Healio Rheuminations

• 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 0:04 ·        Rheumatoid factor quick background and history 00:22 ·        Rheumatology blood tests 2:47 ·        What is Rheumatoid factor? 3:39 ·        Spiderman and latex agglutination: Testing for rheumatoid factor 4:49 ·         4:54 ·        The double discovery of rheumatoid factor 7:52 ·        Putting agglutination on the medical map in 1896 10:03 ·        Pop Quiz! 11:04 ·        Serotherapy 13:00 ·        When did we start using agglutination for testing? 14:07 ·        First discovery of blood groups 14:44 ·        The complement fixation test 17:12 ·        Testing for syphilis with complement fixation and agglutination 20:53 ·        The first discovery of rheumatoid factor 24:02 ·        We forget about rheumatoid factor 27:48 ·        Rediscovering rheumatoid factor 28:20 ·        Analytical ultracentrifugation 32:55 ·        What rheumatoid factor is used for 35:50 ·        Thanks for listening 38:09   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: 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.

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• 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 [email protected]. 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.

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• 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 [email protected]. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. Disclosures: No products or companies that would require financial disclosure are mentioned in this episode.

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• 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 0:01 ·        In this episode 0:12 ·        Leonard Calabrese, DO, is listening! 0:54 ·        Recap of last episode 3:09 ·        Putting the pieces together 5:12 ·        Quick overview of this science heavy episode 6:11 ·        What is psoriasis? 7:26 ·        Immunosuppressants for psoriasis/ Throwing meds at people and seeing what happens 10:10 ·        In the modern world of 1986 – olive oil placebo trial 11:36 ·        A quick aside into fungi 12:35 ·        What kind of T-cells are involved here? 16:41 ·        The TH-1 hypothesis 18:20 ·        IL-23 and IL-17 are doing something 19:34 ·        Going back to the drawing board in 2004 20:00 ·        p40 + p19 = IL-23 21:00 ·        IL-23 via minicircle DNA in mice 23:05 ·        Brand new and shiny TH-17 25:23 ·        The family of IL-17 26:36 ·        What do we know about IL-17 and psoriasis? 27:10 ·        IL-17A vs IL-17F in mouse studies 27:35 ·        Finding the difference between IL-17A and IL-17F in humans 28:23 ·        What exactly is IL-17 doing? 29:30 ·        The articular manifestations of psoriatic arthritis 30:57 ·        Spondylarthritis and the IL 23/17 axis 33:56 ·        T-cells we haven’t talked about 35:40 ·        Summary of this episode 39:08 ·        Thanks for listening 41:34   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: 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.

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• 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 [email protected]. 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.

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