Virtual Rheumatology Learning Collaborative (ViRL)


Virtual Rheumatology Learning Collaborative (ViRL)

The ACR Committee on Training and Workforce is pleased to present the Virtual Rheumatology Learning Collaborative (ViRL). This free 8-week lecture series started on April 6, 2020, and continued through May 29, 2020. 

Watch ViRL Playlist  

This program is designed for educational purposes only. The material presented is not intended to represent the only or the best methods appropriate for the medical situations discussed, but rather is intended to present the opinions of the authors or presenters, which may be helpful to other practitioners. Attendees participating in this education activity sponsored by the ACR do so with full knowledge that they waive any claim they may have against the ACR for reliance on any information presented during this educational activity.


ViRL Recordings

Adult Inflammatory Eye Disorder  

In this presentation, James Rosenbaum, MD, discusses adult inflammatory eye disease, eye disease in rheumatoid arthritis and systemic lupus, the relationship between acute anterior uveitis and spondyloarthritis, and the approach to a patient with orbital inflammation.

PJP Prophylaxis in CTDs  

In this presentation, Rachel Wolfe, MD, discusses the use of prophylaxis and the impact on the rheumatology population.

RA: Epi & Extra-Articular Manifestations of Disease  

In this lecture, Ted Mikuls, MD, MSPH, focuses on the epidemiology and burden posed by rheumatoid arthritis, with a focus on extra-articular disease. Topics covered include genetic and environmental risk factors for RA, the pre-clinical disease course, patterns of disease onset, and outcomes, particularly as they relate to extra-articular manifestations.

RA Pathogenesis  

It could be argued our understanding of the mechanism by which ACPA induce disease has not kept pace with its therapy. For example, what do we actually know about where or how ACPA cause rheumatoid arthritis? What do we actually know about the penetrance of the genetic risk for rheumatoid arthritis? What do we actually know about the ability to eliminate ACPA? View the ViRL lecture from William Rigby, MD.

Non-Radiographic Axial Spondyloarthritis  

In this presentation, John Reveille, MD, reviews axial spondyloarthritis relative to classification criteria, genetics, clinical features, the progression from non-radiographic axial spondyloarthritis to ankylosing spondylitis, and treatment.

RA Therapeutics  

Building on the excellent talk on RA therapeutics from Michael Weinblatt, MD, James O'Dell, MD, highlights the optimal use of MTX, combination DMARD therapy, and niches for all currently used DMARDs. In this lecture, the emphasis is placed on using all the available DMARDs optimally for individual patients.

Past ViRL Recordings

Immune-Related Adverse Events due to Immune Checkpoint Inhibitors  

Immune checkpoint inhibitors are a type of cancer immunotherapy that can cause inflammatory side effects similar to rheumatic diseases. In this lecture, Laura Cappelli, MD, focuses on the diagnosis and management of rheumatic immune-related adverse events that occur due to immune checkpoint inhibitor therapy. The management of patients with preexisting autoimmune disease and cancer who are being treated with immune checkpoint inhibitors is also discussed.
View the lecture summary

Pediatric Rheumatology Overview  

In this lecture, Sangeeta Sule, MD, PhD, focuses on “pediatric rheumatology things to know” for the adult fellow in training. With the shortage of pediatric rheumatologists around the United States, it is important for adult rheumatologists to be familiar with the most common pediatric rheumatologic diseases.

Anti-Resorptive Therapies: When, How Long, What's Next?  

Anti-resorptive therapies are highly efficacious in the management of osteoporosis, and there are many important considerations regarding the selection of oral, intravenous, or subcutaneous treatment options. Consideration should be given to the duration of therapy and should be individualized to each patient based on the patient’s co-morbidities, fall risk, bone density (T-scores by DXA scan), and fracture history. Appropriate institution of a bisphosphonate holiday should be implemented with ongoing careful consideration given to duration of this drug holiday and resumption of treatment.

Clinical Study Design  

The purpose of this presentation is to improve the attendee's ability to critically appraise clinical rheumatology studies. Bryant England, MD, PhD, will cover the principles of establishing causality and the most frequent types of clinical study designs used in rheumatology. Attendees will be asked to apply these study designs to different clinical questions throughout the presentation.
View the lecture summary

Rheumatology Year in Review: Clinical Sciences in 2019  

Daniel Solomon, MD, MPH, reviews the most important clinical science papers in rheumatology of 2019. He describes studies across the spectrum of rheumatic diseases, identifying their key findings and implications for practice.

SLE: New Treatments  

In this presentation, Vasileios Kyttaris, MD, covers late phase trials of medication in SLE. This presentation examines the underlying pathophysiology of the disease and trial design.
View the lecture summary

Myositis Therapies  

This talk reviews the evaluation and management of idiopathic inflammatory myopathies. Treatment algorithms are discussed through a case-based presentation. Promising treatments on the horizon are also highlighted, especially in dermatomyositis.

Rheumatologist's Primer on Pregnancy and Reproductive Health  

This lecture is an overview of the current knowledge of rheumatic disease activity in pregnancy and pregnancy outcomes in those with a variety of rheumatic diseases. In addition, rheumatic disease medication safety in pregnancy will be presented. Appropriate, evidence-based contraception in those with rheumatic diseases will also be addressed.
View the lecture summary

Scleroderma Emergencies  

This talk will review severe emergencies manifesting in patients with scleroderma. Recognizing early signs and symptoms of critical digital ischemia and scleroderma renal crisis is critical to minimize significant morbidity and in some cases mortality. Intestinal pseudo-obstruction can develop in advanced scleroderma gastro-intestinal disease and is associated with poor outcomes. Surgery may not be necessary, but prolonged gut rest and assertive nutrition (e.g. TPN) is often required.

COVID-19 and Rheumatology: A Critical Review of the Data  

As rheumatologists, it is important for us to try and understand the rapidly expanding body of literature surrounding COVID-19 and the use of anti-rheumatic drugs. Investigations into the role of these medications impacts both the pandemic as well as our patients. During this talk, Dr. Anisha Dua and Dr. Michael Putnam briefly address some of the theoretical rationale behind the use of rheumatic drugs in the treatment of COVID-19 patients, and delve into the available data to date, with a focus on hydroxychloroquine/chloroquine and IL-6 inhibition.
View the lecture summary

Antiphospholipid Antibody Syndrome  

This talk reviews the pathogenesis and clinical manifestations of antiphospholipid syndrome (APS). Cases are used to highlight the complexities and nuances of treatment decisions in the management of patients with APS.
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Sjögren's Syndrome  

This lecture examines the benefits and limitations of the 2016 ACR/EULAR classification criteria for Sjögren’s disease, explains the value of ultrasound assessment of salivary glands when Sjögren’s disease is suspected, and demonstrates extra-glandular feature of Sjögren’s disease.
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RA 2020  

RA 2020 reviews therapeutics in rheumatoid arthritis highlighting studies on methotrexate, biologics including withdrawal trials and toxicities, jak inhibitors including efficacy and adverse events including dvt and pulmonary emboli. The talk includes recently presented data at the 2019 annual meeting and new publications.
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Scleroderma and the Gut  

Systemic sclerosis involves the gastrointestinal tract in over 90% of patients, but the presentation of clinical symptoms in patients varies widely. In this talk we will review the clinical and serologic risk factors for severe gastrointestinal involvement in systemic sclerosis, consider the data related to pathogenesis, and treatments. Finally we will focus on a couple of patient cases and go over the approach to evaluation and management.
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Lupus and the Data Behind Plaquenil  

Dr. Michelle Petri, Johns Hopkins University School of Medicine, reviews the epidemiology and pathogenesis of lupus, treatment, and co-morbidity. Dr. Petri also reviews HCQ and COVID-19.
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Cases and Mimics in Axial Spondyloarthritis  

This talk reviews the mimics of axial spondyloarthritis in addition to some of the therapeutic complexities in patients with extra-musculoskeletal manifestations. The learner will be able to identify the axial spondyloarthritis differential diagnosis and understand the sensitivity/specificity of various features of disease.
View the lecture summary

Induction and Maintenance Therapies in ANCA Vasculitis  

This lecture reviews background on GPA and MPA vasculitis with a focus on discussing therapeutic options for inducing and maintaining remission in patients with ANCA vasculitis. Discussion of recent trials including PEXIVAS, MAINRITSAN and other major trials that helped to inform the preliminary ACR/VF Guideline for managing severe AAV are reviewed along with potential new targets which have been identified through increased understanding of the pathophysiology of AAV.
View the lecture summary


The ACR would like to thank the lecturers who have donated their time and expertise to providing these lectures and to the following institutions that supported the effort and were instrumental in making it come to fruition:

Beth Israel Deaconess Medical Center
Boston University
Brigham and Women's Hospital
Dartmouth – Hitchcock Medical Center
Children's National Medical Center
Duke University
Johns Hopkins University
Loma Linda University
Massachusetts General Hospital
Medical University of South Carolina
Northwestern University
Oregon Health and Science University
Rush Medical Center
Scripps Clinic
Stanford University
Tufts University
University of California – Irvine
University of California – San Francisco
University of Chicago
University of Nebraska
University of North Carolina
University of Texas, Houston
University of Colorado
University of Rochester
Vanderbilt University
Wake Forest Medical Center
Yale University

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