Healio Rheuminations

Adam J. Brown, MD

Rheumatology is an incredibly fast-moving and exciting field of medicine that can be difficult to keep up with. This Healio podcast provides busy clinicians with quick updates in the field of autoimmunity, with emphasis on new medications, treatment guidelines and explorations into the pathophysiology of diseases. The show will also feature historical perspectives in the field of rheumatology, as well as fascinating case presentations of medical mysteries complete with discussions from experts in the field.

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Top 10 Healio Rheuminations Episodes

Goodpods has curated a list of the 10 best Healio Rheuminations episodes, ranked by the number of listens and likes each episode have garnered from our listeners. If you are listening to Healio Rheuminations for the first time, there's no better place to start than with one of these standout episodes. If you are a fan of the show, vote for your favorite Healio Rheuminations episode by adding your comments to the episode page.

Urticarial Vasculitis, Part 2: Walking the Balance Beam of Allergy and Rheumatology

Healio Rheuminations

04/18/24 • 35 min

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 [email protected]. 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 Geography of Autoimmunity, Part 2

Healio Rheuminations

08/17/23 • 38 min

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 [email protected]. 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.

Vascular Ehlers-Danlos Syndrome, Part 1

Healio Rheuminations

01/31/23 • 36 min

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 [email protected]. 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.

Part 4, The Story of the Antibody: Two Arms and a Stick

Healio Rheuminations

10/15/20 • 25 min

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 [email protected]. 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.

all CAPS: A Story of Ice and Fire - Part 1

Healio Rheuminations

11/07/19 • 31 min

This first episode delves into the clinical aspects of the Cryopyrin-Associated Periodic Syndromes and includes some helpful tips for sorting out some of the autoinflammatory diseases in the spectrum.

Intro :10
Cryopyrin-Associated Periodic Syndromes (CAPS) :25
Outline of Part 1 2:25
What is CAPS? 3:12
Case #1 – a 25-year-old female with urticaria after cold exposure 4:25
Case #2 – a 55-year-old female with progressive deafness 5:45
The index case of familial cold autoinflammatory syndrome 9:00
The final disease in the spectrum 11:00
A lot of names for the same disease 13:50
Genetics prove these three diseases are in the same spectrum 14:22
Over 100 mutations have been found to-date 16:31
Let’s talk about mosaicism 17:03
Disease characteristics of CAPS 18:15
- Neutrophilic infiltrate in chronic urticaria vs. CAPS 20:00
- Schnitzler syndrome 20:45
- Sensorineural hearing loss 21:58
- Joint pain 24:10
Complication: Amyloidosis 25:29
These diseases were very debilitating 28:38
Episode recap 29:46
Part 2 sneak peek 30:38
Come say hi at ACR! 30:51

We’d love to hear from you! Send your comments/questions to [email protected]. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Ahmadi N, et al. Otolaryngol Head Neck Surg. 2011;145:295-302.

Aksentijevich I, et al. Arthritis Rheum. 2002;46:3340-3348.

Alecu M, et al. Romanian Journal of Morphology and Embryology = Revue Roumaine de Morphologie et Embryologie. 2015;56:7-14.

Hassink SG, Goldsmith DP. Arthritis Rheum. 1983;26:668–673.

Hoffman HM, et al. Nat Genet. 2001;29:301-305.

Hoffman HM, et al. J Allergy Clin Immunol. 2001;108:615-620.

Kile RM, Rusk HA. JAMA. 1940;114:1067-1068.

Levy R, et al. Ann Rheum Dis. 2015;74:2043-2049.

Marzano AV, et al. Clin Exp Rheumatol. 2018;36 Suppl 110:32-38.

Muckle TJ, Wells M. Q J Med. 1962;31:235-248.

Prieur AM, Griscelli C. Rev Rhum Mal Osteoartic. 1980;47:645–649.

Tran TA. Open Access Rheumatol. 2017;9:123-129.

NSAIDs, Part 2: The Dawn of the Anti-Inflammatories

Healio Rheuminations

06/26/24 • 46 min

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 [email protected]. 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.

It's in the Air: Silica exposure and the risk of autoimmunity, Part 4

Healio Rheuminations

11/15/23 • 23 min

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 [email protected]. 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.

Paget's and the Rheumatologist: Why Haven't I Seen This Yet?

Healio Rheuminations

08/18/21 • 45 min

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 [email protected]. 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.

Trials and Tribulations of Tumor Necrosis Factor, Part 2: Even More Necrosis

Healio Rheuminations

04/17/19 • 47 min

This ripping yarn delves into the history of tumor necrosis factor in relation to rheumatoid arthritis with emphasis on the original studies that set the stage for the use of TNF inhibition in RA.

Intro :11
What we’ll cover here :16
Recap of Part 1 1:25
What I discovered when doing this episode 1:22
What this episode won’t address 2:40
Let the tale begin 3:12
A look at matrix metalloproteinases 3:32
A breakthrough in understanding RA 6:28
Two key players: Dr. Mark Feldman and Dr. Ravinder Maini 6:53
The first cytokine research conducted in RA: IL-1 8:00
The next cytokine: Tumor necrosis factor 11:16
What do we know about cytokine production within the joint? 14:33
IL-6 and TGF-beta 19:16
A bit about IL-10 23:57

*Visit Healio.com/rheum for daily news and updates*

How do we choose which cytokines to block to make improvements in RA? 25:16
What about in vivo data? 29:45
The history of infliximab 34:00
Infliximab is approved for RA treatment 45:13
TNF in RA: from bedside, to bench then back to bedside 46:06
It’s important to recognize the researchers who discovered these pathways 46:18
Remember the scientists next time you prescribe a TNF inhibitor 47:05
Read the latest news and commentary on Healio.com/rheumatology and Follow us on Twitter @HealioRheum and @HRheuminations for updates 47:34

We’d love to hear from you! Send your comments/questions to [email protected]. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

References:

Brennan FM, et al. J Autoimmun. 1989;2 Suppl:177-186.

Brennan FM, et al. Lancet. 1989;2:244-247.

Butler MD, et al. Eur Cytokine Netw. 1995;6:225-230.

Chu CQ, et al. Arthritis Rheum. 1991;34:1125-1132.

Dayer JM, et al. J Exp Med. 1985;162:2163-2168.

Di Giovine FS, et al. Ann Rheum Dis. 1988;47:768-772.

Feldmann, M. Nat Rev Immunol. 2002;2:364-371.

Feldmann M, Maini SR. Immunol Rev. 2008;223:7-19.

Fontana A, et al. Rheumatol Int. 1982;2:49-53.

Haworth C, et al. Eur J Immunol. 1991;21:2575-9.

Houssiau FA, et al. Arthritis Rheum. 1988;31:784-8.

Keffer J, et al. EMBO J. 1991;10:4025-4031.

Kulkarni AB, Karlsson S. Am J Pathol. 1993;143:3-9.

Kuruvilla AP, et al. PNAS. 1991;88:2918-2921.

Maini RN, et al. Arthritis Rheum. 1998;41:1552-1563.

Malaviya AN, Mehra NK. Indian J Med Res. 2018;148:263–278.

McInnes IB, Schett G. Nat Rev Immunol. 2007;7:429-442.

Mitchison NA, Medawar PB. Proc R Soc Lond [Biol]. 1964;https://doi.org/10.1098/rspb.1964.0093.

Pettipher ER, et al. Proc Natl Acad Sci U S A. 1986;83:8749-8753.

The Beautiful Cure: The Revolution in Immunology and What It Means for Your Health, University of Chicago Press, Chicago, 2018.

Williams RO, et al. Proc Natl Acad Sci U S A. 1992;89:9784-9788.

The Iron Fist, Part 1: Hemochromatosis and the Rheumatologist

Healio Rheuminations

05/13/21 • 23 min

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 [email protected]. 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.

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