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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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21 episodes
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English

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S1 · E106
Tuesday · 44 min
Antibodies, patterns and the story of ANA in lupus
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 rheuminationspodcast@healio.com. 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
S1 · E107
August 3 · 32 min
The story of vagal nerve stimulation, immune mediated disease
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 rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. Leonard H. Calabrese, DO, can be reached at CALABRL@ccf.org. Follow him @LCalabreseDO.
S1 · E106
June 30 · 40 min
Green goo and glucose: Pleural effusions in rheumatoid arthritis
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 rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.
S1 · E105
May 29 · 25 min
GCA mimics: How to spot them, a case-based discussion with Dr. Leonard H. Calabrese, DO
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 rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.
S1 · E104
April 28 · 46 min
Bats, boats, baths, and vasculitis: The story of ultrasound in GCA
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 rheuminationspodcast@healio.com. 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.
S1 · E103
March 24 · 1 hr 5 min
ILD for the rheumatologist: Digging through the past and making sense of the present
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 rheuminationspodcast@healio.com. 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.
S1 · E102
February 24 · 40 min
Healio Community Book Club: A conversation between Leonard Calabrese, DO and Kevin Tracey, MD, author of The Great Nerve
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 rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.
S1 · E101
January 29 · 31 min
Celebrating 101 episodes of Healio Rheuminations with Dr. Leonard Calabrese
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 rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.
S1 · E100
Nov 25, 2025 · 42 min
The history of giant cell arteritis: Infections, injections and the man who couldn't wear a hat
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 rheuminationspodcast@healio.com. 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.
S1 · E99
Oct 13, 2025 · 38 min
The Unnecessarily Complex Story of Rheumatoid Factor
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 rheuminationspodcast@healio.com. 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.
S1 · E98
Sep 29, 2025 · 21 min
Don't forget the toes: Managing patients with ANCA vasculitis
Active or not active, that is the question. In this week's episode we interview Alexandra Villa-Forte, MD, MPH, a staff physician in the Center for Vasculitis Care and Research at Cleveland Clinic and a leading vasculitis expert, on a pragmatic approach to recognizing disease activity in patients with ANCA vasculitis. · Intro 0:01 · Welcome Alexandra Villa-Forte, MD, MPH 0:10 · Dr. Brown sketches a potential patient that may be seen in practice 0:40 · How are you monitoring patients' kidneys? 1:28 · How reliable are 'no casts' results in urinalysis tests? 4:15 · What is happening in the glomeruli? 5:23 · The importance of monitoring the urinalysis of patients with ANCA vasculitis 7:06 · Symptoms to watch for when tapering off medications 7:43 · Different scenarios with lung symptoms 9:35 · Evaluating patients with GPA; looking at the nose, ear and sinuses 12:20 · Neurologic symptoms in ANCA vasculitis 14:24 · Laboratory monitoring 15:52 · Should ANCA titers be a part of routine vasculitis monitoring? 17:05 · What is your approach using PJP prophylaxis in ANCA-associated vasculitis? 18:05 Thank you, Dr. Villa-Forte! 20:25 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. Disclosures: Brown reports no relevant financial disclosures. Healio was unable to confirm relevant financial disclosures for Villa-Forte at the time of publication.
S1 · E97
Sep 19, 2025 · 33 min
Healio Community Book Club: A conversation between Leonard Calabrese, DO and Eric Topol, MD, author of Super Agers
This special edition episode features the latest installment of Healio Community's book club. Physician author Eric Topol, MD, discusses his book, Super Agers: An Evidence-Based Approach to Longevity, a guide to the science of living a long life free of debilitating diseases with Leonard H. Calabrese, DO, chief medical editor of Healio Rheumatology. · Intro by Adam J. Brown, MD 0:01 · A warm welcome by Leonard H. Calabrese, DO 0:47 · Introducing Eric Topol, MD 1:12 · "Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again" but did you think it would happen this fast? 1:54 · Let's get into "Super Agers" 3:46 · What's killing most people? 6:33 · An evidence-based treatise on healthy aging 9:42 · The role of immune health in longevity 12:55 · What's next on the horizon? 16:14 · A candle in the dark 19:40 · Minimizing the risk of getting old while you age 22:14 · The influence of health behaviors on immunologic wellness 25:15 · The hot issues: GLP-1's 26:28 · A new world for immunology 31:50 · Thank you, Dr. Topol 33:09 · Thanks for listening 33:57 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 rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. Disclosures: No products or companies that would require financial disclosure are mentioned in this episode.
S1 · E96
Jul 28, 2025 · 41 min
The Astounding Account of the IL-17 and Spondylarthritis
In this episode, we focus on the history of researchers discovering the clinical applicability of the IL 23/17 axis, with a particular emphasis on psoriasis, psoriatic arthritis and axial SpA Intro 0:15 In this episode 0:27 Leonard Calabrese, DO, is listening! 1:07 Recap of last episode 3:23 Putting the pieces together 5:32 Quick overview of this science heavy episode 6:27 What is psoriasis? 7:42 Immunosuppressants for psoriasis/ Throwing meds at people and seeing what happens 10:20 In the modern world of 1986 – olive oil placebo trial 11:45 A quick aside into fungi 12:44 What kind of T-cells are involved here? 16:50 The TH-1 hypothesis 18:31 IL-23 and IL-17 are doing something 19:38 Going back to the drawing board in 2004 20:12 p40 + p19 = IL-23 21:08 IL-23 via minicircle DNA in mice 23:09 Brand new and shiny TH-17 25:30 The family of IL-17 26:40 What do we know about IL-17 and psoriasis? 27:17 IL-17A vs IL-17F in mouse studies 27:42 Finding the difference between IL-17A and IL-17F in humans 28:30 What exactly is IL-17 doing? 29:51 The articular manifestations of psoriatic arthritis 31:13 Spondylarthritis and the IL 23/17 axis 34:10 T-cells we haven't talked about 35:49 Summary of this episode 39:17 Thanks for listening 41:38 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: Bashyam H. J Exp Med. 2007;doi:10.1084/jem.2042fta Bjerke R J. Acta Derm Venereol. 1982;PMID:6179355 Cargill M, et al. Am J Hum Genet. 2007;doi:10.1086/511051 Chan J R, et al. J Exp Med. 2006;doi:10.1084/jem.20060244 Cuthbert R J, et al. Ann Rheum Dis. 2019;doi:10.1136/annrheumdis-2019-215210 Ellis C N, et al. JAMA. 1986;doi:10.1001/jama.1986 Ettehadi P, et al. Clin Exp Immunol. 1994;doi:10.1111/j.1365-2249.1994.tb06244.x Furue M, et al. Int J Mol Sci. 2020;doi:10.3390/ijms21041275 Gooderham M J, et al. J Eur Acad Dermatol Venereol. 2018;doi:10.1111/jdv.14868 Lee E, et al. J Exp Med. 2004;doi:10.1084/jem.20030451 Leonardi C L, et al. Lancet. 2008;doi:10.1016/S0140-6736(08)60725-4 Mease P J, et al. Lancet. 2000;doi:10.1016/S0140-6736(00)02530-7 Menon B, et al. Arthritis Rheumatol. 2014;doi:10.1002/art.38376 Moos S, et al. J Invest Dermatol. 2019;doi:10.1016/j.jid.2019.01.006 Muelle W, et al. N Engl J Med. 1979;doi:10.1056/NEJM197909063011016 Papp K A, et al. Lancet. 2008;doi:10.1016/S0140-6736(08)60726-6 Reinhardt A, et al. Arthritis Rheumatol. 2016;doi:10.1002/art.39732 Sherlock J P, et al. Nat Med. 2012;doi:10.1038/nm.2817 Tribe H T. Mycologist. 1998;doi:10.1016/S0269-915X(98)80100-6 Yawalkar N, et al. J Invest Dermatol. 1998;doi:10.1046/j.1523-1747.1998.00446.x Zaba L C, et al. J Allergy Clin Immunol. 2009;doi:10.1016/j.jaci.2009.08.046 Disclosures: Brown reports no relevant financial disclosures.
S1 · E95
Jun 30, 2025 · 42 min
The Tumultuous Tale of Th17-and the IL23/IL17 immune axis
In this episode, we dive into a two-part story of intrigue starting from a paradigm shift in understanding of T cell biology because of a mouse model of post-measles encephalopathy, to the eventual recognition of the IL-23/17 immune axis. • Intro 0:01 • In this episode 0:12 • Interleukin-17 (IL-17) is a relatively recent discovery 1:34 • The beginning of TH-17 2:20 • Looking at autoimmune encephalopathy: A story of measles 03:30 • 1790's woman with post measles inflammatory process in the brain 10:26 • What is causing post-infection encephalitis? 12:00 • Acute disseminated encephalomyelitis 12:30 • How did we find out the immune system was behind this - The rabies vaccine 13:09 • Similarity between the rabies vaccine and infections like measles 16:04 • T-cell lymphocytes 17:12 • The forgotten thymus 18:00 • What's the function of T-cells? 19:35 • How do you tell T-cells apart? 21:14 • The Human Leukocyte Differentiation Antigens Party 24:05 • The godfather of T-cells 24:45 • The TH-1 and TH-2 axis 27:30 • Experimental Autoimmune Encephalomyelitis model screwed everything up 29:16 • Interferon gamma 32:32 • What's missing? IL-23 surprise 33:40 • IL-17 in the 1990's 36:44 • The world is introduced to TH-17 39:12 • Let's recap what we learned 40:30 • That is the end! 42:30 • Thanks for listening 42:39 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: Bashyam H. J Exp Med. 2007;doi:10.1084/jem.2042fta Bennetto L, et al. J Neurol Neurosurg Psychiatry. 2004;doi:10.1136/jnnp.2003.034256 Berche P. Presse Med. 2022;doi:10.1016/j.lpm.2022.104149 El-behi M, et al. J Neuroimmune Pharmacol. 2010;doi:10.1007/s11481-009-9188-9 Gooderham MJ, et al. J Eur Acad Dermatol Venereol. 2018;doi:10.1111/jdv.14868 Hawkes JE, et al. J Immunol. 2018;doi:10.4049/jimmunol.1800013 Rogozynski N, et al. Immunol Lett. 2024;doi:10.1016/j.imlet.2024.106870 Sospedra M, et al. Annu Rev Immunol. 2005;doi:10.1146/annurev.immunol.23.021704.115707 Steinman L. Nat Med. 2007;doi:10.1038/nm1551 Disclosures: Brown reports no relevant financial disclosures.
S1 · E94
May 30, 2025 · 46 min
History of polymyalgia rheumatica: The origin of the pain & link to giant cell arteritis
In this episode, we dive into the history of polymyalgia rheumatica, how it was discovered and its link to giant cell arteritis. Intro 0:01 In this episode 0:10 What is polymyalgia rheumatica (PMR)? 0:24 The history of PMR 02:12 PMR in the 1950s: A formally recognized disease 04:52 What was probably PMR in the 1880s 06:27 Naming PMR: Senile rheumatic gout 07:26 1957: The witch's shot and finally landing on polymyalgia rheumatica 08:30 Where is PMR coming from? 14:42 Injecting joins with saline 16:39 A biopsy study in 1964 19:54 Technetium bone scintigraphy in 1971 and bone scan history 23:01 First look at a PMR ultrasound in 1993 27:00 1997: First use of MRI on PMR patients in Italy 27:49 Going back to 1962: PMRs association with giant cell arteritis 30:40 A paper on muscular involvement in giant cell arteritis: 80-year-old 'robust' partially blind seaman 32:15 First systematic approach: The link between PMR and giant cell arteritis 35:14 80 cases of PMR 38:13 Swedish autopsy studies 41:07 Introduction of advanced imaging in the 1990s 42:40 Summing up PMR through the decades 43:28 That is the end! 45:25 Thanks for listening 45:50 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: Bruk MI. Ann Rheum Dis. 1967;doi:10.1136/ard.26.2.103. Cantini F, et al. J Rheumatol. 2001;28(5):1049-55. De Miguel E, et al. Rheumatology (Oxford). 2024;doi:10.1093/rheumatology/kead189. Dixon AS, et al. Ann Rheum Dis. 1966;doi:10.1136/ard.25.3.203. Hamrin B, et al. Ann Rheum Dis. 1968;doi:10.1136/ard.27.5.397. Salvarani C, et al. Ann Intern Med. 1997;doi:10.7326/0003-4819-127-1-199707010-00005. Shah S, et al. Rheumatology (Oxford). 2025;doi:10.1093/rheumatology/keae569. Disclosures: Brown reports no relevant financial disclosures.
S1 · E93
Apr 23, 2025 · 1 hr 8 min
Pulmonary hypertension, part 4: The therapeutics, with Dr. Joseph Parambil
In the final part of this series, Joseph Parambil, MD, walks us through the approach of managing pulmonary hypertension, reviews the pathophysiology and digs into the mechanisms and the differences in the medications. Intro 0:12 In this episode 0:17 Interview with Joseph Parambil, MD 2:53 Reviewing and clarifying pathophysiology prior to initiating therapeutics 4:13 Evaluating patients in terms of their functional status and how does that play a role in initiating therapies 4:25 Vasoreactivity testing 10:21 The categories of medications 14:40 Endothelin receptor antagonists 37:07 TGF pathway 42:13 Scleroderma patient and treatment 50:19 Do patients get a repeat right-heart catheterization? 55:51 What about the TGF-beta? 56:55 Thank you, Dr. Parambil 58:34 Thanks for listening 59:17 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. Disclosures: Brown and Parambil report no relevant financial disclosures. 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.
S1 · E92
Mar 25, 2025 · 47 min
Pulmonary hypertension, part 3: Early therapies and vascular physiology
In this episode, we dive into the early therapies and how our understanding of vascular physiology drastically changed the management of pulmonary hypertension. Intro 0:12 In this episode 0:18 Recap of part 1 & 2 0:31 What part 3 is about 2:31 WHO conference in 1975: Treating pulmonary hypertension 3:48 The Discovery of Non-Steroidal Anti-inflammatory Drugs (NSAIDs), Part 1 5:20 Epoprostenol 6:18 Prostacyclin 10:37 Endothelin antagonists 11:41 Phosphodiesterase type 5 (PDE5) inhibitors 14:08 Interaction of nerves and blood vessels 15:06 The Soups VS the Sparks 17:36 A dreamed experiment 19:06 Acetylcholine 23:23 Enter "the calabar bean" 24:45 Acetylcholine and vasodilation: 1976 26:01 Rabbit aorta 27:45 Nitric oxide 29:38 Why are we using nitric oxide to treat pulmonary hypertension? 31:31 Tachyphylaxis 33:48 TNT factories 35:09 Nitrous oxide and tachyphylaxis 36:52 Pfizer in the 1980s 38:06 Understanding the trigger of pulmonary hypertension 40:53 PDE5 and nitric oxide and pulmonary hypertension 43:07 The end of the ripping yarns 44:20 Coming up in part 4 46:17 Thanks for listening 47:29 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: Bernard C. C R Soc Biol. 1851;3:163-164. Furchgott RF, et al. Nature. 1980;doi:10.1038/288373a0. Galiè N, et al. N Engl J Med. 2005;doi:10.1056/NEJMoa050010. Ghofrani HA, et al. Nat Rev Drug Discov. 2006;doi:10.1038/nrd2030. Giordano D, et al. Biochim Biophys Acta. 2001;doi:10.1016/s0167-4889(01)00086-6. Guthrie F. Q J Chem Soc. 1859;doi:10.1039/QJ8591100245. Higenbottam T, et al. Lancet. 1984;doi:10.1016/s0140-6736(84)91452-1. Marsh N, et al. Clin Exp Pharmacol Physiol. 2000;doi:10.1046/j.1440-1681.2000.03240.x. Montastruc JL, et al. Clin Auton Res. 1996;doi:10.1007/BF02281906. Nejad SH, et al. Future Cardiol. 2024;doi:10.1080/14796678.2024.2367390. Tansey EM. C R Biol. 2006;doi:10.10116/j.crvi.2006.03.012. Warren JV. Trans Am Clin Climatol Assoc. 1988;99:10-6. Disclosures: Brown reports no relevant financial disclosures.
S1 · E91
Feb 26, 2025 · 48 min
Pulmonary hypertension and the rheumatologist, part 2: The history
In part 2, we dig into the history of pulmonary hypertension. How did this strange diagnosis first get recognized, what does it have to do with cows with thick necks and urinary catheters in the heart? Intro 0:11 In this episode 0:17 Recap of part 1 0:26 How was pulmonary hypertension discovered? 2:38 1891 3:51 1901 5:07 1935 7:02 Hilar dance 12:58 Cardiac catheterization: 1929 15:03 When did cardiac catheterization become relevant? 20:10 1965: Aminorex 24:40 World Health Organization: 1975 26:37 1980s: toxic oil syndrome of Spain 28:20 Preview of part 3 33:15 Back to cardiac catheterization 34:08 Briskets disease 35:45 1947 37:56 Pulmonary physiology and prostaglandin therapies (in the next episode) 38:41 Schistosomiasis outbreaks in Egypt 1938 40:26 Chronic thromboembolism 45:03 Thanks for listening 48:16 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: Barst RJ. Ann Thorac Med. 2008;doi:10.4103/1817-1737.37832. Bodo R. J Physiol. 1928;doi:10.1113/jphysiol.1928.sp002447. Dresdale DT, et al. Am J Med. 1951;doi:10.1016/0002-9343(51)90020-4. Egypt. Stanford.edu. Published 2015. https://schisto.stanford.edu/pdf/Egypt.pdf. Hewes JL, et al. Pulm Circ. 2020;doi:10.1177/2045894019892801. Johnson S, et al. Am J Respir Crit Care Med. 2023;doi:10.1164/rccm.202302-0327SO. Newman JH. Am J Respir Crit Care Med. 2005;doi:10.1164/rccm.200505-684OE. Weir EK, et al. Circulation. 1996;doi:10.1161/01.cir.94.9.2216. Disclosures: Brown reports no relevant financial disclosures.
S1 · E90
Feb 12, 2025 · 52 min
Pulmonary hypertension and the rheumatologist, part 1: A bit of background
In this series, we dive into what rheumatologists should know about pulmonary hypertension, starting an interview with Joseph Parambil, MD, where we learn about the disease, when to suspect and how to work up! Intro 0:11 In this episode 0:16 Preview of the four-part series 4:46 Interview with Joseph Parambil, MD 6:27 How did you become interested in pulmonary hypertension? 7:02 Brown and Parambil discuss the histology of pulmonary hypertension. 10:13 Brown and Parambil discuss a case of pulmonary hypertension. 12:26 What is pulmonary hypertension and what does that mean for a rheumatologist? Where is pulmonary hypertension happening? 13:25 Describe the different groups of pulmonary hypertension. 19:51 A note about Dr. Chatterjee 20:25 Brown and Parambil discuss the groups of pulmonary hypertension. 23:35 What should we know about evaluating patients with pulmonary hypertensions? 26:51 Brown and Parambil discuss bendopnea and other signs of pulmonary hypertension. 29:58 What about the heart sound? 33:06 What should we look for in patients who we suspect to have pulmonary hypertension? 36:52 What should we look for in the tricuspid jet? 38:18 Brown and Parambil discuss the use of echocardiograms in pulmonary hypertension. 39:28 Tell us about the threshold of diagnosis. 40:47 What is the difference between the mean pressure and the wedge pressure? 41:41 What about the role of the pulmonary function test? 43:55 Summary 46:41 Do you think the pulmonary hypertension in scleroderma and lupus are different entities? 48:37 Brown and Parambil discuss the connection of autoimmune disease and pulmonary hypertension. 50:49 Coming up in episode 91 51:50 Thanks for listening 52:25 Disclosures: Brown and Parambil report no relevant financial disclosures. 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. 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.
S1 · E89
Jan 22, 2025 · 33 min
COVID's role in autoimmunity and where we are in the world of long COVID
On this episode, hear the 2024 updates on COVID-19, long COVID and the latest developments in research in rheumatology. Hosted by Dr. Leonard Calabrese. Intro 0:12 In this episode 0:21 Coming up on Healio Rheuminations 0:56 COVID-19, long COVID and the rheumatologist with Leonard Calabrese, DO 2:19 Questions 3:12 Long COVID 4:46 Calabrese's bias 10:15 The evidence 13:08 Auto antibodies 14:54 Why does the body develop auto antibodies? 17:47 COVID-19 and epidemiologic association 22:25 New clinical entity 26:40 Therapeutic implications 31:00 In conclusion 32:00 Thanks for listening 33:18 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.

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