ACR on Air Podcast

In this episode of ACR on Air, we begin the first entry in our Vasculitis Guidelines Miniseries with Sharon Chung, MD, where we take a detailed examination of the 2021 ACR/VF guidelines for managing systemic vasculitis. In part one of the series, Dr. Chung will discuss the importance and creation of the guidelines along with the impact the authors hope to achieve. We then dive into the recommendations for ANCA-associated vasculitis, including GPA, EGPA and NPA. We'll address controversial questions for treatment and the impacts that arise for COVID-19 vaccinations.

Speaker Sharon Chung, MD - Sharon Chung, MD, is Professor of Clinical Medicine at the University of California, San Francisco (UCSF), Division of Rheumatology. She directs the UCSF Vasculitis Clinic, serves as a Medical Consultant for the Vasculitis Foundation, and is a member of the Vasculitis Clinical Research Consortium. Dr. Chung's research interests include identifying the genomic factors that influence disease susceptibility and clinical heterogeneity of the systemic vasculitides. She is the principal investigator for the 2021 ACR/VF guidelines for the management of systemic vasculitis.

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It’s been seven months since the ACR released its COVID-19 Vaccine Clinical Guidance for Patients with Rheumatic and Musculoskeletal Diseases, and we continue to learn more about navigating COVID-19 in rheumatology patients. Some real-world data has become available on patient outcomes. The FDA has issued an EUA for third doses of an available mRNA vaccine in certain immunocompromised patients. Antibody testing continues to be heavily debated. And monoclonal antibody treatment has received an EUA to be used as a prophylaxis measure in patients at high risk for developing severe COVID-19. Dr. Jeff Curtis, Chair of the ACR COVID-19 Vaccine Guidance Task Force, joins us to discuss these developments, updated task force recommendations, and more.

Speaker Jeffery Curtis, MD, MPH - Jeffery Curtis, MD, MPH, is a professor of medicine in the division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham (UAB). Dr. Curtis received a Medical Degree (MD) and a Master of Public Health (MPH) degree from Oregon Health & Sciences University in Portland, OR. He subsequently completed a residency in internal medicine at Oregon Health & Science University and a fellowship in rheumatology at UAB.

He completed a graduate program in Clinical Informatics at Stanford University and received his Master of Science (MS) degree in epidemiology at the Harvard School of Public Health. He is board certified in both rheumatology and clinical informatics.

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Welcome to ACR on Air, the official podcast of the American College of Rheumatology, where Dr. Jonathan Hausmann hosts engaging conversations with leading rheumatology professionals. In today’s episode, guest Dr. Monica Guma is welcomed on to discuss how diet can impact rheumatic diseases. You do not want to miss this conversation about topics like the microbiome, supplements, anti-inflammatory diets, intermittent fasting and more.

Dr. Monica Guma is a rheumatologist and biomedical scientist at UC San Diego. She’s interested in finding biomarkers and therapeutic targets for inflammatory arthritis. Recently, she has been studying diet and how it can affect the molecules in the blood to have anti-inflammatory properties.

To kick off the conversation, Dr. Hausman asks Dr. Guma how she became interested in studying the role of diet among those with rheumatic diseases. She explains that many patients are looking for immediate factors they can control in treating their conditions, such as diet. Listen as she breaks down how modifying one’s diet impacts other inflammatory mediators.

In what ways can the things we eat modulate disease? It is clear now that the microbiome is a key factor in modulating disease. Dr. Guma breaks down this discovery and the supporting. She explains what exactly the microbiome is and its function within the body. The research is all about trying to find the right bacteria to metabolize in a healthier way to avoid triggering inflammation and disease.

Next, Dr. Guma suggests that the microbiome actually varies from person to person. Find out the different factors that play into this, and how she is able to find the right diet for the right person, which she says is her main goal. The evidence is there to suggest that the same diet will work for everyone.

The conversation then shifts to discussing the ITIS diet, designed by Dr. Guma, which promotes inflammation regulation in rheumatic conditions. She explains what the diet entails and how it was developed in partnership with patients. She also explains that it is not possible to get results by only changing a few minute things within the diet, but rather the entire diet has to initially change. The idea was to build a diet that patients easily follow and not feel restricted. Instead of focusing on a diet that is strictly ’good” or “bad”, Dr. Guma advocates for moderation.

The two rheumatologist went on to discuss the difference in eating vitamin-rich foods and taking supplements. Dr. Guma believes supplements are a great addition to a diet, but the best thing to do is to eat healthy foods that contain more than just one specific vitamin or mineral. Equally as important as the foods themselves are the way they are actually cooked. She recommends avoiding frying food and changing habits around how to prepare food.

Dr. Hausmann and Dr. Guma then discuss the best resources for anyone interested in learning more about adopting a healthier way of eating for rheumatic conditions. Dr. Guma gives a small look into her own diet and how parts of the ITIS diet were new even to her. She believes everyone should make the effort to make small changes in their diet for health and longevity. She talks about her observations on intermittent fasting and its effectiveness. Finally, Dr, Guma addresses whether there is any harm in following a specialized diet. It is her hope that patients and listeners will feel well equipped with research and information to make educated and intuitive choices surrounding their own diets.

Speaker Monica Guma, MD, PhD - Monica Guma, MD, PhD, is a rheumatologist who treats a variety of musculoskeletal diseases and autoimmune conditions, including rheumatoid arthritis and spondyloarthritis.

Dr. Guma has been with the Department of Medicine at UC San Diego since 2013. She is also a biomedical scientist, with interest in finding new biomarkers and therapeutic targets for inflammatory arthritis. Her research focuses on the control of intracellular signaling by metabolic changes after cell activation.

Dr. Guma completed a fellowship in rheumatology at UC San Diego School of Medicine. She earned her medical degree from the University Autonomous of Barcelona, where she also completed her residency. Dr. Guma earned her PhD from Pompeu Fabra University in Barcelona and her postdoctoral research training at UC San Diego.

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• Find out more about the American College of Rheumatology
• Learn more about Dr. Jonathan Hausmann
• Connect with Dr. Jonathan Hausmann on Twitter
• Learn more about Dr. Monica Guma
• Read more about the ITIS Diet

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Welcome to ACR on Air, the official podcast of the American College of Rheumatology, where Dr. Jonathan Hausmann hosts engaging conversations with leading rheumatology professionals. Find out more on rheumatic diseases, management issues, and the policies impacting patient care. In today’s episode we invite guest Dr. Chenchen Wang to discuss complementary therapies to treat rheumatic diseases. Don’t miss this conversation as we dissect treatments such as acupuncture, Tai Chi and mindfulness, the evidence behind them in treating patients with rheumatic conditions and practical advice regarding how to get started with many of these practices. These treatments should be used in conjunction with, not instead of, more traditional treatments as recommended by your rheumatologist or healthcare professional.

Dr. Hausmann begins the discussion by asking Dr. Wang how she initially became interested in her field of work. Listen as Dr. Wang shares her story of involvement and evolution within rheumatology, beginning over 25 years ago.

Then, Dr. Hausmann asks for Dr. Wang’s clarification on terms such as alternative, complementary, and integrative medicine. Dr. Wang explains how, in recent years, terminology of alternative medicine has advanced into being integrative alongside conventional medicine. Integrative medicine refers to bringing conventional and alternative medicines together.

Now that the concept of integrative health has been established, Dr. Hausmann and Dr. Wang jump into discussing specific treatments. Dr. Wang sheds light on two positive updates regarding insurance coverage for integrative medicine in 2020. She then breaks down the process of acupuncture, as well as its science and history, citing a recently published review paper she worked on, regarding acupuncture as treatment for chronic pain. Learn as they answer many of their most commonly received questions. How can patients find an effective acupuncturist and is it safe for everyone? How effective is Tai Chi for patients with osteoarthritis, fibromyalgia and other chronic conditions?

How can integrative health affect patients' wellbeing beyond pain treatment? Dr. Wang reveals her observations of enhanced self confidence in patients who practice Tai Chi, in both body and mind. She gives very practical advice for those interested in the practice, including how to get started. Additionally, you will learn about the positive effects mindfulness and good eating habits may have on chronic pain relief. Finally, Dr. Wang states how patients can approach the techniques discussed today and incorporate them into their existing care standards.

Speaker Chenchen Wang, MD, MSc - Chenchen Wang, MD, MSc, is a professor at Tufts University School of Medicine and director of the Center for Complementary and Integrative Medicine in the Division of Rheumatology at Tufts Medical Center in Boston. She holds leadership and mentoring roles in the Tufts Clinical and Translational Science Institute research environment, collaborating actively with multidisciplinary teams globally in complementary and integrative health disciplines. Dr. Wang completed her rheumatology and clinical epidemiology training at McGill University in 1999.

Her research focuses on clinical and epidemiological studies of complementary and integrative medicine and their applications to treatments in chronic musculoskeletal pain conditions, especially osteoarthritis, rheumatoid arthritis, fibromyalgia, and systemic lupus erythematosus.

Don’t forget to like, share, and subscribe!

• Find out more about the American College of Rheumatology
• Submit a nomination for an ACR Award
• Learn more about Dr. Jonathan Hausmann
• Connect with Dr. Jonathan Hausmann on Twitter
• Learn more about Dr. Chenchen Wang

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In today’s episode, guests Dr. Aruni Jayatilleke and Dr. Christine Peoples are invited to talk about telemedicine. You do not want to miss this conversation on the good, the bad, and the ugly aspects of telemedicine, along with how to have a successful appointment, what financial coverage is available, and what the future looks like.

Dr. Hausmann jumps into the conversation asking his guests about the sudden uptick in telemedicine over the past year and the relaxed standards that have occurred. A key question discussed is if the infrastructure was present before the pandemic, what were the barriers from doing more telemedicine visits prior to COVID-19? Dr. Peoples shares that she has worked in this space for the past seven years, but the pandemic certainly thrust telemedicine into the spotlight.

They go on to discuss the details of CMS coverage and the quick shift in medical facilities and hospitals to assist patients who were in their own homes. They also talk about the challenges and benefits for some rural areas to reach those patients who are unable to get to doctor visits.

The conversation continues with a discussion of other benefits like patients thinking more about their symptoms on a day-to-day basis, the relaxed conversational feel of telehealth visits, and the education providers can share with patients. While the format, style, and feel of these visits are more conversational, it also means providers are relying heavily on the patients’ responses and must guide patient expectations while working through the issues via phone call. This has also fundamentally changed rheumatology training. The conversation goes into how have providers dealt with the inability to physically touch patients, the importance of the physical exam to diagnose, and ways they have found to enhance the information received within the current limitations.

Other questions and concerns addressed include:

• What are the drawbacks of telemedicine where it’ is falling short?
• Getting patients back into the offices to keep better “tabs” on them.
• Determining if limited phone relationships lead to less investment from patients.
• Distinguishing the best visit type for each patient.
• Will physicians continue to be reimbursed for telehealth visits beyond April 2021?
• What can rheumatologists and patients do to make the best of these telemedicine visits?

This conversation comes to a close as the host and guests discuss healthcare disparities and the future of telemedicine. Will telemedicine bridge the gap, or will it make the healthcare disparities even greater? Listen to the variables that can affect or support patient access in between office visits—smartphones, Wi-Fi access, email access, etc. They talk about getting patients access to the technology they need. Lastly, the host and guests talk about the possibilities for collaboration and a multidisciplinary approach for future visits.

Speaker Aruni Jayatilleke, MD - Dr. Aruni Jayatilleke is the program director for the rheumatology fellowship at Temple University. She has been involved in the COVID-19 Global Rheumatology Alliance’s initiatives in response to the pandemic. Her research interests include digital technology in rheumatology and in medical education. She also has clinical interests in reproductive health in rheumatology as well as in SAPHO syndrome.

Speaker Christine Peoples, MD - Dr. Christine Peoples is currently a clinical assistant professor of medicine in the Division of Rheumatology and Clinical Immunology at the University of Pittsburgh. Dr. Peoples earned a bachelor’s in biology from Allegheny College and went on to receive her medical degree from the Pennsylvania State University College of Medicine. She completed her internship and residency in internal medicine at the Beth Israel Deaconess Medical Center and her fellowship in rheumatology at the University of Pittsburgh Medical Center. She is board certified in internal medicine and rheumatology. She is a champion of telehealth and recognizes the opportunity to expand much-needed clinical care to rheumatology patients regardless of geographic location.

Resources:

• Learn more about the American College of Rheumatology
• Nominate a Rheumatology Change Maker today
• Learn more about Dr. Jonathan Hausmann
• Learn more about Arundathi Jayatilleke, MD
• Learn more about Christine Peoples, MD

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