Healio Rheuminations

Do you know which U.S. president had Addison's disease? Or how rumors from WWII led to funding for research on cortisol? In this episode, take a trip down memory lane as we detail the history of steroids and the scientists whose work lead to the discovery of prednisone.

• Intro :14
• A query: What other disease is attributed to Thomas Addison? :40
• Overview of the layers of the adrenal gland 1:18
• History of the adrenal gland 2:10
• Thomas Addison enters the scene 3:39
• Kennedy and terminology 6:15
• Charles Brown-Sequard helps describe function of adrenal glands 7:13
• George Oliver and Edward Sharpey-Schafer help understand adrenal gland 8:44
• Adrenaline is discovered 10:03
• Steroid chemistry begins in earnest 10:14
• Steroids discovered, but questions remain 10:25
• WWII rumors spur research on cortin 11:15
• Edward Calvin Kendall, Tadeus Reichstein and Philip Showalter Hench receive Nobel prize for their discoveries relating to the hormones of the adrenal cortex 12:23
• Committee of 14 chemists assembled 14:24
• 1948: The case of Mrs. G 15:21
• Pharmaceutical companies race to produce cortisone 17:08
• How we arrived at prednisone 17:43
• The answer to the question: "What other disease was described by Thomas Addison?" 18:34

We'd love to hear from you! Send your comments/questions to [email protected].

References:

Benedek TG. Clin Exp Rheumatol. 2011;29:S-5-12.

Burns CM. Rheum Dis Clin North Am. 2016;doi: 10.1016/j.rdc.2015.08.001.

Lawrence L. Controversial 'father' of endocrinology: Brown-Séquard. Endocrine Today. February 2008. https://www.healio.com/endocrinology/news/print/endocrine-today/%7B0b1791e0-0e1c-42ac-bec3-d5b67bb054f6%7D/controversial-father-of-endocrinology-brown-squard. Accessed April 10, 2018.

Pearce JMS. J R Soc Med. 2004;97:297-300.

Biosimilars are a fascinating new category of medication and are quickly becoming part of the rheumatologist's treatment armamentarium, but they can be confusing to understand. This episode will enhance your knowledge of this new class of medications by providing a better understanding of how biologics differ from most other medications, and why biosimilars aren't just generics of biologics. This episode also takes a brief look into the history of drug regulation with a focus on biosimilars and how they're FDA approved.

• Intro :12
• What is a biologic? 1:21
• What makes a generic? 5:05
  • History of drug regulation in the U.S. 5:10
• What makes a biologic? 11:43
  • Monoclonal antibodies 11:51
• Where do biosimilars come from? 14:16
  • Definition 15:03
  • Manufacturing process 15:17
  • FDA approval process 16:00
• Trials of biosimilars 19:44

We'd love to hear from you! Send your comments/questions to [email protected].

Resources:

Bridges SL Jr., et al. Arthritis Rheumatol. 2018;doi:10.1002/art.40388.

Hornecker JR. Generic Drugs: History, Approval Process, and Current Challenges. U.S. Pharmacist. 2009;34(6)(Generic Drug Review suppl):26-30.

Janssen WF. The Story of the Laws Behind the Labels. https://www.fda.gov/downloads/AboutFDA/WhatWeDo/History/FOrgsHistory/EvolvingPowers/UCM593437.pdf. Published June 1981. Accessed April 14, 2018.

Liu JKH. Ann Med Surg (London). 2014;doi:10.1016/j.amsu.2014.09.001.

Morrow T, Felcone LH. Biotechnol Healthc. 2014;1:24-26,28-29.

Leonard Calabrese, DO, details the clinical manifestations of giant cell arteritis, the complex scenarios rheumatologists face when working with GCA, and the pathogenesis of this disease. Calabrese also shares clinical pearls and tips for success.

• Introduction of Leonard Calabrese, DO :12
• Goals of this episode :31
• The disease that rheumatologists love 1:02
• History of giant cell arteritis 1:51
• Gene Hunder, MD, defines large vessel involvement in late '80s, '90s 4:18
• Epidemiology of giant cell arteritis 4:32
• Manifestations in detail 5:13
  • Cranial arteritis 5:20
  • Jaw claudication 6:04
  • Ocular involvement 6:44
• Signs and symptoms 7:03
• The most important thing about ocular ischemia in GCA 9:01
• Stroke: A major complication of cranial ischemic GCA 9:25
• PMR and/or systemic inflammatory presentations 11:33
• A more recent presentation: inflammatory disease of unknown origin 12:19
• Large vessel presentations 13:12
• Diagnosis of GCA is based on clinical suspicion 14:00
• Ophthalmologists must have hypervigilance 14:22
• It's a team sport to attack this disease 14:58
• Overview of clinical manifestations 15:08
• Histopathology 16:10
• How the biopsy should be done 16:38
• What about healed arteritis? 17:18
• What about arteritis of the vasa vasorum? 17:41
• Episode recap 17:54
• The most important thing to know 18:17

Leonard Calabrese, DO, is head of Cleveland Clinic's Section of Clinical Immunology, co-director of Center for Vasculitis Care and Research, and chief medical editor of Healio Rheumatology.

We'd love to hear from you! Send your comments/questions to [email protected].

What do a fever, stiff neck and leukocytosis have in common with a large swollen knee? Listen to this medical mystery to see if you can figure out the diagnosis, then stick around to hear interesting information you may not know about the disease, including historical perspectives.

• Intro :10
• A 71-year-old man presents with unilateral knee swelling, fever and neck stiffness :37
  • Medication overview 2:12
  • Physical exam findings 2:24
  • Laboratory findings 3:03
  • Imaging results 3:33
  • Rheumatology consult 4:30
  • Now what? 5:08
  • CT scan is ordered 6:04
  • The meningitis mimicker 6:24
• History of pseudo-gout 6:54
• What do we know about chondrocalcinosis? 7:53
• History of Crowned Dens syndrome 9:37
• Cervical spine anatomy review 11:05
• Data from a single center 12:40
• Can this be dangerous? 13:40
• Are we sure this is pseudo-gout? 14:20
• The role of the CT in the diagnosis of this case 14:50
• Treatment options 15:44
• "Why not treat the patient with steroids from the start?" 16:12
• Email me with questions, or if you know any cases of hydroxyapatite-induced Crowned Dens 16:39

We'd love to hear from you! Send your comments/questions to [email protected].

References:

Ali S, et al. J Radiol Case Rep. 2011;doi:10.3941/jrcr.v5i8.802.

Bouvet JP, et al. Arthritis Rheumatism. 1985;28:1417-20.

Ciricillo SF, Weinstein PR. J Neurosurg. 1989;71:141-143.

Goto S, et al. J Bone Joint Surg Am. 2007;89:2732-2736.

Marson P, Pasero G. Reumatismo. 2012; 63: 199-206.

Salaffi F, et al. Clin Exp Rheumatol. 2008;26:1040-1046.