ACR on Air

In this episode, we explore the unique challenges and considerations in treating older adults, focusing on the need for a different approach to care due to polypharmacy and multimorbidity. We delve into the complexities of managing these patients, emphasizing the importance of understanding frailty—how to assess, prevent, and address it. The discussion also covers late-onset rheumatoid arthritis, its distinction from rheumatoid arthritis, and why it often goes underdiagnosed and undertreated. We introduce the 5 M’s framework; a geriatric care model that helps clinicians focus on what truly matters to older adults. Additionally, we address the role of palliative care in rheumatology, highlighting its importance beyond end-of-life care, and provide guidance on shared decision-making with older adults and their families to ensure patient-centered outcomes.   

Dr. Jason Liebowitz, an assistant professor of medicine and accomplished writer at Columbia University, shares his fascinating journey as a physician-writer. He discusses how writing helps him process experiences and connect with patients, emphasizing its healing power in medicine. The conversation touches on balancing AI tools with authentic writing voice, the evolving role of physicians in public communication, and practical advice for aspiring writer-healthcare professionals. Liebowitz inspires listeners to embrace storytelling as a vital part of their medical practice.

Happy New Year, Dear Listener! We’re back for 2025 and have with us Dr. Carol Langford, President of The American College of Rheumatology (ACR) and Dr. Adam Goode, President of The Association of Rheumatology Professionals (ARP) as our guests. In this episode you’ll get an in-depth look at the collaborative efforts driving the ACR and ARP, direct from our leadership!   Dr. Langford and Dr. Goode share with us their journeys into leadership, key initiatives for this year and their vision for advancing the field of rheumatology. We’ll also discuss workforce shortages, technological advancements affecting our field and fostering a more inclusive community. 

Dr. Pui Y. Lee, a pediatric rheumatologist at Boston Children's Hospital and assistant professor at Harvard Medical School, shares his expertise on Deficiency of Adenosine Deaminase 2 (DADA2). He discusses the rarity of this hereditary auto-inflammatory disease and its diverse symptoms. The conversation dives into the significance of genetic testing and the challenges in diagnosis and treatment, including the ethical concerns surrounding pre-symptomatic care. Lee highlights innovative treatments like gene therapy and the importance of collaborative care for better patient outcomes.

As 2024 ends, the ACR’s Government Affairs Committee looks ahead to the 119th Congress to address key issues in rheumatology. For our second annual legislative and policy update, we’re joined by Dr. Lennie McDaniel, head of ACR’s Washington DC office, and Dr. Christina Downey, Chair of the Government Affairs Committee, to share insights from their ACR Convergence 2024 session. Topics include Medicare cuts, physician payments, pharmacy benefit managers (PBMs), telemedicine reimbursement changes, and how you can advocate for better outcomes with the ACR. 

Dr. Lisa R. Sammaritano, a leading expert in lupus at Weill Cornell Medicine, discusses the groundbreaking updates to the ACR Lupus Nephritis Guideline, a decade in the making. She shares insights on innovative treatment strategies, including combination therapies and the push to minimize glucocorticoid use for better patient outcomes. The conversation highlights the unique needs of both pediatric and adult patients, the promise of a triple therapy approach, and challenges in managing class 5 lupus nephritis, emphasizing the importance of individualized care.

Dr. Jose Kennedy Amaral Pereira, a rheumatologist from Brazil specializing in chronic chikungunya arthritis, joins Dr. Daniela DiMarco, an infectious disease physician focusing on STIs. They delve into the alarming rise of chikungunya in Brazil, comparing it to dengue and discussing its severe joint pain symptoms. The duo emphasizes the difficulty of distinguishing chronic chikungunya from rheumatoid arthritis. They also tackle the complexities of diagnosing syphilis, especially its mimicking of rheumatic diseases, underscoring the importance of precise testing in rheumatology.

Dr. Amanda Nelson, a rheumatologist and epidemiologist specializing in osteoarthritis and machine learning, joins Dr. Bella Mehta, an academic rheumatologist focused on health disparities and big data, to discuss the transformative role of AI in healthcare. They explore AI's potential in enhancing diagnostic accuracy, patient personalization through digital twins, and the analysis of medical images using deep learning. The conversation navigates the promise of AI in rheumatology while addressing ethical considerations and the need for careful oversight to ensure equitable and effective use.

Dr. Tanaz Kermani, founder of the Vasculitis Program at UCLA, dives into the complexities of ANCA-associated vasculitis. She discusses when to choose rituximab over cyclophosphamide and the potential of avacopan as an adjunct therapy. The conversation covers critical decision-making in steroid tapering and the viability of plasma exchange. Kermani also highlights the significance of accurate diagnosis through biopsies, emphasizing the role of pathologists in managing this rare autoimmune disorder.

Dr. Sara McCoy, a dedicated rheumatologist and Sjögren's specialist, delves into the complexities of Sjögren’s Disease, which intricately impacts multiple organs beyond dry eyes and mouth. She discusses how patients' antibody profiles can reveal disease severity, and the potential of advanced diagnostics like salivary gland ultrasounds. Excitingly, she highlights pioneering uses of mesenchymal stromal cells that may transform treatment options. The importance of structured diagnosis and support networks for patients is also emphasized, shedding light on the future of Sjögren's research.