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

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. 

In this episode of ACR Journals on Air, Dr. Jason Knight joins us to discuss his recent Arthritis & Rheumatology review on antiphospholipid syndrome (APS), an autoimmune disease marked by complex thromboinflammatory processes. We explore the evolving understanding of APS pathogenesis, the role of antiphospholipid antibodies, Beta-2 glycoprotein I, and NETosis, as well as current and emerging treatment strategies. Dr. Knight also shares insights from his research career and reflects on the personal and professional journey behind his work. A must-listen for clinicians and researchers focused on autoimmunity and translational science. 

In this episode of ACR Journals on Air, host Dr. Vicki Shanmugam returns to the mic and dives into the CLASS Project—an ambitious international study on anti-synthetase syndrome recently published in Arthritis & Rheumatology. Joined by Drs. Sara Faghihi-Kashani, Akira Yoshida, and Giovanni Zanframundo, she explores the clinical characteristics, antibody profiles, and skin and lung manifestations of this complex autoimmune condition. The conversation covers everything from global collaboration challenges to nuanced antibody testing and rare clinical features like hikers’ feet. With insightful perspectives from each guest, this episode sheds light on the evolving understanding of anti-synthetase syndrome and the future directions of the CLASS initiative. 

With the growing shortage of rheumatology specialists in the U.S., healthcare systems face increasing delays, clinician burnout, and inefficiencies. In this episode, we explore a promising solution: the integration of physician assistants/associates (PAs) into rheumatology practice. We’re joined by Benjamin Smith, PA-C, Associate Dean and Program Director at Florida State University, and first author of "Profile and Attributes of Physician Assistants/Associates in Rheumatology" published in Arthritis Care & Research. He shares insights into the demographics, workload, satisfaction, and future potential of rheumatology PAs, highlighting their expanding role in addressing workforce gaps and enhancing patient care.