Healio Rheuminations

In this episode of Rheuminations, host Adam J. Brown, MD, untangles the confusing serologies of lupus by learning about their discoveries from the beginning. He answers questions like what's the deal with immunofluorescence patterns, why does SSA/SSB have two names (Ro/LA), and is double-stranded DNA antibody really attracted to both strands?

· The story of antibodies in lupus. 3:27

· The "LE" factor. 10:11

· The changing fluorescent patterns of the staining of the nucleus/ENAs. 18:50

· The anti-Smith antibody. 24:51

· The mysteries of SSA and SSB. 28:52

· Double-stranded DNA. 36:32

· Crithidia luciliae. 40:30

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:

Aarden LA, et al. Ann NY Acad Sci. 1975;doi:10.1111/j.1749-6632.1975.tb29197.x

Alspaugh MA, et al. Arthritis Rheum. 1976;doi:10.1002/art.1780190214

Aslpaugh MA, et al. J Clin Invest. 1975;doi:10.1172/JCI108007

Arana R, et al. J Clin Invest. 1967;doi:10.1172/JCI105677

Clark G, et al. J Immunol. 1969;PMED:4179557

Dubois EL, et al. Blood. 1957;doi:10.1182/blood.V12.7.657.657

Friou GJ, et al. J Immunol. 1958;doi:10.4049/jimmunol.80.4.324

Hargraves MM. Proc Staff Meet Mayo Clin. 1949;doi:10.1016/S0025-6196(25)08519-2

Haserick JR, et al. Am J Med Sci. 1950;doi:10.1097/00000441-195006000-00010

Rowell NR, et al. Arch Dermatol. 1963;doi:10.1001/archderm.1963.01590200064012

Tan EM, et al. J Clin Invest. 1966;doi:10.1172/JCI105479

Tsokos GC. J Immunol. 2006;doi:10.4049/jimmunol.176.3.1295

In this episode of Rheuminations, guest host Leonard H. Calabrese, DO, sits down with David Chernoff, MD, chief medical officer of SetPoint Medical, to discuss the vagus nerve and recent developments in immune mediated disease.

· The story of Kevin Tracey, MD. 5:08

· Going from cytokines to the vagus nerve to immune mediated inflammatory disease. 7:23

· The ups and downs of non-surgically implanted devices. 13:28

· The pivotal studies. 15:35

· Gadolinium MRI. 24:03

· The gut-brain immune axis. 29:35

We'd love to hear from you! Send your comments/questions to Dr. Brown at [email protected]. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. Leonard H. Calabrese, DO, can be reached at [email protected]. Follow him @LCalabreseDO.

In this episode of Rheuminations, host Adam J. Brown, MD, will walk you through the history of pleural effusions in rheumatoid arthritis. He discusses topics ranging from fascinating case studies to how pleural effusions are treated today.

· Diving into pleural effusions. 2:38

· What's in the fluid? 12:01

· When did pleural effusions become linked to RA? 15:18

· The glucose talk. 27:04

· Green effusions. 32:40

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

Not all jaw claudication is giant cell arteritis. Hear some interesting cases and learn about things to look for in the labs to suspect an alternative diagnosis along with co-host Leonard H. Calabrese, DO.

· When GCA isn't GCA, walking through mimic cases 2:43

· Infectious mimics 14:36

· Large vessel involvement cases 16:47

· GCA as a medical emergency 22:05

· Erdheim-Chester disease 23:40

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

In this week's episode we interview Kinanah Yaseen, MD, a rheumatologist from Cleveland Clinic's department of rheumatic and immunologic diseases about using ultrasound for giant cell arteritis.

· Intro by Adam J. Brown, MD 0:12

· Dr. Brown's recent patient 1:34

· History of ultrasound and GCA 3:20

· Episode overview 7:05

· History of echolocation; how bats helped us invent ultrasound 8:00

· What is a bat bomb? 14:56

· How the Titanic helped us invent ultrasound 16:48

· Neurologists bring ultrasound to medicine 20:09

· OB/GYN is next to use ultrasound 23:11

· Ultrasound image quality becomes better 26:32

· Ultrasound use in giant cell arteritis 28:44

· Welcome Kinanah Yaseen, MD 33:49

· Using ultrasound in the clinic 34:25

· Can you walk us through an ultrasound of the axillary and vertebral arteries? 37:16

· Can you tell us why we stopped looking for sites to biopsy by finding narrowing of the vessels? 38:19

· Tell us about the halo sign 39:10

· How do you validate your ultrasound skills? 40:20

· If we start a patient on steroids, how useful is an ultrasound? 42:35

· Episode summary 44:20

· Thank you for listening 45:57

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

Kinanah Yaseen, MD, is a is a staff member of Cleveland Clinic's department of rheumatic and immunologic diseases.

References:

Friedman, G, et al.Isr J Med Sci. 1988

Kaproth-Joslin K A, et al. Radiographics. 2015 ;doi:10.1148/rg.2015140300

Puéchal X, et al. Lancet. 1995;doi:10.1016/s0140-6736(95)92626-7

Schmidt W A, et al. Lancet. 1995;doi:10.1016/s0140-6736(95)93005-1

Sigel B. Ultrasound Med Biol. 1998;doi:10.1016/s0301-5629(97)00264-0

Editor's Note: This has been updated to include references.

In this week's episode we interview Joseph Parambil, MD, staff member in the department of pulmonary, allergy and critical care medicine at Cleveland Clinic, about the current challenges of interstitial lung disease, or ILD.

· Intro by Adam J. Brown, MD 0:12

· Welcome back Joseph Parambil, MD 0:32

· But first, some medical history on ILD 1:04

· ILD vs. IPF 2:26

· A quick aside into silicosis and bleomycin 4:27

· Trying to describe pulmonary fibrosis 5:23

· The different types of ILD 9:44

· Finding a slow progression of disease and autoimmune conditions 10:59

· Pulmonary fibrosis diagnoses in 1963 14:41

· The modern era of ILD 16:22

· Nonspecific interstitial pneumonia 20:12

· Handing things over to Dr. Parambil 23:01

· Helping rheumatologists understand ILD/The alphabet soup 24:34

· The shift from biopsies and using immunosuppression 33:07

· Is the workup similar for UIP and NSIP? 35:26

· Is there a standard protocol for workup in terms of serologies? 36:30

· The danger of choosing the wrong treatment 38:43

· Immunosuppression in patients with pulmonary hypertension and ILD 40:52

· UIP and ANCA vasculitis 42:12

· Compared to ten years ago, how are we doing with treatments? 43:10

· Where are we with lung transplants? 50:49

· Looking at hematopoietic stem cell transplants 53:24

· The importance of early diagnosis 54:14

· Antifibrotic medicines 56:15

· Chronic and acute interstitial lung diseases 58:41

· Thank you, Dr. Parambil 1:03:54

· A conclusion from Dr. Brown 1:04:20

· Thank you for listening 1:04:55

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

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.

References:

Homolka J. CMAJ. 1987;PMID:3315158

Liebow A, et al. : "Frontiers of Pulmonary Radiology." The interstitial pneumonias, pp. 102-141. 1969. Grune & Stratton.

Liebow A, et al. Calif Med. 1969;PMID:PMC1501512

Noble PW, et al. Am J Respir Cell Mol Biol. 2005;doi:10.1165/rcmb.F301

Scadding JG, et al. Thorax. 1967;doi:10.1136/thx.22.4.291

Disclosures: Brown and Parambil report no relevant financial disclosures.

This special edition episode features the latest installment of Healio Community's book club. Physician author Kevin J. Tracey, MD, discussed his book, The Great Nerve: The New Science of the Vagus Nerve and How to Harness Its Healing Reflexes in which he explores the potential of stimulating the vagus nerve to treat rheumatoid arthritis and other diseases.

· Intro by Adam J. Brown, MD 0:14

· A warm welcome from Leonard H. Calabrese, DO 0:25

· Introducing Kevin J. Tracey, MD 0:58

· The connection between the brain and the immune system 3:25

· Where was the switch that combined neural networks and immune response? 5:55

· A brief summary of the main parts of The Great Nerve: The New Science of the Vagus Nerve and How to Harness Its Healing Reflexes 9:18

· The science of vagal nerve stimulation 11:03

· What are the pros and cons of different strategies of stimulating the vagus nerve? 16:28

· Different inflammatory responses to implant devices 17:35

· Data on vagus nerve stimulation 21:38

· Adopting new technology 25:40

· Enhancing immune health through brain health 28:35

· Wellness behaviors 32:55

· A motivated patient 36:16

· Thank you, Dr. Tracey 38:03

· Thanks for listening 39:26

Don't miss out! To engage in future conversations like this with physician authors on Healio Community, register here.

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

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 [email protected]. 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 [email protected]. 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.

The story of rheumatoid factor could be a 10 minute episode, but in this episode, we dig deep into the history of the lab techniques leading up to this discovery…that happened twice.

• Intro 0:15
• Rheumatoid factor quick background and history 00:36
• Rheumatology blood tests 3:02
• What is Rheumatoid factor? 3:49
• Spiderman and latex agglutination: Testing for rheumatoid factor 4:50
• The double discovery of rheumatoid factor 8:03
• Putting agglutination on the medical map in 1896 10:08
• Pop Quiz! 11:21
• Serotherapy 13:10
• When did we start using agglutination for testing? 14:17
• First discovery of blood groups 14:50
• The complement fixation test 17:22
• Testing for syphilis with complement fixation and agglutination 21:01
• The first discovery of rheumatoid factor 24:11
• We forget about rheumatoid factor 27:44
• Rediscovering rheumatoid factor 28:20
• Analytical ultracentrifugation 32:50
• What rheumatoid factor is used for 36:01
• Thanks for listening 38:22

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:

Assadian O et al. Wien Klin Wochenschr. 2010;doi:10.1007/s00508-009-1297-1

Edelman GM, et al. J Exp Med. 1958;doi:10.1084/jem.108.1.105

Franklin EC, et al. J Exp Med. 1957;doi:10.1084/jem.105.5.425

Fraser KJ. Semin Arthritis Rheum. 1988;doi:10.1016/0049-0172(88)90035-2

Jonsson R. Ann Rheum Dis. 2020;doi:10.1136/annrheumdis-2019-216822

Mohd Noor NH, et al. Cureus. 2024;doi:10.7759/cureus.68903

Tan EM, et al. J Exp Med. 2016;doi:10.1084/jem.20160792

Disclosures: Brown reports no relevant financial disclosures.