Healio Rheuminations

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 rheuminationspodcast@healio.com. 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 rheuminationspodcast@healio.com. 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 rheuminationspodcast@healio.com. 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 rheuminationspodcast@healio.com. 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 rheuminationspodcast@healio.com. 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 rheuminationspodcast@healio.com. 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 rheuminationspodcast@healio.com. 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.

This episode delves into the clinical presentation of serum sickness along with a dash of Arthus reaction, to boot! Brought to you by GSK. Intro :10 Today’s episode :26 Let’s get into some cases 4:11 The Arthus reaction 6:06 What is another example of the same thing happening but on a systemic level? 7:25 Breaking down the clinical features of serum sickness 14:20 How confident are we that the compliment levels always drop? 16:26 How common is serum sickness? 19:45 The mechanistics of rituximab 21:36 A preview of parts two and three 27:37 Episode wrap-up 28:38   Disclosures: Brown reports no relevant financial disclosures. 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: Bayer G, et al. Eur J Intern Med. 2019;67:59-64. Karmacharya P, et al. Semin Arthritis Rheum. 2015;35-334-340. Lawley TJ, et al. J Invest Dermatol. 1985;85:129s-132s.

Why is hemochromatosis so common? What is iron actually doing to the joint? Does phlebotomy help? What’s going on with iron and Popeye? These are the questions we tackle in the second episode of hemochromatosis: Iron and Bone! Brought to you by GSK. Intro :19 Today’s episode :29 Why is hemochromatosis so common? 1:06 The history of Popeye the Sailor Man 3:37 Treatment with phlebotomy 8:35 Why doesn’t join pain improve? 12:03 What is Kashin-Beck disease? 14:18 Mouse studies from the 1970s 19:45 What about histology? 25:36 Episode wrap-up 28:34 Disclosures: Brown reports no relevant financial disclosures. 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: Adams PC, et al. Hepatology. 1997;25:162-166. Adams PC, et al. N Engl J Med. 2005;352:1769-1778. Brighton CT, et al. Arthritis Rheum. 1970;13:849-857. Heiland GR, et al. Ann Rheum Dis. 2010;69:1214-1219. Hiyeda, K. Jap Med Sci. 1939;4:91-106. Powell LW, et al. Lancet. 2016;388:706-716. Rametta R, et al. Int J Mol Sci. 2020;21:3505. Sella EJ, Goodman AH. J Bone Joint Surg Am. 1973;55:1077-1081. Sutton M. Internet Journal of Criminology. 2010;1-34.

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 rheuminationspodcast@healio.com. 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.