The Evidence Based Rheumatology Podcast

Good RCT this week, investigating the CD20 B cell inhibitor obinutuzumab for SLE. Sign up for my newsletter if you would like to have a read-along companion piece! Paper: https://www.nejm.org/doi/full/10.1056/NEJMoa2516150 Landing Page: https://ebrheum.com/ Substack: https://autoimmunedevreport.substack.com/

Quick podcast this week about a nifty head to head study that I had previously missed. Worth reading if - like me - you're still trying to figure out how the heck to manage osteoporosis. Paper: https://pubmed.ncbi.nlm.nih.gov/28755782/

Today I cover the recent publication of the RESET-RA study, which evaluated vagal nerve stimulation to treat rheumatoid arthritis. Have a listen in full, but let me be clear upfront: I do not think this works and will not be referring any patients to receive it. This will forever be my pivotal example of the effect of unblinding, but would love to hear if you think different! Paper: https://www.nature.com/articles/s41591-025-04114-7 Supplement (see S4): https://www.nature.com/articles/s41591-025-04114-7#Sec27

Surprisingly (unbelievably?) impressive RCT evaluating the Blys/APRIL inhibitor "telitacicept" for patients with SLE (mixed SLE and SLE-LN). Very curious to see where the FDA goes with this one. Paper: https://www.nejm.org/doi/full/10.1056/NEJMoa2414719

Ever wonder how often you really need to check "monitoring" labs? If so then this is the podcast for you! Bryant England mentioned this during his excellent Year in Review session at ACR Convergence 2025. I've been meaning to cover it and finally got around to doing so. Have a listen and share with friends! Paper: https://pubmed.ncbi.nlm.nih.gov/40854212/

Covering a very interesting study this week, which investiaged the PDE4B inhibitor nerandomilast for patients with progressive pulmonary fibrosis (specifically including 325 patients with autoimmune ILD). Would have been yet another ho hum trial if not for the big reveal... have a listen to find out! Article: https://www.nejm.org/doi/full/10.1056/NEJMoa2503643

Another episode looking into safety this week! Tackling that pesky issue of TNFs and CHF. Be sure to subscribe to my newsletter and check out the papers below! Newsletter: https://sprw.io/stt-ee87b4 ATTACH: https://pubmed.ncbi.nlm.nih.gov/12796126/ RENEWAL: https://www.ahajournals.org/doi/10.1161/01.cir.0000124490.27666.b2 Observational Studies: https://pubmed.ncbi.nlm.nih.gov/23155221/

Covering an interesting but ultimately disappointing post hoc study of multiple upadacitinib trials in RA. Initially some hope for clarity in the "Do JAKs cause all the badness?" questions, but ultimately landing me about where I have been since ORAL-SURVEILLANCE was published Paper: https://www.sciencedirect.com/science/article/pii/S0003496724423091

Interesting read this week - I cover a nifty little paper that presented data about adrenal insufficiency after stopping prednisolone, published in JAMA Open in March 2025. Open Access Journal Here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831668

Interesting NEJM trial this week comparing methotrexate to prednisone for pulmonary sarcoidosis. Paper available here: https://www.nejm.org/doi/full/10.1056/NEJMoa2501443

Podcast this week about the recently published SELECT-GCA study, which evaluated the use of the janus kinase inhibitor upadacitinib (Rinvoq) for patients with new and relapsing GCA. Successful trial and an interesting topic. Paper itself here: https://www.nejm.org/doi/full/10.1056/NEJMoa2413449

This week I cover another of my newsletters, though I mostly use it as a skeleton to riff on a common (and challenging) issue for rheumatology consultants; diagnosing HLH. Check out the guidelines themselves here and have a listen to the podcast! https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00273-4/fulltext

Another day, another b cell podcast. Seems to be all the rage! This week I discuss the recently published NEJM trial of the anti CD20 agent obinutuzumab in lupus nephritis. Worth a read and listen, paper can be found here: https://www.nejm.org/doi/full/10.1056/NEJMoa2410965

What do you do when observational data and RCTs conflict? This week I'm covering the "real world PEXIVAS" study that was done by the French Vasculitis Study Group. Great read, interesting issues, have a listen and be sure to share with friends!

One of my rare case-report podcasts, a topic that I typically avoid. The craze about CAR-T has also made me a little crazy, though, so I wanted to share what I think may be the ultimate destination for "more B cell depletion than rituximab" strategies. Article: https://www.nejm.org/doi/full/10.1056/NEJMc2407150

Podcast this week about overdiagnosis! Currently one of my favorite topics and something that I think will be an emerging issue in our field. We recently published a Viewpoint in Lancet Rheumatology (https://pubmed.ncbi.nlm.nih.gov/39341221/) addressing this issue. I'm going to read from it and after that will be giving a few final (spicy) thoughts on the topic. Hope you find it worthwhile! s

New RCT in a new disease with a new drug! But is it as shiny as one would hope? Interesting discussion today about what a trial means, how it will affect practice, and how we could do better as a field. Happy holidays everyone!

Reading one of my recent newsletters this week, this one about PMR tapers. Be sure to subscribe at ebrheum.com if you want access to the visuals and upcoming editions!

Quick rundown of an important rheumatology RCT this week, discussing the IL-5 inhibitor benralizumab for the treatment of relapsing/refractory EGPA. MANDARA Study: https://www.nejm.org/doi/full/10.1056/NEJMoa2311155

Important methodology podcast this week, covering a lot of ground with expert epidemiologist Rishi Desai. Really enjoyed our conversation and glad to be publishing today! **House Keeping Note: we actually recorded this ~15 months ago but I somehow lost the audio... which somehow re-appeared! #technology STAR-RA: https://pubmed.ncbi.nlm.nih.gov/35027405/

Exciting podcast this week about the upcoming / impending use of CAR-T in rheumatology. Highly recommend rheumatologists learn about this now; it's going to be a big thing for many years to come. In a future episode I will lay out my case for skepticism, but for now I think a good run down of the first big published series will be enough! NEJM CAR-T Case Series: https://www.nejm.org/doi/full/10.1056/NEJMoa2308917 Nature Review Article: https://www.nature.com/articles/s41584-024-01139-z

This week's podcast will be a quick read of one of my newsletters. The title basically speaks for itself! Find the newsletter and my other work at ebrheum.com

At ACR23 I had a twitter-disagreement about steroid tapers from PEXIVAS with Mike Walsh, the lead author on the PEXIVAS trial. He kindly agreed to join me for a moderated discussion. Loved hearing his perspective and have to admit he pulled me closer to his practice... but not all the way there. Longer podcast than usual but I prefer to release audio uncut and this took as long as it needed! Hoping y'all enjoy. Articles referenced during the podcast: PEXIVAS: https://www.nejm.org/doi/full/10.1056/nejmoa1803537 PEXIVAS DAH Subset: https://www.atsjournals.org/doi/10.1164/rccm.202308-1426OC Fussner Abstract: https://acrabstracts.org/abstract/characteristics-and-outcomes-of-participants-with-and-without-diffuse-alveolar-hemorrhage-in-the-plasma-exchange-and-glucocorticoids-in-severe-anca-associated-vasculitis-pexivas-trial/ Walsh Meta Analysis: https://pubmed.ncbi.nlm.nih.gov/35217545/

Rheum4Debate is back! In this episode I moderated a debate between two pulmonologists about RA-ILD. As a reminder, Rheum4Debate is an Oxford-style debate show, where two debators disagree over a motion during 3 rounds of discussion. The motion for todays show was: “Asymptomatic patients with rheumatoid arthritis and high risk features for interstitial lung disease should be screened using pulmonary function testing and a high resolution CT scan” Joshua defended the motion and Scott argued against it. I thoroughly enjoyed the discussion and am sure you will as well!

Nice study this week on an important topic. Can we prevent the development of rheumatoid arthritis by initiating DMARDs during a preclinical phase? Lots to discuss: what does it mean to be "pre-clinical?" How does this fit with other studies of this nature? Check it out! https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02650-8/fulltext

Informative podcast this week with Dr. Alexander Oldroyd, the first author of the recently published "International Guideline for Idiopathic Inflammatory Myopathy-Associated Cancer Screening." The article itself appeared in Nature Reviews Rheumatology and provides what I think is a very useful framework for approaching this issue. Article: https://www.nature.com/articles/s41584-023-01045-w

Quick methodology episode this week discussing the concept of "fragility" in randomized controlled trials of lupus. Really enjoyed discussing this paper and was grateful to have been a part of it. Get the text here: https://lupus.bmj.com/content/lupusscimed/11/1/e001068.full.pdf

Today I'm taking another twitter discussion into the podcast realm! Dr. Bhaskar Dasgupta has published hundreds of papers about polymyalgia rheumatica and giant cell arteritis, including a recent publication in Nature Reviews: Rheumatology that piqued my interest (https://www.nature.com/articles/s41584-023-00976-8). In this podcast we discuss screening for GCA among patients with PMR, what it means to have a diagnosis, the role of novel IL-6 inhibitors, and many other topics. Have a listen and follow me @ebrheum and Dr. Dasgupta @profbdasgupta

Interesting topic and interesting paper this year, including discussion of observational biases, positive and negative controls, and interpreting data as it comes. Paper: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2810259

Important trial on the podcast this week! I take a deep dive into the recently published SAPHYR study, which evaluated the use of the IL6 inhibitor sarilumab for patients with PMR. A few aggravating quibbles but overall a very useful trial and an important step forward for patients with PMR. Article: https://www.nejm.org/doi/full/10.1056/NEJMoa2303452

This week I took a twitter disagreement from the impersonal world of twitter to the podcast world of a back and forth conversation. Really enjoyed talking to Dr. Len Calabrese about monoclonal antibodies, FDA regulatory pathways, and life in general.

Excited to share an editorial that I wrote along with Cody Bruggemeyer and Desh Nepal, two trainees with me at the Medical College of Wisconsin. We discussed what I believe to be a pervasive (but seldom discussed) issue in rheumatology RCTs: unblinding. I suspect many of our studies suffer from this. Have a listen!

Happy to share the FIRST randomized trial in CPPD today. It's kind of a weird study but worth a quick discussion. https://www.sciencedirect.com/science/article/pii/S2665991323001650

This week I dive into the health related quality of life measures that were reported in the ADVOCATE study. I found them overall somewhat convincing and they have affected my practice. Have a listen and be sure to follow along. Find my work at ebrheum.com

Quick episode this week from a recent Perspective piece I had published in the New England Journal. Have a listen or a read! https://www.nejm.org/doi/full/10.1056/NEJMp2304828

Podcast this week discussing key opinion leaders (KOLs) and pharmaceutical companies. Please subscribe to my newsletter (ebrheum.com) and be sure to share the podcast with friends!

Nice quick RCT rundown this week, covering the ALLHEART study, a pragmatic RCT of urate lowering therapy to reduce cardiovascular disease. Quick listen for a useful teaching point! https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01657-9/fulltext

Today I cover the recently published long-COVID study from Norway. It's a great paper that challenges much of the prevailing wisdom. I think there are some interesting limitations, but anyone who sees post COVID patients (aka all of us) would do well to read it. Or have a listen here! PDF: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802893

Fun study this week from JAMA Network Open and the French Vasculitis Study Group. They used a target trial emulation (one of my favorites) to ask whether RTX > CYC in AAV (another one of my favorites). I tried to use this to compare between observational and randomized data. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799018

This week I hope to debunk one of rheumatology's "paradoxes." We love to talk about these and subject our fellows to memorizing them for the boards. We often use them to guide clinical practice, but I suspect that many "paradoxes" are actually the result of shoddy epidemiology. Todays' paper from JAMA dermatology covers one that I have heard frequently, which is that steroids cause psoriasis flares. I hope you enjoy! Follow me @ebrheum and check out my newsletter where I cover more of these (links on ebrheum.com)

Today I'll be reading one of my recent newsletters! It's kind of a fun run-down of my anti-azathioprine stance. As I say in the piece, some patients may benefit from azathioprine and I am not saying it is an entirely useless drug or that nobody should ever prescribe it. Rather, I am just saying that it is likely the worst option for nearly every indication for which it could be prescribed. Please subscribe AND JOIN my newsletter if you would like to support my writing and podcasting! https://t.co/RIzRvWnSfv

Today I review a recent large meta analysis of randomized controlled trials of statin use. Super interesting findings that have changed my clinical practice. Check out the paper here and listen to the episode! Paper: https://www.thelancet.com/article/S0140-6736(22)01545-8/fulltext "Internet driven cult" editorial: https://pubmed.ncbi.nlm.nih.gov/28738422/

Change of pace today! I interviewed Jason Liebowitz and Phil Seo about their new book entitled "Clinical Innovation in Rheumatology: Past, Present, and Future." I thoroughly enjoyed the book and had a great time interviewing them about some of their "futuristic" topics. Grab the book (or better yet, have your division get some copies) at the link below and be sure to share the podcast with friends! https://www.routledge.com/Clinical-Innovation-in-Rheumatology-Past-Present-and-Future/Liebowitz-Seo/p/book/9781032074917

Quick episode this week to share an editorial I recently wrote with Jay Patel and Anisha Dua. We cover one of my least phrases in medicine, the "diagnosis of exclusion." Hope you enjoy! Find the original paper here: https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keac278/6584804

Exciting (negative) results from a large RCT on the podcast this week as well as a (mini) rant about how we should be spending our time as rheumatologists and the false security of ineffective treatments. Let me know what you think on twitter @ebhruem https://www.nejm.org/doi/full/10.1056/NEJMoa2202106

Interesting case-crossover study today evaluating the association between HCQ dosing and risk of SLE flares. Super worth your time to read the paper or listen to this episode! https://jamanetwork.com/journals/jama/article-abstract/2796634

Podcast is back! This week I discuss a pivotal RCT in dermatomyositis. Check it out and be sure to subscribe to my newsletter at ebrheum.com!

Mixing it up again this week to discuss an editorial by Miguel Hernan and a systematic review of target trials in rheumatology. It's kind of a fun free-form stream of consciousness. Hope you enjoy! Links: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5888052/ https://pubmed.ncbi.nlm.nih.gov/32381560/