Uric Acid: How Low Can You Go

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.  

Our guest this week is Dr. April Barnado, the first author of a study which analyzed a cohort of 3.2 million patients with Systemic Lupus Erythematosus (SLE), during pregnancy, from 1989 to 2020. Her team’s work, titled “Systemic Lupus Erythematosus Delivery Outcomes Are Unchanged Across Three Decades“ was published in “ACR Open Rheumatology”, and found some amazing trends regarding outcomes of the pregnancies and even in medication use. The study, its methods, conclusions and Dr. Barnado’s advice on breaking into academic research, is the focus of our show.  

Our guest this week is Dr. Tony Merriman, whose latest work: “Association of Gout Polygenic Risk Score With Age at Disease Onset and Tophaceous Disease in European and Polynesian Men With Gout“, attempted to determine whether a gout polygenic risk score (PRS) is associated with age at gout onset and tophaceous disease in European, East Polynesian, and West Polynesian men and women with gout. However, what this study found regarding the predictability of these associations, specifically how it affects men and women differently, may have been something no one could have predicted. 

This week we get to “The Heart of the Matter” a little differently. To begin, our guest is the first author of a manuscript whose objective was to determine the prevalence and correlation of subclinical myocardial inflammation in patients with rheumatoid arthritis (RA), titled: “Myocardial Inflammation, Measured using 18-FDG-PET-CT is associated with Disease Activity in Rheumatoid Arthritis“. Her name is Dr. Isabelle Amigues, and her story of survival and reinvention (much like the conclusions of her paper) exemplify how matters of the heart can be far more complex and impactful than they appear. 

Our guest this week, Dr. Alexandru-Emil Matei, is the first author of a study that endeavored to evaluate immune cell activation in scleroderma. His study, written for the completion of his medical training in Romania is titled: “Identification of a Distinct Monocyte-Driven Signature in Systemic Sclerosis Using Biophysical Phenotyping of Circulating Immune Cells“ (recently published in “Arthritis & Rheumatology”) performed biophysical phenotyping of circulating immune cells by employing a novel high-throughput method called ‘real-time fluorescence and deformability cytometry’ (RT-FDC). Dr. Matei’s study attempts to demonstrate that RT-FDC measures can “detect changes in the biophysical properties of individual immune cell populations in SSc patients”. If demonstrated, then RT-FDC may be used as another tool in identifying pathologic immune cell activation, being that immune cells like monocytes play a major role in systemic sclerosis (SSc).

Caring for older adults who suffer from rheumatic disease comes with it the need to manage multimorbidity, polypharmacy, and geriatric syndromes. Often, shifting priorities for those suffering with rheumatic musculoskeletal diseases (RMDs) is needed, sometimes leading to a prescribing cascade. The practice of ‘deprescribing’, an approach to optimize medication use to deliver a more ‘goal-concordant’ type of care was the focus of Dr. Una Makris and Dr. Jiha Lee’s latest research: “Optimizing Medication Use in Older Adults With Rheumatic Musculoskeletal Diseases: Deprescribing as an Approach When Less May Be More“ When caring for older adults with RMDs, it very well may be, that “Less is More”.