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Healio Rheuminations


Mar 27, 2020

Try your hand at this medical mystery, which is followed by some didactics on a fascinating disease which will hopefully make sense of this inscrutable title.

Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com

  • Intro :22
  • What to expect in each episode :30
  • The case: A 75-year-old man with Sjogren’s and MALT lymphoma presents with recurrent cerebral infarcts of multiple territories 1:10
    • Rheumatology is consulted 6:11
    • Decreased sensation in toes occurs between strokes 7:14
    • What’s going on with this patient? 8:36
    • What additional labs can we perform? 9:36
    • We spin the urine 11:10
    • What kind of vasculitis are Sjogren’s and lymphoma associated with? 12:22
    • C3 and C4 had already been performed 13:00
    • An overall picture of this patient 13:54
    • What about the strokes? 14:19
    • Should we do more imaging? 15:57
    • At this point we can make a clinical decision 16:33
    • Why make a decision so quickly vs. waiting for biopsy? 18:18
    • Two things you must check before moving forward with a cryoglobulinemic vasculitis 19:46
    • Spoiler alert: The patient is doing really well 20:16

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

  • What is cryoglobulinemic vasculitis? 21:00
  • What are these immunoglobulins? There are three types of cryoglobulins 22:55
  • Usually driven by another identifiable disease 25:18
  • What is making these immunoglobulins? 26:49
  • We don’t know why these immunoglobulins behave this way 27:18
  • How do you explain the kidneys? 28:28
  • What’s occurring at the tissue level? 29:35
  • How does type 1 present? 30:50
  • Type 2 and type 3 31:12
  • What other organ systems are involved? 33:11
  • I hope you enjoyed this patient presentation 36:00
  • What we’ll discuss in episodes 2 and 3 36:05
  • Thanks for listening 38:03

**Coming soon from Healio, Unmasking COVID-19, a podcast hosted by Gitanjali Pai, MD, infectious disease physician at Memorial Hospital and Physicians’ Clinic in Stilwell, Oklahoma. In this timely new show, Dr. Pai will explore COVID-19’s impact on vulnerable patient populations by answering questions from experts in various medical fields, including oncology, endocrinology and rheumatology. To submit your question for Dr. Pai, email covid19podcast@healio.com.**

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum @LCalabreseDO @CCalabreseDO

Disclosure: Brown reports no relevant financial disclosures.

References:

Fuentes A, et al. Current Rheumatology Reports. 2019;21:60.

Silva F, et al. J Autoimmun. 2019;105:102313.