Around the Rheum with Drs. Daniel Ennis & Janet Pope

A 70-year-old woman arrives at the hospital with weeks of fever, cough, and night sweats. Antibiotics help some symptoms, but the fevers persist. Extensive investigations turn up clues in her lungs and liver, yet no clear answer.In this Medical Mysteries episode of Around the Rheum, Dr. Athena Huynh brings the case to hosts Dr. Daniel Ennis and Dr. Janet Pope. They work through the possibilities as new symptoms emerge, weighing what the test results can tell them, which findings might be distractions, and where a biopsy could help.The conversation follows the case through an unusually long diagnostic journey. Athena, Dan, and Janet reflect on why the answer was so difficult to see at first — and what it means to care for a patient while the disease is still revealing itself.All in all, this is another great medical mystery that is solved by our team!  Dr. Athena Huynh is a PGY5 rheumatology resident at the University of British Columbia. She brings to the episode a case she encountered during her internal medicine training and has continued to think about since.Dr. Daniel Ennis is a rheumatologist and clinical faculty member at the University of British Columbia. Dr. Janet Pope is a rheumatologist and Professor of Medicine at Western University.Around the Rheum is produced by the Canadian Rheumatology Association Communications Committee. The podcast team includes Dr. Dax G. Rumsey, Dr. Daniel Ennis, Dr. Janet Pope, Erin Stewart and David McGuffin of ExploreProductions.ca Theme music is by Aaron Fontwell. Learn more at rheum.ca.

“Lupus is a disease of a thousand faces”—and some of its most difficult symptoms are the ones clinicians cannot see."In this episode, hosts Dr. Daniel Ennis and Dr. Janet Pope are joined by Dr. Zahi Touma to explore cognitive neuropsychiatric symptoms in patients with systemic lupus erythematosus (SLE). They examine the difference between patient-reported “brain fog” and objectively measured cognitive impairment, the cognitive domains most commonly affected, and why symptoms can be so difficult to attribute to the disease itself.Dr. Touma discusses what long-term research reveals about cognitive trajectories in patients with SLE, including why some patients remain stable, some experience persistent impairment, and others fluctuate over time. The conversation also considers the influence of depression, chronic pain, and sleep disorders; the limitations of current blood tests and brain imaging; and emerging research into functional imaging; and potential biomarkers such as calprotectin.Most pertinently, the episode asks what rheumatologists can do now. While better screening tools and targeted treatments are still being developed, the first step is listening to patients, taking their cognitive concerns seriously, and offering appropriate reassurance that impairment does not necessarily mean continued decline.Dr. Zahi Touma is an Associate Professor of Medicine and Clinician-Scientist with the University of Toronto, the Krembil Research Institute, and Schroeder Arthritis Institute. He is also the director of the Lupus Program at Toronto’s University Health Network (UHN). His research is focused on patients with systemic lupus and also measurement science, with a particular interest in the assessment of disease activity, patient-reported outcomes, and cognitive function.Dr. Daniel Ennis is a rheumatologist and clinical faculty member in the Division of Rheumatology at the University of British Columbia.Dr. Janet Pope is a professor of medicine at Western University and division head of rheumatology at St. Joseph’s Health Care London. Her research focuses on systemic sclerosis, lupus and rheumatoid arthritis.Around The Rheum is produced by the CRA Communications Committee. A special thank you to the podcast team, Dr. Dax G. Rumsey (CRA Communications Committee Chair), Dr. Daniel Ennis (Host), Dr. Janet Pope (Host), David McGuffin of ExploreProductions.ca and Erin Stewart (CRA) for leading production.Our theme music was composed by Aaron Fontwell.For more on the work of the Canadian Rheumatology Association, visit rheum.ca

Turning 18 doesn’t mean that a young person is suddenly ready to manage a lifelong illness alone. Between 25 and 75 percent of young people with rheumatic diseases experience a gap in care or are lost to follow-up after moving into the adult system — even though most will require ongoing treatment and monitoring.Join pediatric rheumatologist Dr. Michelle Batthish as she chats with our hosts Dr. Janet Pope and Dr. Daniel Ennis about why transition should be a gradual process rather than a single transfer of care.They explore how clinicians can assess readiness, help patients become more independent with appointments and medications, and support parents as their role changes. They also discuss young-adult rheumatology (YARD) clinics, the reasons patients are lost to follow-up, and the importance of addressing mental health, relationships, and the other pressures facing young adults.Dr. Michelle Batthish is a pediatric rheumatologist at McMaster Children’s Hospital and associate professor of pediatrics at McMaster University. She is a CanChild scientist and chairs the Canadian Rheumatology Association’s Transition Working Group. Her research focuses on healthcare transition and quality improvement in pediatric rheumatology.Dr. Daniel Ennis is a rheumatologist and clinical faculty member in the Division of Rheumatology at the University of British Columbia.Dr. Janet Pope is a professor of medicine at Western University and division head of rheumatology at St. Joseph’s Health Care London. Her research focuses on systemic sclerosis, lupus and rheumatoid arthritis.Around The Rheum is produced by the CRA Communications Committee. A special thank you to the podcast team, Dr. Dax G. Rumsey (CRA Communications Committee Chair), Dr. Daniel Ennis (Host), Dr. Janet Pope (Host), David McGuffin of ExploreProductions.ca and Erin Stewart (CRA) for leading production.Our theme music was composed by Aaron Fontwell.For more on the work of the Canadian Rheumatology Association, visit rheum.ca

In this episode of Around the Rheum, hosts Dr. Daniel Ennis and Dr. Janet Pope sit down with Dr. Luke Chen for a deep dive into an approach to patients presenting with hypereosinophilia. Recorded at the Canadian Rheumatology Association (CRA)’s 2026 Annual Scientific Meeting in Halifax, the conversation explores how hematologists, rheumatologists, allergists, infectious disease specialists, and others work together to diagnose and manage these complex disorders.Dr. Chen discusses the broad differential diagnosis behind eosinophilia — from Eosinophilic Granulomatosus with Polyangiitis (EGPA) and IgG4-related disease to parasitic infections to rare hematologic disorders to 'Idiopathic' Hypereosinophilic Syndrome (I-HES) — and the uncertainty clinicians often face when distinguishing overlapping eosinophilic diseases. The discussion also highlights emerging therapies including IL-5 inhibitors, JAK inhibitors, interferon, and biologics, alongside the practical realities of access to treatment in rare disease care.Thoughtful, practical, and candid, this episode offers insight into multidisciplinary medicine, diagnostic humility, and caring for patients living with rare inflammatory diseases. It touches on the importance of being okay with uncertainty in the rare disease space.Dr. Luke Chen is a hematologist and Professor of Medicine at Dalhousie University in Halifax, Nova Scotia. His clinical and research interests focus on rare inflammatory diseases and eosinophilic disorders. He is the founder of the Coastal Rare Inflammatory Diseases Program, supporting physicians caring for patients with rare diseases across Canada.Around The Rheum is produced by the CRA Communications Committee. A special thank you to the podcast team, Dr. Dax G. Rumsey (CRA Communications Committee Chair), Dr. Daniel Ennis (Host), Dr. Janet Pope (Host), David McGuffin of Explore Productions, and Erin Stewart (CRA) for leading production.Our theme music was composed by Aaron Fontwell.For more on the work of the Canadian Rheumatology Association, visit rheum.ca.

In this episode, Dr. Proton Rahman reflects on his journey from patient with spondyloarthritis to internationally recognized rheumatologist and newly appointed member of the Order of Canada. He shares how his lived experience shapes his approach to patient care, offering insight into empathy, trust, and connection in chronic disease management.Dr. Rahman also discusses the influence of key mentors — including Dr. Dafna Gladman, herself an Officer of the Order of Canada — in shaping his path into research and his work in the genetics of psoriatic arthritis and beyond! The conversation highlights the shift toward polygenic risk and the ongoing challenge of translating genetic discoveries into clinical practice.Looking ahead, Dr. Rahman explores the future of rheumatology, emphasizing precision medicine, improved diagnostics, and more effective use of existing therapies. A thoughtful discussion on humility, mentorship, and the evolving complexity of modern rheumatology.Dr. Proton Rahman is Clinical Chief of Rheumatology at Newfoundland and Labrador Health Services and John Lewis Distinguished Professor at Memorial University. A global expert in spondyloarthritis and psoriatic arthritis, his research focuses on the genetics of inflammatory arthritis and its translation into improved patient care. He is a recent appointee as a Member of the Order of Canada.Around The Rheum is produced by the CRA Communications Committee. A special thank you to the podcast team, Dr. Dax G. Rumsey (CRA Communications Committee Chair), Dr. Daniel Ennis (Host), Dr. Janet Pope (Host) David McGuffin (exploreproductions.ca),and Erin Stewart (CRA) for leading production.Our theme music was composed by Aaron Fontwell.For more on the work of the Canadian Rheumatology Association, visit rheum.ca

Hosts: Dr. Daniel Ennis, Dr. Janet PopeGuests: Dr. Marinka Twilt (Pediatric Rheumatologist, University of Calgary; ASM Program Committee Chair), Dr. Mo Osman (University of Alberta; Abstract Chair & ASM Planning Committee Co-Chair)We’re coming to you almost live from Halifax for Day 3—the final day of the Canadian Rheumatology Association ASM. The day featured strong podium presentations, a high-yield state-of-the-art lecture on Still’s disease, and a powerful closing keynote on health equity.Podium sessions highlighted emerging science across the spectrum, including sex-based differences in psoriatic arthritis linked to genetic and epigenetic factors, novel monogenic variants in pediatric lupus with neurocognitive involvement, and ongoing inequities in access to therapies for JIA across provinces.The state-of-the-art lecture on Still’s disease emphasized its spectrum across pediatric and adult care, with practical treatment strategies and increasing recognition of associated interstitial lung disease. Key points included the role of HLA-DRB1*15 as a risk marker, the importance of early treatment, and the potential for IL-1 and IL-6 therapies to contribute to complications in select patients.Workshops reinforced these themes, focusing on practical approaches to diagnosing and managing Still’s disease, including lung involvement and the role of JAK inhibitors in refractory cases.The meeting closed with a distinguished investigator lecture from Dr. Cheryl Barnabe, highlighting inequities in care for Indigenous populations and the importance of culturally safe, community-based care to address both geographic and systemic barriers.Main TakeawaysGenetic and epigenetic factors may explain sex differences in psoriatic arthritis Monogenic variants continue to reveal complexity in pediatric lupus Significant inequities persist in access to therapies for JIA across provinces Still’s disease spans pediatric and adult care with shared mechanisms HLA-DRB1*15 may help predict lung complications in Still’s disease Culturally safe, community-based care is essential to improving health equityWhat’s NextCRA ASM 2026 will be held in Vancouver.More highlights coming next year—see you in Vancouver!

Hosts: Dr. Daniel Ennis, Dr. Janet PopeGuests: Dr. Marinka Twilt (Pediatric Rheumatologist, University of Calgary; ASM Program Committee Chair), Dr. Mo Osman (University of Alberta; Abstract Chair & ASM Planning Committee Co-Chair)We’re coming to you almost live from Halifax for Day 2 of the Canadian Rheumatology Association ASM. The day featured diverse podium science, practical workshops, and a lively Great Debate on DMARD tapering.Podium sessions highlighted lupus research on cancer risk, rising costs and work disability in RA, and new biologic insights into flares, with B-cell changes supporting patient-reported disease activity in lupus.Workshops focused on practical tools, including capillaroscopy for early CTD detection, pediatric updates on neonatal lupus risk (anti-Ro vs anti-La), and a structured lab-based approach to unexplained lymphadenopathy.The Dunlop-Dottridge Lecture reviewed statin-associated myositis, emphasizing delayed onset, persistence after discontinuation of the statins, and early IVIG-based treatment.The Great Debate explored DMARD tapering, reinforcing that while guidelines are cautious, real-world care requires shared decision-making and a focus on the lowest effective dose rather than full discontinuation.Main TakeawaysRising costs and ongoing work disability remain significant in RAPatient-reported flares have a clear biological basisStatin-associated myositis can occur years after statin use and requires early IVIGDMARD tapering should be individualized, with focus on lowest effective doseWhat to Watch for on Day 3State-of-the-art lecture on Still’s disease across the lifespanMore high-impact podium presentationsClinical workshops, including one on topical therapiesGala dinner and closing eventsMore highlights coming tomorrow—stay tuned!

Hosts: Dr. Daniel Ennis, Dr. Janet PopeGuest: Dr. Marinka Twilt (Pediatric Rheumatologist, University of Calgary; ASM Program Committee Chair)We’re coming to you almost live from Halifax for Day 1 of the Canadian Rheumatology Association ASM. The day featured key updates across the field, including gaps in pediatric trials, growing recognition of autoinflammatory diseases, and the expanding role of genetics.The SELECT-GCA trial reinforced that upadacitinib is effective for both induction and maintenance of Giant Cell Arteritis (GCA), with high relapse rates after stopping—supporting longer-term treatment. In pediatric ANCA vasculitis, rituximab showed similar efficacy to cyclophosphamide with a safer profile.Sessions on “tough-to-treat RA” highlighted how often non-inflammatory factors drive symptoms, while Clinical Pearls and Medical Mysteries emphasized revisiting diagnoses and the importance of pathology and genetics.The keynote by Dr. Elizabeth Volkman rounded out the day with a focus on holistic care and patient empowerment. Main TakeawaysGCA likely requires longer-term therapy to prevent relapseRituximab is a safe, effective alternative in pediatric ANCA vasculitis“Tough-to-treat RA” often reflects non-inflammatory diseaseReassess when treatments fail—diagnosis evolvesGenetics and pathology are increasingly central to complex casesHolistic care and patient empowerment matter for outcomesWhat to Watch on Day 2New myositis insights, including statin-associated diseasePodium presentations showcasing emerging researchHands-on workshops (including TMJ)Poster tours, with a focus on trainee workThe Great Debate: “Be it resolved that medications should be tapered in patients with inflammatory arthritis in remission.”More highlights coming tomorrow—stay tuned!

Autoinflammatory diseases are often considered rare — but, in clinical practice, they may be far more common than we think. In this episode of Around the Rheum, hosts Dr. Daniel Ennis and Dr. Janet Pope speak with Dr. Jason An, a Toronto rheumatologist with expertise in autoinflammatory disorders.Together, they explore how these conditions differ from classic autoimmune disease, why adult rheumatologists should be thinking about them more often, and how to approach diagnosis when the presentation doesn’t fit neatly into familiar categories.Dr. An also shares practical strategies for recognizing autoinflammatory patterns, interpreting genetic testing, and using targeted therapies both diagnostically and therapeutically.In this episode we discuss:The evolving definition of autoinflammatory disease and how it differs from autoimmune diseaseWhy these disorders are not just pediatric diseases and may present in adulthoodA practical cytokine-based framework for classifying autoinflammatory diseasesThe four major inflammatory “buckets”:IL-1–mediated diseasesIL-18-mediated diseasesTNF / NF-κB pathway disordersInterferonopathiesClinical pattern recognition in patients with recurrent fevers and systemic inflammationThe role and limitations of genetic testing in autoinflammatory diseaseWhy variants of uncertain significance (VUS) may still be clinically meaningful in adultsUsing targeted therapies as diagnostic tools (colchicine, IL-1 blockade, JAK inhibitors)When rheumatologists should consider referral to an autoinflammatory disease specialistRecommended reading:Dr. An’s review on autoinflammatory diseases in The Journal of Rheumatology:https://www.jrheum.org/content/51/9/848Dr. Jason An, MD, MSc is an adult rheumatologist specializing in the diagnosis and treatment of autoinflammatory diseases who works in community practice in the Greater Toronto Area (GTA)Around The Rheum is produced by the CRA Communications Committee. A special thank you to the podcast team, Dr. Dax G. Rumsey (CRA Communications Committee Chair), Dr. Daniel Ennis (Host), Dr. Janet Pope (Host) David McGuffin (exploreproductions.ca), and Erin Stewart (CRA) for leading production.Our theme music was composed by Aaron Fontwell.For more on the work of the Canadian Rheumatology Association, visit rheum.ca

Dr. Kam Shojania is a Clinical Professor at the University of British Columbia, Head of Rheumatology at Vancouver General Hospital, and Medical Director of the Mary Pack Arthritis Program. He co-leads the DART Clinic at St. Paul's Hospital, a combined dermatology-rheumatology clinic focused on complex inflammatory skin and connective tissue diseases. Dr. Sheila Au is a Clinical Professor in the Department of Dermatology and Skin Science at the University of British Columbia and a medical dermatologist at St. Paul’s Hospital. She co-leads the DART Clinic and specializes in inflammatory and autoimmune skin disease, with a focus on morphology-based diagnosis and collaborative care.