Healio Rheuminations

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 [email protected]. 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 [email protected]. 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 [email protected]. 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 [email protected]. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

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. Cassandra Calabrese 4:08
• Is there always a cat exposure? 5:19
• Are there other animals to look out for? Or other scenarios? 6:15
• Endocarditis and Bartonella – consider these when things aren't adding up 7:20
• What about Bartonella quintana, do you always treat it? 9:43
• It seems Bartonella can be more subtle than other infectious endocarditis, is that true? 10:49
• When suspicious, how do we test for Bartonella? 11:57
• Titer is important 13:57
• How do you treat this? 14:43
• What are long-term outcomes like? 16:38
• Thank you, Dr. Calabrese 17:35
• Warthan-Starry stain 17:54
• Thanks for listening 21:24

Cassandra Calabrese, DO, is associate staff in the department of rheumatic and immunologic disease and the department of infectious disease at Cleveland Clinic Foundation.

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

Disclosures: Brown and Calabrese report no relevant financial disclosures.

References:

Wright JR. Arch Pathol Lab Med. 2021;145:1297-1306.

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 this infection organism is? 11:51
• A quick refresher of Koch's postulates 12:58
• How did they get the volunteers to do this? 13:33
• The story of how Bartonella got its name 17:00
• What is Bartonella bacilliformis? 17:38
• Who is Richard Strong? 26:29
• How do we finally prove that Carrion's disease is what Carrion had proven? 28:25
• About Bartonella henselae 32:21
• Recapping the episode 36:39
• Thanks for listening 37:24

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

Disclosure: Brown reports no relevant financial disclosures.

References:

Anstead GM. Lancet Infect Dis. 2016;16:e164–172.

Salinas-Flores D. Revista de la Facultad de Medicina, Universidad Nacional de Colombia. 2016;64:517.

Schultz MG. Am J Trop Med Hyg. 1968;17:503-515.

Vinson JW, et al. Am J Trop Med Hyg. 1969;18:713-22.

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
• Check out Rheum + Boards on Healio at com/rheumandboards 28:31

Disclosure: 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 and be sure to check out Rheum + Boards – your destination for rheumatology education and quizzes!

References:

Aslangul E, et al. J Rheumatol. 2014;doi:10.3899/jrheum.130150.

Beydon M, et al. Rheumatology (Oxford). 2021;doi:10.1093/rheumatology/keab691.

Im JH, et al. Vector Borne Zoonotic Dis. 2018;18:291-296.

Jacobs RF, Schutze GE. Clin Infect Dis. 1998;26:80-84.

Maman E, et al. Clin Infect Dis. 2007;45:1535-1540.

Raybould JE, et al. Infect Dis Clin Pract (Baltimore). 2016;24:254-260.

Zangwill KM, et al. N Engl J Med. 1993;329:8-13.

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.

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 complexes are pathogenic 24:09
• Frank Dixon's findings using radioactive iodine tagging 28:22
• Episode wrap-up 29:00
• Thanks for listening! 32:11

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:

Germuth FG Jr, et al. Johns Hopkins Med J. 1967;120:225-251.

Kano K, Milgrom F. Vox Sanguinis. 1980;38:121-137.

McCluskey RT, et al. J Exp Med. 1960;111:181-194.

Waksman BH. Medicine (Baltimore). 1962;41:93-141.

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 happened to Dr. Pirquet? 20:44
• Pirquet's medical student, Bela Schick 25:35
• Episode wrap-up 27:27
• The next episode 27:56
• Thanks again for listening! 29:17

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:

Shulman ST. J Pediatric Infect Dis Soc. 2017;6:376-379.

Silverstein AM. Nat Immunol. 2000;1:453-455.