.06.012. Symmons DP. Lupus. 1995;doi:10.1177/096120339500400303. Vento S, et al. Front Med. 2020;doi:10.3389/fmed.2020.00202.

This episode delves into what we can learn about the impact of the environment on autoimmunity, digging into how rates of autoimmunity can vary drastically in different parts of the world. ·       Intro 0:12 ·       In this episode 0:16 ·       Dr. Brian Greenwood 0:22 ·       The geography of autoimmunity 7:01 ·       Type 1 diabetes 10:31 ·       Finland and type 1 diabetes 13:57 ·       Socioeconomics 17:59 ·       Genetics and autoimmune diseases 24:19 ·       Migration studies 24:53 ·       Denmark and multiple sclerosis 30:06 ·       Coming up in part 3 36:02 ·       Thanks for listening 38:16 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: Bach JF. N Engl J Med. 2002;doi:10.1056/NEJMra020100. Bodansky HJ, et al. BMJ. 1992;doi:10.1136/bmj.304.6833.1020. Dean G, et al. J Neurol Neurosurg Psychiatry. 1997;doi:10.1136/jnnp.63.5.565. Hammond SR, et al. Brain. 2000;doi:10.1093/brain/123.5.968. Hawkes CH, et al. Mult Scler Relat Disord. 2019;doi:10.1016/j.msard.2019.08.001. Karvonen M, et al. Diabetes Care. 1999;doi:10.2337/diacare.22.7.1066. Kondrashova A, et al. Diabetes Care. 2007;doi:10.2337/dc06-0711. Marciulionyte D, et al. Diabetologia. 2001;doi:10.1007/s001250051574. Nielsen NM, et al. Brain. 2019;doi:10.1093/brain/awz088. Patterson CC, et al. Diabetologia. 2012;doi:10.1007/s00125-012-2571-8. Sandy JL, et al. Pediatr Diabetes. 2021;doi:10.1111/pedi.13191.

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.

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.

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.

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.

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.

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.

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.

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

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

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.

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.

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. 

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