A 70-year-old woman arrives at the hospital with weeks of fever, cough, and night sweats. Antibiotics help some symptoms, but the fevers persist. Extensive investigations turn up clues in her lungs and liver, yet no clear answer.

In this Medical Mysteries episode of Around the Rheum, Dr. Athena Huynh brings the case to hosts Dr. Daniel Ennis and Dr. Janet Pope. They work through the possibilities as new symptoms emerge, weighing what the test results can tell them, which findings might be distractions, and where a biopsy could help.

The conversation follows the case through an unusually long diagnostic journey. Athena, Dan, and Janet reflect on why the answer was so difficult to see at first — and what it means to care for a patient while the disease is still revealing itself.

All in all, this is another great medical mystery that is solved by our team!

Dr. Athena Huynh is a PGY5 rheumatology resident at the University of British Columbia. She brings to the episode a case she encountered during her internal medicine training and has continued to think about since.

Dr. Daniel Ennis is a rheumatologist and clinical faculty member at the University of British Columbia. Dr. Janet Pope is a rheumatologist and Professor of Medicine at Western University.

Around the Rheum is produced by the Canadian Rheumatology Association Communications Committee. The podcast team includes Dr. Dax G. Rumsey, Dr. Daniel Ennis, Dr. Janet Pope, Erin Stewart and David McGuffin of ExploreProductions.ca Theme music is by Aaron Fontwell. Learn more at rheum.ca.

“Lupus is a disease of a thousand faces”—and some of its most difficult symptoms are the ones clinicians cannot see."

In this episode, hosts Dr. Daniel Ennis and Dr. Janet Pope are joined by Dr. Zahi Touma to explore cognitive neuropsychiatric symptoms in patients with systemic lupus erythematosus (SLE). They examine the difference between patient-reported “brain fog” and objectively measured cognitive impairment, the cognitive domains most commonly affected, and why symptoms can be so difficult to attribute to the disease itself.

Dr. Touma discusses what long-term research reveals about cognitive trajectories in patients with SLE, including why some patients remain stable, some experience persistent impairment, and others fluctuate over time. The conversation also considers the influence of depression, chronic pain, and sleep disorders; the limitations of current blood tests and brain imaging; and emerging research into functional imaging; and potential biomarkers such as calprotectin.

Most pertinently, the episode asks what rheumatologists can do now. While better screening tools and targeted treatments are still being developed, the first step is listening to patients, taking their cognitive concerns seriously, and offering appropriate reassurance that impairment does not necessarily mean continued decline.

Dr. Zahi Touma is an Associate Professor of Medicine and Clinician-Scientist with the University of Toronto, the Krembil Research Institute, and Schroeder Arthritis Institute. He is also the director of the Lupus Program at Toronto’s University Health Network (UHN). His research is focused on patients with systemic lupus and also measurement science, with a particular interest in the assessment of disease activity, patient-reported outcomes, and cognitive function.

Dr. Daniel Ennis is a rheumatologist and clinical faculty member in the Division of Rheumatology at the University of British Columbia.

Dr. Janet Pope is a professor of medicine at Western University and division head of rheumatology at St. Joseph’s Health Care London. Her research focuses on systemic sclerosis, lupus and rheumatoid arthritis.

Around The Rheum is produced by the CRA Communications Committee. A special thank you to the podcast team, Dr. Dax G. Rumsey (CRA Communications Committee Chair), Dr. Daniel Ennis (Host), Dr. Janet Pope (Host), David McGuffin of ExploreProductions.ca and Erin Stewart (CRA) for leading production.

Our theme music was composed by Aaron Fontwell.

For more on the work of the Canadian Rheumatology Association, visit rheum.ca

Turning 18 doesn’t mean that a young person is suddenly ready to manage a lifelong illness alone. Between 25 and 75 percent of young people with rheumatic diseases experience a gap in care or are lost to follow-up after moving into the adult system — even though most will require ongoing treatment and monitoring.

Join pediatric rheumatologist Dr. Michelle Batthish as she chats with our hosts Dr. Janet Pope and Dr. Daniel Ennis about why transition should be a gradual process rather than a single transfer of care.

They explore how clinicians can assess readiness, help patients become more independent with appointments and medications, and support parents as their role changes. They also discuss young-adult rheumatology (YARD) clinics, the reasons patients are lost to follow-up, and the importance of addressing mental health, relationships, and the other pressures facing young adults.

Dr. Michelle Batthish is a pediatric rheumatologist at McMaster Children’s Hospital and associate professor of pediatrics at McMaster University. She is a CanChild scientist and chairs the Canadian Rheumatology Association’s Transition Working Group. Her research focuses on healthcare transition and quality improvement in pediatric rheumatology.

Dr. Daniel Ennis is a rheumatologist and clinical faculty member in the Division of Rheumatology at the University of British Columbia.

Dr. Janet Pope is a professor of medicine at Western University and division head of rheumatology at St. Joseph’s Health Care London. Her research focuses on systemic sclerosis, lupus and rheumatoid arthritis.

Around The Rheum is produced by the CRA Communications Committee. A special thank you to the podcast team, Dr. Dax G. Rumsey (CRA Communications Committee Chair), Dr. Daniel Ennis (Host), Dr. Janet Pope (Host), David McGuffin of ExploreProductions.ca and Erin Stewart (CRA) for leading production.

Our theme music was composed by Aaron Fontwell.

For more on the work of the Canadian Rheumatology Association, visit rheum.ca