ACR Journals On Air

Recent research indicates that those who suffer from AxSpA may have some hope in protecting against events of Uveitis! Dr. Katie Bechman, first author Incidence of Uveitis in Patients With Axial Spondylarthritis Treated With Biologics or Targeted Synthetics: A Systematic Review and Network Meta-Analysis, explains her team’s research findings and how they came to this exciting conclusion!

“If I have seen further, it is because I stand on the shoulders of giants” Sir Isaac Newton famously stated in a letter to polymath scientist, Robert Hooke back in 1675. Today, Dr. Mary Crow, MD, aides Arthritis & Rheumatology launch a series on immunology, for rheumatologists. She is the co-author of the article Standing on Shoulders: Interferon Research, from Viral Interference to Lupus Pathogenesis and Treatment. In this episode, we stand with Dr. Crow to look back at the achievements made by brilliant minds in interferon research and analyze the unbroken line their advancements in rheumatology have led to today’s discoveries, with more to com

Is there an increased risk of cancer once a patient has Scleroderma? If so, what is the risk and how does one go about showing this? Dr. Ami A Shah, Director of the Division of Rheumatology at Johns Hopkins sits down with us to explain those answers. We go over the methods, results and conclusions of the recent study Distinct Scleroderma Autoantibody Profiles Stratify Patients for Cancer Risk at Scleroderma Onset and During the Disease Course published in Arthritis & Rheumatology. Afterward, Dr. Shah shares with us her journey to becoming a physician-scientist and mentoring others in Scleroderma research through a K24 grant.

Welcome back to “Journals”! Our topic of discussion today comes from the manuscript Anti-Gephyrin Antibodies: A Novel Specificity in Patients With Systemic Sclerosis and Lower Bowel Dysfunction and our guest today is the study’s first author, Dr. Zsuzsanna McMahan. The study recognizes that the enteric nervous system (ENS) regulates the gastrointestinal (GI) function, which is commonly impaired in those who suffer from systemic sclerosis (SSc). Dr. McMahan and her team’s objective for this study was “to identify novel anti-ENS autoantibodies with an aim to clinically phenotype SSc GI dysfunction”. We sit down with Dr. McMahan and discuss the study’s methods and discoveries. Plus, her experience transitioning from a junior to an independent investigator and what advice she can offer our young listeners for the journey along the way.

Dr. Tobit Steinmetz is our guest this week, author of the manuscript recently published in “Arthritis and Rheumatology” titled: "Association of Circulating Antibody-Secreting Cell Maturity with Disease Features in Primary Sjogren's Syndrome." Dr. Steinmetz and his team endeavored to better understand the hyperactivity observed among B cells, which play a major role in Primary Sjogren’s Syndrome (SS). To do this, he and the team examined the quantity, maturity and inflammatory properties of Antibody Secreting Cells (ASCs) in the B cell effector branch, which became the focus of the study. Tune in to hear how this was done, what their observations and conclusions were plus, Dr. Steinmetz’s insights for those looking to enter a postdoctoral position!

After a major event, it’s important to take stock of the causes of such an event, but just as important, on the reactions to it. No other event has challenged humanity in recent memory like COVID-19. Today we discuss the pandemic in relationship to its impact on those who suffer with rheumatic disease and examine the global response. Our guest is Dr. Evelyn Hsieh, MD, PhD, the first author of the paper: Global Perspective on the Impact of the COVID-19 Pandemic on Rheumatology and Health Equity , which was recently published in Arthritis Care & Research.

Sometimes, we learn more from what isn’t achieved than when we achieve an expected result. Such is the case for our next guest, Dr. David R. Jayne, who is the first author of Clinical and Biomarker Responses to BI 655064, an Antagonistic Anti-CD40 Antibody, in Patients With Active Lupus Nephritis: A Randomized, Double-Blind, Placebo-Controlled, Phase II Trial , a study designed to characterize a dose-response relationship between an anti-CD40 monoclonal antibody known as Bi 655064 and complete renal response (CRR) in patients with active lupus nephritis (LN). Dr. Jayne and his research team’s study may not have shown this dose-response relationship, but what was gained along the way surely shows the power of the negative study!

Knowing that glucocorticoids significantly increase the risk of fractures and is the most common cause of secondary osteoporosis, the use of the steroid has always been viewed as a doubled edged sword and “Bad for the Bones”. This week, we welcome Dr. Giovanni Adami, first author of Bone Loss in Inflammatory Rheumatic Musculoskeletal Disease Patients Treated with Low-Dose Glucocorticoids and Prevention by Anti-Osteoporosis Medications , whose goal for this study was to assess if a “safe” dose of glucocorticoids exists, with an attention focus on those with inflammatory rheumatic musculoskeletal diseases (iRMDs) to determine if a low enough dose of glucocorticoids can still reduce inflammatory burden and yet significantly reduce expected risk of fracture.

The pandemic has changed much in our world—from the way we work, to the way we shop, and even the way we learn. Rheumatology wasn’t immune from such changes and when medical institutions needed to adjust their practices to accommodate a changing world around them, the process by which fellowship interviews were conducted needed to change as well. Thus, a shift to the video communication platform Zoom was made. Now, as the pioneering cohorts of the new Zoom matching process graduate, we are joined by Bharat Kumar, MD, MME, FACP, RhMSUS. Dr. Kumar has been doing a lot of research on what went well, what didn’t, and what merits rethinking. Dr. Kumar is the first author of the manuscript Reimagining the Rheumatology Fellowship Interview: Using Participatory Design-Thinking Process to Create a More Applicant-Centered Experience.

Our next guest, Dr. Paul Monach, reviews “Complement”, focusing on its application in the clinical setting. In his work, Dr. Monach presents a typical case with a broad differential diagnosis, then provides an overview of the complement system along with clinical diseases with complement-driven mechanisms. Dr. Shanmugam reviews this manuscript published in Arthritis & Rheumatology plus an analysis of the laboratory tests. Later in the show, Dr. Monach gives us his insights on how he combines his clinical work with his translational work in immunology and acts Chief of Immunology at the VA in Boston, Massachusetts!

End-stage renal disease is a dangerous reality for those who suffer from Lupus Nephritis (LN), despite improvements in immunosuppressive therapy in the last 20 years. Our next guest, Dr. Brad H Rovin, MD, FACP, FASN, is the first author of the manuscript “Kidney-Related Outcomes and Steroid-Sparing Effects in Patients with Active Lupus Nephritis Treated with Obinutuzumab: A Post Hoc Analysis of a Phase 2 Trial.” which was recently published in Arthritis & Rheumatology. This study was a post hoc analysis of the NOBILITY trial and was conducted to assess kidney-related outcomes in patients using Obinutuzumab.

This week on ‘Journals’, we turn our attention to a rare but challenging and heart-breaking complication of rheumatic disease, Congenital Heart Block. Sir Deryck and Lady Va Maughan Professor of Rheumatology and Director of the Division of Rheumatology at New York University School of Medicine, Dr. Jill Buyon joins us today to present her latest research “Prospective Evaluation of Anti-SSA/Ro Pregnancies Supports the Utility of High Titer Antibodies and Fetal Home Monitoring for the Detection of Fetal Atrioventricular Block.”.

This week on ‘Journals’, we’ll look at not just one, but two studies that endeavored to define knee osteoarthritis (OA) through magnetic resonance imaging (MRI) imagery. The manuscripts we’ll be discussing are: Development of a Magnetic Resonance Imaging–Based Definition of Knee Osteoarthritis: Data From the Multicenter Osteoarthritis Study Diagnostic accuracy of candidate MRI knee osteoarthritis definitions versus radiograph in an acute anterior cruciate ligament injury cohort Our guest is lead author and social media influencer for rheumatology, Dr. Jean Liew, MD, MS (@Rheum_cat)

This week we welcome our next guest, Dr. John D. Pauling to ‘Journals’. Dr. Pauling is the senior author of the manuscript “Assessment of the Systemic Sclerosis-Associated Raynaud’s Phenomenon Questionnaire: Item Bank and Short Form Development”, which endeavored to “develop, refine and score a novel patient-reported outcome instrument to assess the severity and impact of Raynaud’s Phenomenon (RP) in Systemic Sclerosis (SSc)”. In this episode, we discuss the challenges associated with measuring one of the most common disease manifestations of scleroderma, Raynaud’s, and how the Assessment of Systemic Sclerosis-Associated Raynaud’s Phenomenon (ASRAP) questionnaire was harmonious in the paper’s results and final conclusions.

Assessing disease activity in large vessel vasculitis can be a challenge. And as imaging techniques evolve, clinicians must evaluate how to harness new imaging modalities in clinical care. In an attempt to predict the progression of large vessel vasculitis (LVV), our next guest, Dr. Kaitlin Quinn, used the vascular activity seen on a fluorodeoxyglucose-positron emission tomography (FDG-PET) scan to determine if there is an observable association with angiographic change. Dr. Quinn, author of the study Association of 18F-Fluorodeoxyglucose–Positron Emission Tomography Activity With Angiographic Progression of Disease in Large Vessel Vasculitis, breaks down her study and its methods along with her observations and findings for us.

This week our guest is Dr. Joyce Chang, MD, MSCE, a recipient of the Lupus Foundation of America’s “Mary Betty Stevens Young Investigator Award”, who shares her latest study, its methods, conclusions and career journey with us! Dr. Chang’s latest study “Improving Outcomes of Pediatric Lupus Care Delivery With Provider Goal-Setting Activities and Multidisciplinary Care Models“ used the pediatric Lupus Care Index (pLCI) and population management strategies for improving outcomes in childhood SLE. Later, we spent some time with Dr. Chang and asked what she sought out in her first faculty appointment and how she ensured she would hit the ground running.

Patients with Rheumatoid Arthritis (RA) need rehabilitation to improve functional limitations and slow disability. But in what doses? Using the FORWARD databank, our next guest Dr. Kaleb Michaud, PhD, identified a cohort and gathered data on rehabilitation dose and their functional outcomes. His study’s objective (titled: “Examining Rehabilitation Dose in Adults With Rheumatoid Arthritis: Association With Baseline Factors and Change in Clinical Outcomes“) determine if there was a meaningful change in physical function, pain and fatigue over a six-month period when evaluating baseline factors and rehabilitation dose. This study, recently published in Arthritis Care & Research is the subject of our discussion today.

Photosensitivity among patients with SLE is a well-known symptom. However, what is not well-known is why. Our guest this week, Dr. J. Michelle Kahlenberg MD, PhD and team, endeavored to uncover that answer. The article, “Regulation of Photosensitivity by the Hippo Pathway in Lupus Skin” was the result of this study, which was published in “Arthritis & Rheumatology” earlier this year. Dr. Kahlenberg joins us for this episode to discuss the study’s methods, results and its surprising conclusion: a novel driver was discovered!

It has only been three years since the start of the COVID-19 pandemic and we’re only just now beginning to investigate the impact it has had on our collective societies. The full impact will likely not be known for years to come, if ever. As those studies are beginning, our next guests wanted to evaluate the pandemic’s impact in their spheres of interest. First author, Dr. Kristie Kuhn, MD, PhD along with Dr. Liana Fraenkel, MD, MPH and team asked the question: “What is the impact of COVID on our early career investigators and trainees and what can be done about it?”. The results of their study are found in “Impact of the COVID-19 Pandemic on Early Career Investigators in Rheumatology: Recommendations to Address Challenges to Early Research Careers” and were recently published in “Arthritis Care & Research”

This week, we take a look at the practical management of pain and the advancement of science regarding it, with our guest Dr. Dan Clauw. Co-author of the paper: “Identifying and Managing Nociplastic Pain in Individuals With Rheumatic Diseases: A Narrative Review”, Dr. Clauw joins us today to discuss the work to introduce the three types of pain classified by “The International Association for the Study of Pain” and the mechanisms that underlie pain, as it relates to the field of rheumatology.