B Prepared: Mechanisms of B Cell Tolerance in Health and Autoimmunity

In this episode, we sit down with Dr. Sandra Pinho, Assistant Professor in the Department of Pharmacology and Regenerative Medicine at the University of Chicago, to explore the fascinating intersection of stem cell biology, aging, and the bone marrow niche. From her early days studying biology in Portugal to groundbreaking research in London and New York, Dr. Pinho shares her scientific journey and the mentors who shaped her career. In a conversation that begins with Halloween monsters and ends with cutting-edge aging research, we uncover how megakaryocytes—cells best known for making platelets—play surprising roles in immune regulation and the aging process. Dr. Pinho discusses how changes in these cells can influence immune balance, contribute to age-related dysfunction, and even hint at new therapeutic strategies for healthy aging. Blending curiosity, science, and a touch of the spooky, this episode offers both personal insight and a deep dive into the hidden dynamics of our "spooky skeletons." 

In this episode, we talk with Dr. Sharon about the complex intersection of oncology and autoimmunity through the lens of immune checkpoint inhibitors (ICIs)—therapies that have transformed cancer care but can also unleash immune-related adverse events (irAEs). Dr. Elad explains how ICIs work, why they can trigger autoimmune-like toxicities, and what distinguishes rheumatologic irAEs from classic autoimmune diseases. We explore the mechanistic overlaps between cancer immunotherapy and autoimmunity, the ethical and clinical dilemmas of balancing immune suppression with cancer control, and emerging biomarkers that may predict risk. Dr. Sharon also reflects on his career journey—from leading drug development efforts at the National Cancer Institute to returning to academia—and shares insights on collaboration, innovation, and the evolving partnership between oncologists and rheumatologists in managing these challenging conditions. 

In this episode, we sit down with Dr. Kristin to discuss her session at ACR Convergence on taking a personalized approach to pulmonary hypertension in connective tissue diseases. She shares why now is the critical moment for this shift and how "personalized" care extends beyond biomarkers and imaging to encompass clinical nuances, patient-reported symptoms, and multidisciplinary collaboration. We explore the key challenges in detecting pulmonary hypertension early, the promise of emerging technologies like AI-assisted imaging and molecular diagnostics, and the subtle red flags clinicians should recognize in at-risk patients. Dr. Kristin also reflects on her unique dual training in rheumatology and pulmonology, the defining moments that shaped her career, and how mentorship continues to drive innovation and compassion in the care of patients with connective tissue lung disease. 

In this episode, Dr. Shaun Jackson uses a compelling patient case to illuminate the complex mechanisms of immune tolerance and autoimmunity. He explains how B cells learn to avoid targeting the body's own tissues through central and peripheral tolerance—and how these safeguards can fail. The discussion covers the roles of germinal centers, T cells, and rare genetic disorders in shaping immune regulation, with Alport's syndrome and post-transplant Goodpasture's disease serving as striking examples. Dr. Jackson also reflects on emerging directions in autoimmune research and shares his journey from medical training in South Africa to leading a research program in Seattle, offering valuable insights for future physician-scientists. 

In this episode, our guests Dr. Sabrina Hoa and Dr. Marie Hudson explore new insights into late-onset interstitial lung disease (ILD) in scleroderma. Using data from the Canadian Scleroderma Research Group, they discuss how ILD can still develop years after diagnosis, challenging traditional screening timelines. They cover key findings, clinical implications, treatment patterns, and the need for more inclusive trials. The conversation also touches on mentorship and what's next in scleroderma research. 

In this episode, we review the Arthritis & Rheumatology manuscript, "Diagnosis and Treatment of Castleman Disease," with Drs. Luke Chen and David Fajgenbaum. The discussion (which provides an essential, up-to-date overview of a rare but critical disease) highlights the clinical subtypes of Castleman Disease, its overlap with autoimmune and autoinflammatory syndromes, and current diagnostic and treatment strategies. Dr. Chen offers a hematologist's perspective on disease classification, pathology, and practical management tips, while Dr. Fajgenbaum shares insights from his personal experience as a patient and his work advancing research through the Castleman Disease Collaborative Network and Every Cure. 

In this episode of ACR Journals on Air, host Dr. Vicki Shanmugam speaks with Dr. Alain Sanchez-Rodriguez about a new study from the Lupus Midwest Network (LUMEN), published in Arthritis Care & Research. They explore how patients with systemic lupus erythematosus (SLE) experience delays and disparities in care, the types of physicians involved in diagnosis, and what the data reveals about access to specialized treatment. Dr. Sanchez-Rodriguez also shares his research journey and insights on improving equity in rheumatology. 

This episode explores the ARChiVe Registry, a longitudinal database for pediatric vasculitis, with guest Dr. Sam, a pediatric rheumatologist and bioinformatician. The discussion covers the registry's design, patient selection, and key outcomes, including remission rates, hospitalization, and damage scores (pVDI) across treatment strategies. Dr. Sam highlights how these findings inform clinical practice and discusses the challenges of observational data. The episode also touches on his unique background in social pediatrics and health informatics, emphasizing the evolving role of clinicians as both diagnosticians and data stewards in rheumatology research. 

This week, we explore the potential role of sodium-glucose cotransporter-2 (SGLT2) inhibitors in patients with systemic lupus erythematosus (SLE) and comorbid type 2 diabetes (T2D)—a population historically excluded from landmark SGLT2i trials. Our guest, Dr. Karen Costenbader, discusses the rationale behind the study, the nuances of trial emulation design, and key findings regarding cardiovascular and renal outcomes, infection risk, and prescribing patterns in this complex cohort. We also unpack implications for clinical decision-making and the evolving landscape of metabolic and cardiovascular care in autoimmune disease. 

Today, we explore why naming matters—especially when it comes to peripheral nervous system disorders in autoimmune diseases like Sjögren's. Dr. Shanmugam is joined by Dr. Ghaith Noaiseh and Kathy Hammitt, two key contributors to the recently published manuscript, "Recommendations for Aligned Nomenclature of Peripheral Nervous System Disorders Across Rheumatology and Neurology," in Arthritis & Rheumatology.  Together, they discuss the critical importance of unified terminology across specialties, the implications for diagnosis and treatment, and how clearer, consistent language can empower both clinicians and patients. The conversation also delves into the development of Clinical Practice Guidelines and how this nomenclature effort supports interdisciplinary care, research, and patient advocacy. Tune in for expert insight and a behind-the-scenes look at a major collaborative effort to bring clarity to complex clinical conversations.