The Evidence Based Rheumatology Podcast

This week's podcast will be a quick read of one of my newsletters. The title basically speaks for itself! Find the newsletter and my other work at ebrheum.com 

At ACR23 I had a twitter-disagreement about steroid tapers from PEXIVAS with Mike Walsh, the lead author on the PEXIVAS trial. He kindly agreed to join me for a moderated discussion. Loved hearing his perspective and have to admit he pulled me closer to his practice... but not all the way there. Longer podcast than usual but I prefer to release audio uncut and this took as long as it needed! Hopin...

Rheum4Debate is back! In this episode I moderated a debate between two pulmonologists about RA-ILD. As a reminder, Rheum4Debate is an Oxford-style debate show, where two debators disagree over a motion during 3 rounds of discussion. The motion for todays show was:  “Asymptomatic patients with rheumatoid arthritis and high risk features for interstitial lung disease should be screened using pulmona...

Nice study this week on an important topic. Can we prevent the development of rheumatoid arthritis by initiating DMARDs during a preclinical phase? Lots to discuss: what does it mean to be "pre-clinical?" How does this fit with other studies of this nature?    Check it out! https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02650-8/fulltext

Informative podcast this week with Dr. Alexander Oldroyd, the first author of the recently published "International Guideline for Idiopathic Inflammatory Myopathy-Associated Cancer Screening." The article itself appeared in Nature Reviews Rheumatology and provides what I think is a very useful framework for approaching this issue. Article: https://www.nature.com/articles/s41584-023-01045-w

Quick methodology episode this week discussing the concept of "fragility" in randomized controlled trials of lupus. Really enjoyed discussing this paper and was grateful to have been a part of it. Get the text here: https://lupus.bmj.com/content/lupusscimed/11/1/e001068.full.pdf

Today I'm taking another twitter discussion into the podcast realm! Dr. Bhaskar Dasgupta has published hundreds of papers about polymyalgia rheumatica and giant cell arteritis, including a recent publication in Nature Reviews: Rheumatology that piqued my interest ( https://www.nature.com/articles/s41584-023-00976-8 ).    In this podcast we discuss screening for GCA among patients with PMR, what it...

Interesting topic and interesting paper this year, including discussion of observational biases, positive and negative controls, and interpreting data as it comes.    Paper: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2810259

Important trial on the podcast this week! I take a deep dive into the recently published SAPHYR study, which evaluated the use of the IL6 inhibitor sarilumab for patients with PMR. A few aggravating quibbles but overall a very useful trial and an important step forward for patients with PMR.   Article: https://www.nejm.org/doi/full/10.1056/NEJMoa2303452

This week I took a twitter disagreement from the impersonal world of twitter to the podcast world of a back and forth conversation. Really enjoyed talking to Dr. Len Calabrese about monoclonal antibodies, FDA regulatory pathways, and life in general. 

Excited to share an editorial that I wrote along with Cody Bruggemeyer and Desh Nepal, two trainees with me at the Medical College of Wisconsin. We discussed what I believe to be a pervasive (but seldom discussed) issue in rheumatology RCTs: unblinding. I suspect many of our studies suffer from this. Have a listen! 

Happy to share the FIRST randomized trial in CPPD today. It's kind of a weird study but worth a quick discussion.  https://www.sciencedirect.com/science/article/pii/S2665991323001650

This week I dive into the health related quality of life measures that were reported in the ADVOCATE study. I found them overall somewhat convincing and they have affected my practice. Have a listen and be sure to follow along. Find my work at ebrheum.com 

Quick episode this week from a recent Perspective piece I had published in the New England Journal. Have a listen or a read! https://www.nejm.org/doi/full/10.1056/NEJMp2304828

Podcast this week discussing key opinion leaders (KOLs) and pharmaceutical companies. Please subscribe to my newsletter (ebrheum.com) and be sure to share the podcast with friends! 

Nice quick RCT rundown this week, covering the ALLHEART study, a pragmatic RCT of urate lowering therapy to reduce cardiovascular disease. Quick listen for a useful teaching point!  https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01657-9/fulltext

Today I cover the recently published long-COVID study from Norway. It's a great paper that challenges much of the prevailing wisdom. I think there are some interesting limitations, but anyone who sees post COVID patients (aka all of us) would do well to read it. Or have a listen here!    PDF: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802893

Fun study this week from JAMA Network Open and the French Vasculitis Study Group. They used a target trial emulation (one of my favorites) to ask whether RTX > CYC in AAV (another one of my favorites). I tried to use this to compare between observational and randomized data.    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799018 

This week I hope to debunk one of rheumatology's "paradoxes." We love to talk about these and subject our fellows to memorizing them for the boards. We often use them to guide clinical practice, but I suspect that many "paradoxes" are actually the result of shoddy epidemiology. Todays' paper from JAMA dermatology covers one that I have heard frequently, which is that steroids cause psoriasis flare...

Today I'll be reading one of my recent newsletters! It's kind of a fun run-down of my anti-azathioprine stance. As I say in the piece, some patients may benefit from azathioprine and I am not saying it is an entirely useless drug or that nobody should ever prescribe it. Rather, I am just saying that it is likely the worst option for nearly every indication for which it could be prescribed. Please...

Today I review a recent large meta analysis of randomized controlled trials of statin use. Super interesting findings that have changed my clinical practice. Check out the paper here and listen to the episode!    Paper: https://www.thelancet.com/article/S0140-6736(22)01545-8/fulltext "Internet driven cult" editorial: https://pubmed.ncbi.nlm.nih.gov/28738422/  

Change of pace today! I interviewed Jason Liebowitz and Phil Seo about their new book entitled "Clinical Innovation in Rheumatology: Past, Present, and Future." I thoroughly enjoyed the book and had a great time interviewing them about some of their "futuristic" topics. Grab the book (or better yet, have your division get some copies) at the link below and be sure to share the podcast with friends...

Quick episode this week to share an editorial I recently wrote with Jay Patel and Anisha Dua. We cover one of my least phrases in medicine, the "diagnosis of exclusion."    Hope you enjoy! Find the original paper here: https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keac278/6584804

Exciting (negative) results from a large RCT on the podcast this week as well as a (mini) rant about how we should be spending our time as rheumatologists and the false security of ineffective treatments.  Let me know what you think on twitter @ebhruem   https://www.nejm.org/doi/full/10.1056/NEJMoa2202106

Interesting case-crossover study today evaluating the association between HCQ dosing and risk of SLE flares. Super worth your time to read the paper or listen to this episode!    https://jamanetwork.com/journals/jama/article-abstract/2796634