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Dr. Denis Poddubnyy

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RheumaCastRheumaCastWhy Treatment Fails in Axial Spondyloarthritis — And What We Can Do About ItIn this episode of RheumaCast, we discuss one of the most frustrating aspects of axial spondyloarthritis (axSpA): treatment failure. Despite the availability of multiple biologic and targeted therapies, over half of patients do not achieve remission.What causes this non-response? We explore two major culprits—misdiagnosis and the presence of nociplastic pain—and examine how imaging pitfalls, overlapping mechanical conditions like osteitis condensans ilii, and inadequate communication between clinicians and radiologists can lead to suboptimal management. Learn how standardized MRI protocols, expert interpretation, and emerging tools like AI and molecular imaging can improve diagnostic precision and patient outc...2025-04-2508 minRheumaCastRheumaCastSacroiliac Joint Variants: When Normal Anatomy Mimics DiseaseIn this episode of RheumaCast, we explore how anatomical variations of the sacroiliac joints (SIJ) can complicate the diagnosis and management of axial spondyloarthritis (axSpA). We walk you through common SIJ variants—such as crescent-shaped ilium, accessory joints, and transitional vertebrae—and explain how these can mimic sacroiliitis on MRI.We discuss how to differentiate true inflammation from mechanical stress reactions, when to use CT for clarification, and the implications of these findings for diagnosis, treatment, and research. If you’ve ever wondered how much “background noise” anatomy adds to SIJ imaging, this episode is for you.This...2025-04-1310 minRheumaCastRheumaCastStatistical Pitfalls in Rheumatology Research: 15 Tips from an ExpertIn this episode of RheumaCast, we delve into common statistical missteps in rheumatology research—and how to avoid them. Professor Stian Lydersen shares insights from reviewing over 700 manuscripts for Annals of the Rheumatic Diseases and RMD Open. From handling missing data to the proper use of t-tests, this concise guide covers 15 essential statistical principles that every rheumatology researcher should know. Whether you're preparing your next manuscript or reviewing one, this episode is packed with practical guidance to improve the quality and clarity of your work.This episode is based on the publication: Lydersen S, et al. Ann Rh...2025-03-2220 minRheumaCastRheumaCastUnderstanding Nociplastic Pain: What It Is and How to Treat ItIn this episode, we explore a compelling review that tracesthe evolution of our understanding of nociplastic pain—from fibrositis to fibromyalgia and beyond.🧠 Key Takeaways from the Discussion:✅ The shift from peripheral to central painmechanisms in fibromyalgia✅ How nociplastic painintersects with inflammatory rheumatic diseases✅ Why traditional analgesics(NSAIDs, opioids) are ineffective—and what really works✅ The role of functional brainimaging and quantitative sensory testing indiagnosing central sensitizationThis episode is particularly relevant for clinicians, researchers, and anyone treating chronic pain syndromes in rheumatology. Tune in to hear how rheumatologists helped shape the under...2025-03-1612 minRheumaCastRheumaCastHow to Detect Enthesitis? A Multicenter Study Comparing Ultrasound and Physical Examination in SpondyloarthritisIn this episode we discuss a recent multicenter study involving over 400 patients with spondyloarthritis, which explored the detection of enthesitis.Researchers compared ultrasound findings with physical examinations to assess agreement between the two methods across various lower limb entheses and different types of ultrasound lesions.The study also examined the prevalence and clinical significance of subclinical enthesitis, where ultrasound detects inflammation that is not apparent during a physical exam. Findings revealed notable discrepancies between the two assessment approaches, underscoring the need for a more integrated strategy that combines both techniques for a more precise evaluation of enthesitis...2025-03-0914 minRheumaCastRheumaCastEULAR Recommendations: Targeted Therapy in Inflammatory Arthritis and Cancer HistoryA new episode focusses on the recently published 2024 EULAR points to consider on the initiation of targeted therapies in patients with inflammatory arthritis and a history of cancer.This importnat guideline provides practical advice for rheumatologists navigating the complexities of managing patients with both inflammatory arthritis like rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis,and a past cancer diagnosis.In this episode, we'll delve into key aspects of these recommendations, including:• The importance of assessing the individualized risk of cancer recurrence,• The necessity of co-management with oncology specialists and shared decision-making with pati...2025-03-0418 minRheumaCastRheumaCastWhat is the impact of sex on treatment response in axial spondyloarthritis?This study explores the impact of axial spondyloarthritis (axSpA) subtype and sex on the discontinuation of first-line biologic DMARDs (bDMARDs). The key findings indicate that patients with non-radiographic axSpA (nr-axSpA) and female patients are more likely to discontinue bDMARD therapy and exhibit lower treatment survival rates compared to their counterparts. Listen to get more details in this deep dive.Based onRemalante-Rayco P, et al. Ann Rheum Dis 2025and develop with NotebookLM.2025-02-2307 minRheumaCastRheumaCastASAS Definition of Difficult-to-Manage Axial SpondyloarthritisThis episode deals with the development of a consensus-based expert definition for difficult-to-manage (D2M) axial spondyloarthritis (axSpA), including treatment-refractory (TR) disease. The Assessment of SpondyloArthritisInternational Society (ASAS) spearheaded this effort through a literature review and a two-round Delphi process. The resulting D2M definition encompasses treatment failure, suboptimal disease control, and acknowledgement ofproblematic signs/symptoms by physicians or patients. TRaxSpA falls under this D2M umbrella but requires evidence of treatment failure and objective signs of inflammatory activity. Endorsed by ASAS, the definition aims tostandardize the identification of patients with unmet needs and facilitate further research and improved...2025-02-1612 minRheumaCastRheumaCastColchicine or no colchicine in gout patients starting with urate-lowering therapy?This research investigates the impact of colchicine, a medication used to prevent gout flares, on cardiovascular events in patients initiating urate-lowering therapy. Using a large UK primary care database, the study compared patients prescribed colchicine prophylaxis with those who received no prophylaxis. The findings suggest that colchicine prophylaxis is associated with a reduced risk of myocardial infarction or stroke in gout patients starting urate-lowering therapy. Based on Cipolletta E, et al. Lancet Rheumatol 2025 and developed with NotebookLM.2025-02-0910 minRheumaCastRheumaCastCan you get good medical advice from ChatGPT and similar AI chatbots? An example with back pain.This study assesses the accuracy and readability of four AI chatbots (ChatGPT 3.5, Bing, Bard, and ChatGPT 4.0) in answering common patient questions about low back pain (LBP). Researchers evaluated responses against established LBP guidelines, finding moderate accuracy overall, but with significant variations across topics (self-management, treatment, and risk factors). This podcast is based on the publication by Simone P.S. Scaff et al. Ann Rheum Dis 2025;84(1):143-149 and is developed with NotebookLM. 2025-02-0210 minRheumaCastRheumaCastExtra-Musculoskeletal Manifestations in JAKi-Treated PsA and axSpA PatientsThis episode deals with the development of extra-musculoskeletal manifestations (EMMs) in patients with psoriatic arthritis or axial spondyloarthritis treated with a Janus-kinase-1-Inhibitor upadacitinib. The study analyzed data from five clinical trials, comparing upadacitinib to placebo and adalimumab. Results indicate low rates of EMM development overall, with numerically lower uveitis rates observed in upadacitinib-treated patients compared to those receiving placebo, particularly in radiographic axial spondyloarthritis. This episode is based on the publication Poddubnyy D, et al. Arthritis Rheumatol 2024, doi: 10.1002/art.43069. and developed with Notebook LM. 2025-01-2613 minRheumaCastRheumaCastMRI Inflammation Resolution and Axial Spondyloarthritis OutcomesThis study investigates the link between MRI-detected inflammation and clinical outcomes in axial spondyloarthritis (axSpA) patients treated with a TNF inhibitor etanercept. Using data from the ESTHER trial, the study found a strong association between the resolution of inflammation on MRI and improved clinical outcomes, as measured by the ASDAS score. Specifically, reducing inflammation on sacroiliac joint MRI scans significantly predicted better clinical outcomes six months later. This podcast is based on the publication Torgutalp M, et al. RMD Open. 2025 Jan 6;11(1):e004921. and is developed with NotebookLM.2025-01-1910 minRheumaCastRheumaCastHow to differentiate between various causes of osteoproliferation in the hands?This research article investigates the relationship between osteo-proliferative lesions on finger phalanges, sex, age, and osteoarthritis. Using X-rays of 1153 patients, researchers examined the frequency and location of these lesions, finding that men showed more lesions than women, with age and osteoarthritis positively correlated with lesion extent. A modified Osseographic Scoring System was used to evaluate the findings, showing excellent inter-reader agreement. The study's anatomical dissection of a finger helped clarify the origin of these lesions, emphasizing the importance of differentiating normal aging changes from pathological conditions like psoriatic arthritis. Based on Hermann S et al. Diagnostics 2022; 12: 618. 2025-01-1209 minRheumaCastRheumaCastHow to differentiate between osteitis condensans and spondyloarthritis?This study compares osteitis condensans ilii (OCI) and axial spondyloarthritis (axSpA), focusing on their clinical, laboratory, and MRI characteristics. Researchers found that OCI predominantly affects women and lacks the inflammatory markers typical of axSpA. While both conditions can present with sacroiliac joint osteitis on MRI, OCI shows anterior localization and an absence of erosions, distinguishing it from axSpA. The study highlights the challenges in differentiating these conditions and emphasizes the need for comprehensive clinical and imaging assessment. The findings provide valuable information for the differential diagnosis of these two conditions. This episode is based on Poddubnyy D...2025-01-0511 minRheumaCastRheumaCastTNF Blockade Ineffective for Chronic Low Back Pain Associated with Modic Type 1 Changes on MRIThis episode focuses on a randomized, placebo-controlled trial that evaluated the efficacy of infliximab, a tumor necrosis factor (TNF) inhibitor, in alleviating chronic low back pain in patients with Modic type 1 changes (degenerative disc disease with bone marrow edema) identified on magnetic resonance imaging (MRI). The results indicate that TNF blockade is not effective for this condition. This podcast is based on the publication by Gjefsen E, et al (2024) and was developed with NotebookLM. 2024-12-0816 minRheumaCastRheumaCastWhat is chronic non-bacterial osteitis (CNO)?This article presents expert consensus recommendations for diagnosing and treating chronic non-bacterial osteitis (CNO) in adults. A systematic review of existing literature and a multidisciplinary expert panel informed the creation of a standardized disease definition and proposed the term "CNO" to replace previous, less precise terminology. The recommendations cover diagnostic imaging, laboratory testing, and a tiered treatment approach starting with NSAIDs and moving to intravenous bisphosphonates or TNF-α inhibitors as needed. Long-term follow-up and a multidisciplinary care team are emphasized, along with a research agenda to improve understanding and treatment of this rare condition. 2024-12-0119 minRheumnow PodcastRheumnow PodcastACR24 - Day2aBimekizumab in PsA Showed Sustained Reductions in Disease Impact:Dr. Eric Dein talks with Dr. Ana-Marie Orbai  CAR-T Therapy and Lupus:Dr. Akhil Sood talks with Dr. Chris Wincup Cycling vs Switching after TNFi Failure in axSpA:Dr. Lihi Eder Difficult to manage AxSpA:Dr. Sheila Reyes talks with Dr. Denis Poddubnyy  Gender Differences in AxSpA:Dr. Adela Castro Metabolic Dysregulation and RA Interstitial Lung Disease:Dr. Mrinalini Dey  PsA Ultrasound Updates:Dr. Catherine Bakewell and Dr. Lihi Eder  SELECT-GCA: Efficacy and Safety of Upadacitinib:Dr. Richard Conway 2024-11-1729 minRheumaCastRheumaCastLow Back Pain and Suspicion of Axial Spondyloarthritis – Does the MRI Protocol Matter?This episode of RheumaCast deals the long-anticipated global consensus on MRI protocols for the diagnosis and differential diagnosis of axial spondyloarthritis (axSpA). Experts from ASAS and SPARTAN, including radiologists and rheumatologists, have developed a comprehensive, standardized imaging protocol designed to maximize diagnostic accuracy and aid early identification of axSpA. The protocol specifies a four-sequence approach focusing on inflammation, structural damage, and bone-cartilage interface visualization—essential elements to ensure consistency in detecting sacroiliitis and distinguishing it from other conditions. This podcast is based on the publication ⁠Lambert R, et al. Ann Rheum Dis 2024 Aug 6:ard-2024-225882⁠ ...2024-11-0111 minRheumaCastRheumaCastDiagnosis of Axial Spondyloarthritis - Enhancing Rheumatologist-Radiologist CommunicationThis episode of RheumaCast dives into the latest expert guidelines from the Assessment of Spondyloarthritis International Society (ASAS) for imaging referrals in patients with suspected or confirmed axial spondyloarthritis (axSpA). We explore how these recommendations, designed by an international task force, aim to improve communication between rheumatologists and radiologists, ensuring imaging requests are precise, informative, and clinically relevant. By standardizing essential clinical data in referral forms, these guidelines support more accurate diagnoses, enhanced report quality, and ultimately better patient management in axSpA. Join us as we discuss the significance, application, and expected impact of these recommendations in clinical practice.2024-10-2618 minMedical Digest & Congress ReportMedical Digest & Congress ReportSecukinumab versus standard-of-care in axial spondyloarthritis - report from EULAR2024Professor Denis Poddubnyy shared the results of AScalate trial, Secukinumab versus standard-of-care in axial spondyloarthritis, a randomized controlled open-label trial for treat-to-target outcomes. Video: https://medicaldigest.org/scientific-contents/interview:secukinumab-versus-standard-care-axial-spondyloarthritis2024-06-2006 minRheumnow PodcastRheumnow PodcastTNR- Spondyloarthritis InnovationsThis is a replay from the live RNL 2023 meeting and session on SPONDYLOARTHRITIS INNOVATIONS held on March 19, 2023.  This POD (session) devoted to advances in Spondyloarthritis and featured three excellent lectures: - Dr. Atul Deodhar –  Five Advances in SpA - Dr. Denis Poddubnyy - Evaluation of the SI Joint  - Dr. John Reveilee – A Family Hx of AS – what does it mean This Spondyloarthritis Innovations session was sponsored by Lilly 2023-05-2449 min