Three Autoimmune Diseases In Brief

Rheumatoid arthritis, lupus, and Crohn’s disease are autoimmune diseases that share a lot of commonalities. This episode covers when and how they were first recognized and described. Research: Aceves-Avila, Francisco Javier et al. “The Antiquity of Rheumatoid Arthritis: A Reappraisal.” The Journal of Rheumatology 2001; 28:4. Arnaud, Laurent et al. “The History of Lupus Throughout the Ages.” Journal of the American Academy of Dermatology. Volume 87, Issue 6, December 2022. https://www.sciencedirect.com/science/article/abs/pii/S0190962220307726 Barber, Megan R W et al. “Global epidemiology of systemic lupus erythematosus.” Nature reviews. Rheumatology vol. 17,9 (2021): 515-532. doi:10.1038/s41584-021-00668-1 Bornstein, Joseph E. and Randolph M. Steinhagen. “History of Crohn’s Disease.” From Crohn’s Disease: Basic Principles. Springer. 2015. Crohn & Colitis Foundation. “IBD before the Foundation.” https://www.crohnscolitisfoundation.org/about/our-beginning Entezami, Pouya et al. “Historical perspective on the etiology of rheumatoid arthritis.” Hand clinics vol. 27,1 (2011): 1-10. doi:10.1016/j.hcl.2010.09. Geller, Stephen A. and Fernando P F de Camposc. “Crohn disease.” Autopsy Case Rep [Internet]. 2015; 5(2):5-8. http://dx.doi.org/10.4322/acr.2015.001 Hyndman, I. J. (2017), Rheumatoid arthritis: past, present and future approaches to treating the disease. Int J Rheum Dis, 20: 417-419. https://doi.org/10.1111/1756-185X.12823 Kirsner, J B. “Historical origins of current IBD concepts.” World journal of gastroenterology vol. 7,2 (2001): 175-84. doi:10.3748/wjg.v7.i2.175 Laberge, Monique, and Philip E. Koth. "Rheumatoid Arthritis." The Gale Encyclopedia of Medicine, edited by Jacqueline L. Longe, 6th ed., vol. 7, Gale, 2020, pp. 4474-4480. Gale In Context: Science, link.gale.com/apps/doc/CX7986601640/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=8b8ee977. Accessed 30 Apr. 2025. Laurent Arnaud - I6 The history of lupus throughout the ages: Lupus Science & Medicine 2020;7:. https://doi.org/10.1136/lupus-2020-eurolupus.6 org. “The History of Lupus.” https://www.lupus.org/resources/the-history-of-lupus Mandal, Dr. Ananya. “Rheumatoid Arthritis History.” News Medical. 7/7/2023. https://www.news-medical.net/health/Rheumatoid-Arthritis-History.aspx Medical News Today. “The History of Rheumatoid Arthritis.” 5/2/2023. https://www.medicalnewstoday.com/articles/rheumatoid-arthritis-history Michniacki, Thomas. “Crohn’s Disease: An Evolutionary History.” University of Michigan Library. 2006-05 http://hdl.handle.net/2027.42/96969 Potter, Brian. “The History of the Disease Called Lupus.” Journal of the History of Medicine and Allied Sciences , JANUARY 1993, Vol. 48, No. 1 (JANUARY 1993). Via JSTOR. http://www.jstor.com/stable/24622869 Sathiavageesan, Subrahmanian, and Suganya Rathnam. “The LE Cell-A Forgotten Entity.” Indian journal of nephrology vol. 31,1 (2021): 71-72. doi:10.4103/ijn. IJN_249_19 Scofield, R Hal, and James Oates. “The place of William Osler in the description of systemic lupus erythematosus.” The American journal of the medical sciences vol. 338,5 (2009): 409-12. doi:10.1097/MAJ.0b013e3181acbd71 "Systemic Lupus Erythematosus." National Institute of Arthritis and Musculoskeletal and Skin Diseases Pamphlets, National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2001, p. 1. Gale Academic OneFile, link.gale.com/apps/doc/A79512544/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=534bac78. Accessed 30 Apr. 2025. Thomas, Donald E. et al. “The first use of “lupus” as a disease.” Lupus. 2025, Vol. 34(1) 3–9. Tish Davidson, and Rebecca J. Frey. "Crohn's Disease." The Gale Encyclopedia of Medicine, edited by Jacqueline L. Longe, 6th ed., vol. 2, Gale, 2020, pp. 1423-1427. Gale In Context: Science, link.gale.com/apps/doc/CX7986600509/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=2687d598. Accessed 30 Apr. 2025. Van Hootegem, Phillippe. “Is Crohn’s A Rightly Used Eponym?” J Crohns Colitis. 2020 Jul 9;14(6):867-871. doi: 10.1093/ecco-jcc/jjz183. See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

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• 2:06Holly Frey?

  Welcome to Stuff You Missed in History Class, a production of iHeartRadio.

• 2:17Tracy V. Wilson?

  Hello and welcome to the podcast. I'm Tracy V. Wilson.

• 2:20Holly Frey?

  And I'm Holly Frey.

• 2:22Tracy V. Wilson?

  On April 22nd of 2025, that is this year, the U.S. Department of Health and Human Services had a press conference about a plan to phase eight synthetic food dyes out of the U.S. food supply by the end of 2026. Now, that, that's like a whole can of worms. It's not really what this episode is about. We're not really going to get into it. But at this press conference for this announcement, Secretary of Health and Human Services, Robert F. Kennedy Jr., gave a speech in which he described a long list of diseases and conditions as injuries. And he claimed he had never heard of them when he was a kid.

• 3:05Tracy V. Wilson?

  Now, RFK Jr. was born in 1954, so he was kind of implying that these diseases weren't really around in the 50s and the 60s and that they are, in fact, injuries caused by things like synthetic food dyes.

• 3:19Tracy V. Wilson?

  The diseases and conditions that he named in this speech included narcolepsy, which was first described in writing in 1621. We did a two-part episode on narcolepsy in 2015. Also included was what he called juvenile diabetes, which is now called type 1 diabetes. That was, of course, a big part of our two-parter on the discovery of insulin, which came out in 2020. Diabetes was first described in the Ebers Papyrus, which dates back to about 1500 BCE, so almost 3,500 years before RFK Jr. was born. If it's not obvious, I gotta be in my bonnet about this speech.

• 4:03Tracy V. Wilson?

  None of these diseases from the speech are new. And while the prevalence of some of them does seem to be increasing, in a lot of cases, that's a global trend, not something unique to the United States and its food supply. And we don't necessarily know the reasons behind this particular, any particular increase. Some of it, though... Is definitely more about expanded definitions and better testing diagnosis and treatment than we had half a century ago, though. Also, some of it is just about people living longer and surviving things that would have killed them in earlier eras. So I thought about doing something

• 4:46Tracy V. Wilson?

  called six impossible episodes. Diseases RFK Junior says he has never heard of, but some of the things he listed off weren't really diseases. They were more like generic descriptions or whole categories. And also, that seemed like too much for one episode. So I narrowed this down to three autoimmune diseases that he mentioned in this speech. They are rheumatoid arthritis, lupus, and Crohn's disease. This is not a thorough history of all of them. This is really about when and where these diseases were first recognized and described.

• 5:20Holly Frey?

  So all three of these diseases have some things in common. And rather than repeating those commonalities every time, we're going to start with some of them. So as Tracy just said, they are all autoimmune diseases, meaning they all involve the body's immune system attacking healthy tissue. And there is no one definitive, exact known cause for any of them. It's likely a combination of genetic and environmental factors, such as exposure to things like pollution or tobacco smoke, as well as possibly hormones. All three of these diseases are more prevalent in women, in some cases, much more prevalent in women. It is also possible that viral infections may be involved in triggering all of these illnesses, or triggering flare ups of the illnesses

• 6:05Holly Frey?

  after they've developed.

• 6:07Tracy V. Wilson?

  In terms of that genetic element, there is no single gene or gene mutation that conclusively causes any of these. Rheumatoid arthritis, for example, has at least 46 different genes that are known to contribute to it in some way. These diseases all tend to run in families, but having an immediate family member with one of them means that a person is more likely to develop it, not that they are guaranteed to develop it.

• 6:38Holly Frey?

  If one identical twin has one of these diseases, the other twin is more likely to have it as well. But the rate of both identical twins having the disease isn't anywhere close to 100%. Studies vary somewhat, but generally speaking, if one identical twin has rheumatoid arthritis, the other twin develops it only about 15% of the time. With Crohn's disease, that number is 30%, and it's less than 50% with lupus. Identical twins have the same DNA, and if they grew up in the same household, they would likely have very similar, if not identical, environmental factors affecting their health. So the fact that that rate is nowhere near 100% suggests that it's more complicated and that there are other factors going on,

• 7:24Holly Frey?

  or that some elements are just random.

• 7:27Tracy V. Wilson?

  Social determinants of health probably play a part in these diseases as well. Those are non-medical factors, like a person's income, wealth, education, and where and how they grew up. These social determinants may be connected to some of the racial disparities that do exist for some of these diseases. For example, rheumatoid arthritis is most prevalent in white women. But in the United States, Black, Hispanic, and Latina, Indigenous, Alaska Native, Asian American, and Pacific Islander women are all disproportionately more likely to develop lupus. There's some suggestion that social determinants are connected to these disparities.

• 8:12Tracy V. Wilson?

  Similarly, Crohn's disease is less prevalent in the tropics, which has led to a hypothesis that it might be connected to exposure to sunlight or to a person's vitamin D levels.

• 8:25Holly Frey?

  There is also no one single diagnostic test for any of these. They all require some combination of family history, physical exams, lab work, and imaging or biopsies. So while the diseases themselves are not new, some of the tools used to detect them are. That also means getting a diagnosis can be time and labor Intensive and in the US where we don't have universal healthcare. That means it's also often very expensive. Each of these can also be mistaken for other similar diseases, both in living people and in the archaeological record. So all of this together means that it can be really, really tricky to tell when humans first started experiencing these diseases.

• 9:10Holly Frey?

  But in all of them, it was definitely before the 20th century.

• 9:15Tracy V. Wilson?

  Of these three diseases, Crohn's disease was the one that was named and thoroughly described the most recently, so we will start there. This is an inflammatory bowel disease that causes symptoms like abdominal cramps, pain, and diarrhea, which can be bloody. These can happen as flare ups with periods of feeling relatively well in between those flare ups. As this condition progresses, it can cause thickening in some of the tissues of the digestive tract, as well as perforations or fistulas in the intestinal tissue. It commonly affects the ileum, which is the last part of the small intestine.

• 9:57Holly Frey?

  The severity of Crohn's disease can vary from person to person, and it can also vary over time and eventually cause complications in other systems of the body. Treatments include diet and lifestyle modifications, anti-inflammatory drugs, corticosteroids, immune system suppressors, monoclonal antibodies, and antibiotics if infections develop. Damage to the intestine can lead to a need for surgery, and sometimes more than one surgery.

• 10:27Tracy V. Wilson?

  Crohn's disease is not caused by stress or diet, but both of those things can affect a person's symptoms, including contributing to flare ups. Since the disease can affect a person's ability to absorb nutrients, some people have to carefully manage what they eat, and for some people, that just becomes kind of exhausting over time. This disease can also be really life altering. The symptoms that it can cause can be incredibly uncomfortable and embarrassing, and sometimes people have a hard time leaving the house to do things they enjoy or to travel during a flare because they might not have access to a bathroom when they need it. A lot of people with Crohn's disease and with the other autoimmune diseases that

• 11:12Tracy V. Wilson?

  we're talking about today also talk about how hard it can be socially as their friends and family members just assume that they're flaky or that they don't care when they have to turn down invitations or cancel their plans last minute. They also talk about things like bosses assuming that they are lazy or unreliable rather than understanding the realities of their medical condition.

• 11:36Holly Frey?

  It's really tricky to know when people first started experiencing Crohn's disease because there are a lot of different diseases and conditions that can cause chronic diarrhea and abdominal pain. Greek physician Areteus of Cappadocia, who lived in the first century CE, described a young man who was having recurring bouts of diarrhea and abdominal distress, but we don't have a way to know whether this was Crohn's disease specifically. Similarly, Saxon King Alfred the Great, who lived in the ninth century, had recurring debilitating abdominal pain and diarrhea, but we don't know the exact cause.

• 12:12Tracy V. Wilson?

  King Louis XIII of France died in 1643 at the age of 42 after experiencing recurring chronic diarrhea and other abdominal issues for years. An autopsy was conducted after his death, and that showed that he had perforations in his small intestine, which can be indicative of Crohn's. But he also had signs of tuberculosis, which can lead to some similar abdominal issues as well.

• 12:41Holly Frey?

  In 1761, Italian anatomist Giovanni Battista Morgagni wrote about a 20-year-old man who had died. Morgagni conducted an autopsy and found lesions in the man's large and small intestines, including perforations and ulcerations, which again, could have been from Crohn's disease. A century later, Albert von Saxon Coburg, Prince Consort of Queen Victoria, died at the age of 42 of what was described at the time as typhoid fever. But modern researchers examining his medical records have found evidence that he had some kind of chronic intestinal disease that was like Crohn's.

• 13:19Tracy V. Wilson?

  In 1875, Samuel Wilkes and Walter Moxon published a case report in which they described a young woman who had died after experiencing severe bloody diarrhea.

• 13:33Tracy V. Wilson?

  They performed an autopsy and they found that she had ulcerations and inflammations throughout her colon. This is often cited as the first very clear clinical description of ulcerative colitis. Ulcerative colitis and Crohn's disease are very similar and they are generally differentiated by exactly where in the digestive system the damage is occurring.

• 13:58Holly Frey?

  In 1932, Burl Crohn, Leon Ginsberg, and Gordon D. Oppenheimer published a paper in the Journal of the American Medical Association called "Regional Iliitis: A Pathological and Clinical Entity." They reported on 14 patients who had what they called "Regional Iliitis." All 14 had abdominal cramps, diarrhea, fever, and weight loss, and they had been treated with surgery. They all had evidence of fistula formation, and they were all emaciated and anemic. At least half of them had previously had their appendix removed, possibly because doctors had mistaken their symptoms for appendicitis.

• 14:39Holly Frey?

  The paper included radiological images and ruled out abdominal tuberculosis as the cause of these issues.

• 14:46Tracy V. Wilson?

  These authors presented regional iliitis as a new disease, but there had been several other papers published in the first decades of the 20th century that had also reported very similar patterns of intestinal inflammation, perforations, and fistula formation. Even so, though, this is considered a landmark paper. And even though the authors had used the name "Regional Iliitis," soon people were calling it "Crohn's Disease" after author Burl Crohn. While Crohn was listed first among this paper's authors, that was just because their names were alphabetical on the paper. He actually preferred the name "Regional Iliitis."

• 15:29Holly Frey?

  So Crohn's disease got its name in 1932, but it's very likely that it existed long before that. Its prevalence does seem to be increasing worldwide, not just in the United States, but we really do not know exactly why.

• 15:44Tracy V. Wilson?

  We will talk about rheumatoid arthritis after we take a quick sponsor break.

• 15:53Holly Frey?

  A rare disease diagnosis can change your life, but it doesn't have to define your future. Tune in for season seven of Untold Stories: Life with a Severe Autoimmune Condition, a Ruby Studio production in partnership with Argenx. Hosted by public health and policy expert Dr. Martine Hackett, Untold Stories: Life with a Severe Autoimmune Condition pushes the conversation within the rare disease community forward. Featuring guests living with MG, CIDP, myositis, SMA, and other rare autoimmune conditions, each episode explores hope, progress, and connection. How does research create new opportunities? How do shared experiences help light the way forward? How do we best show up for each other?

• 16:38Holly Frey?

  Tune in to find out. Listen on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.

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• 18:52Tracy V. Wilson?

  All three of the diseases that we're talking about today are inflammatory autoimmune diseases. In rheumatoid arthritis or RA, the inflammation is in the synovial membranes that line the joints. This causes joint pain, swelling, and loss of function. Other symptoms can include fatigue, fever, and weight loss. This inflammatory process damages the joints over time, and it can also damage other body systems. Rheumatoid arthritis is the most common chronic inflammatory joint disease in the world. And in the United States, it's the third most common type of arthritis after osteoarthritis and gout.

• 19:35Tracy V. Wilson?

  Juvenile RA also affects children and can start in infancy.

• 19:40Holly Frey?

  As with Crohn's disease, the prevalence of rheumatoid arthritis does seem to be increasing. Again, globally, not just in the US, although rates of RA vary dramatically from one part of the world to another. Some of this apparent increase is because of changing definitions, though. The American College of Rheumatology and the European Alliance of Associations for Rheumatology issued revised definitions for RA in 2010. And these new definitions focus on symptoms that are present at the earliest stages of the disease, which was not the case before.

• 20:14Tracy V. Wilson?

  A range of treatments exist to help manage RA, and a lot of them are targeting the symptoms. These include over the counter pain relievers, steroids, and disease modifying anti rheumatic drugs, or DMards. Occupational therapy and lifestyle modifications can be involved, and surgeries can as well.

• 20:36Holly Frey?

  DMards are part of the treatment for a lot of autoimmune diseases, and many of them started out as anti malaria drugs. In many cases, it's not fully understood why these can be helpful for autoimmune diseases, but it is likely connected to the way they affect the immune system. One of them, hydroxychloroquine, became sought after in the early days of the COVID-19 pandemic after a paper was published suggesting that it could be helpful for both treatment and post exposure prophylaxis.

• 21:07Tracy V. Wilson?

  Experts raised serious concerns about this paper almost immediately. Among other things, it included only 36 people, and eventually that paper was retracted. The FDA issued an emergency use authorization for hydroxychloroquine as a COVID treatment, and then revoked that authorization just a couple of months later as it became increasingly clear that hydroxychloroquine did not treat or prevent COVID. But by that point, President Donald Trump had called it a game changer, which had spiked huge demand for it. Some people, including Robert F. Kennedy Jr., continued to promote hydroxychloroquine

• 21:50Tracy V. Wilson?

  as a COVID treatment for years after it was shown not to work for that purpose. Kennedy also spread the baseless conspiracy theory that hydroxychloroquine and ivermectin were effective against COVID, but that the FDA was barring people's access to them because it was in cahoots with the vaccine industry.

• 22:11Holly Frey?

  This is demonstrably untrue. And all of this caused serious problems for people who were using hydroxychloroquine to manage their RA, or their lupus, which we're going to talk about shortly, or other autoimmune diseases. People could not get access to their necessary medication because people who did not need it and were not going to benefit from it were taking it for something it was not effective against. Some people with autoimmune diseases couldn't get access to hydroxychloroquine anymore and had to start taking other medications that were not as effective for them, or weren't effective for them at all, or which had much more pronounced and serious side effects. People can experience flare-ups when stopping hydroxychloroquine, even if they're moving

• 22:56Holly Frey?

  to other medications, so these needless shortages demonstrably harmed people.

• 23:03Tracy V. Wilson?

  In terms of when people started experiencing RA, there is more debate about that than about either of the other two diseases we're talking about today. There are three overarching theories. One is that RA is an ancient disease all around the world, which people have experienced for millennia. Another is that RA didn't appear until far more recently, sometime in the 18th century, and was triggered by something that was part of the Industrial Revolution, like maybe something involving pollution or industrial chemicals, something like that. But a third idea is that RA was an ancient disease in the Americas and then was introduced

• 23:48Tracy V. Wilson?

  to Europe through exploration and colonization, starting after the 15th century. The idea here is that there is more older archaeological evidence that's suggestive of rheumatoid arthritis in the Americas than there is in other parts of the world. So maybe there was some kind of disease trigger involved that Europeans did not encounter until that exchange with the Americas. Or maybe RA is related to tobacco consumption or tobacco smoke. Tobacco is native to the Americas, and it was introduced to Europe by Christopher Columbus's expeditions. A counterpoint to that idea is that there's at least some suggestion that RA was present

• 24:32Tracy V. Wilson?

  in Europe prior to Columbus's voyages.

• 24:36Holly Frey?

  Supporters of each of these three hypotheses point to various details to back up their claims, like Greek physician Hippocrates described a type of arthritis that appeared by the age of 35 and spread quickly from the feet to the hands, then the elbows and knees, then the hips. That sounds more like rheumatoid arthritis than osteoarthritis, which can happen in more than one joint, but typically doesn't affect that many joints in that many parts of the body that quickly. Roman physician Scrabonius Largus also described a form of arthritis that mostly affected women, and he did that around 100 BCE. Michael Selles's Chronographia, written in the 11th century, describes Roman Emperor

• 25:20Holly Frey?

  Constantine IX as experiencing a disease that affected his feet, and then his hands, and then his shoulders, and then his whole body. Given medical understanding at the time, it's described as humors attacking these parts of his body.

• 25:36Tracy V. Wilson?

  There are also some possible examples of RA in works of art from before the Industrial Revolution. One example is Rubens' The Three Graces, which was painted in the 1630s. This painting features three nude women, and the one on the far left has her hand on the upper arm of the woman next to her. Her wrist is flexed laterally, and her fingers appear to be bent in a way that resembles somebody whose hand has been damaged by RA. This model may be Rubens's wife, Helena Formant, and there are some other portraits of her that have similar depictions of her hands.

• 26:18Holly Frey?

  All of this could be describing or depicting rheumatoid arthritis, but we don't know for sure, since there are also other diseases and conditions that can cause joint damage. This is also true of joint damage that's suggestive of RA in the archaeological record. RA can leave evidence on the bones, but so can other diseases, including ankylosing spondylitis, or AS, which primarily affects the spine. It wasn't until the 20th century that researchers started differentiating between RA and AS, which led to some earlier RA findings in the archaeological record being reinterpreted as AS or as some other condition.

• 27:01Tracy V. Wilson?

  By the 17th century, though, physicians in Europe were starting to differentiate between different types of arthritis and different inflammatory diseases and processes. For example, in 1676, physician Thomas Siddenham published "Observationis Medicaid", which differentiated between rheumatism and gout. Gout is an inflammatory arthritis that today we know is caused by uric acid buildup in the blood. Gout often affects the big toe, but it can occur in any joint. In the 18th century, William Heberdin the Elder also described rheumatism and gout as two different diseases.

• 27:44Holly Frey?

  In 1782, Johan Pettersson of Iceland described a chronic arthritis happening on both sides of the body that seemed to be systemic. It was more prevalent in women, and the incidence seemed to peak around the age of 40. This sounds a lot like RA, but the person who is usually cited as providing the first clear, clinical description of RA is Augustin Jacob Landry Bové in 1800. He was a 28-year-old resident physician at the Saint-Pierre Asylum in France. He described a set of patients, most of them poor women, who had severe joint pains not caused by osteoarthritis.

• 28:25Holly Frey?

  He thought this was a type of gout, and he called it "gout asthenic primitive", or "primary asthenic gout."

• 28:32Tracy V. Wilson?

  In 1853, French neurologist Jean-Martin Charcot wrote a doctoral thesis in which he described arthritis, muscular atrophy, and muscular and skeletal malformations. This condition, as he was describing it, seemed to go into remission spontaneously, but then it would recur. Six years later, English physician Alfred Baron Garrard wrote "Treatise on the Nature of Gout and Rheumatic Gout", which again differentiated between gout, caused by excess uric acid in the blood, and what he called rheumatic gout, which was a different thing. Garrard's son Archibald also became a doctor and coined the term "rheumatoid arthritis"

• 29:17Tracy V. Wilson?

  in his Treatise on Rheumatism and Rheumatoid Arthritis in 1890.

• 29:22Holly Frey?

  Archibald Garrard was one of the people who thought there was archaeological evidence of rheumatoid arthritis going back to the ancient world. But in the 20th century, American physician Charles Short looked back at some of the same reports that Archibald Garrard had used and concluded that they were describing a range of different diseases and conditions and not rheumatoid arthritis. This included ankylosing spondylitis, osteoarthritis, and gout. So Short argued that RA was a modern disease and not an ancient one. As we said earlier, there continues to be debate on this today.

• 29:59Tracy V. Wilson?

  The debate is not about it starting in the 1950s and 60s, though. All of the debate is centuries earlier than that. We will have one more sponsor break, and then we will talk about lupus.

• 30:15Holly Frey?

  A rare disease diagnosis can change your life, but it doesn't have to define your future. Tune in for season seven of Untold Stories: Life with a Severe Autoimmune Condition, a Ruby Studio production in partnership with Argenx. Hosted by public health and policy expert Dr. Martine Hackett, Untold Stories: Life with a Severe Autoimmune Condition pushes the conversation within the rare disease community forward. Featuring guests living with MG, CIDP, myositis, SMA, and other rare autoimmune conditions, each episode explores hope, progress, and connection. How does research create new opportunities? How do shared experiences help light the way forward? How do we best show up for each other?

• 30:59Holly Frey?

  Tune in to find out. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

• 31:13Speaker 01

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• 31:40Speaker 03

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• 32:11Holly Frey?

  Hi, I'm Jenna Oshkowitz. You might know me from Glee. This is At the Table, the food allergy podcast, a show about food, connection, and what it really looks like to live with food allergies. Each episode, we hear stories from real people like Daniel.

• 32:25Speaker 01

  People would always think I was lactose intolerant, so I just kind of shortened my explanation to I'm deathly allergic, in a big way that defined a lot of my childhood.

• 32:36Holly Frey?

  And while there are challenges, there are moments that remind you you're not alone.

• 32:41Speaker 01

  One of the best guys that I dated, he made a point to memorize all my food allergies.

• 32:47Holly Frey?

  So join us and hear their stories and more, because living with food allergies isn't just about what you can't eat, it's about still having your seat at the table. Brought to you by Genentech and Novartis. Listen to At the Table, the food allergy podcast, on America's number one podcast network, iHeart. Follow At the Table and start listening on the free iHeartRadio app today.

• 33:14Tracy V. Wilson?

  The last autoimmune disease we're talking about is lupus. The word lupus is part of the name of several diseases today, but when people say lupus, they are usually talking about systemic lupus erythematosis, or SLE. I have heard people say the word erythematosis and arithmatosis a number of different ways of pronouncing that last word. Regardless, it comes from the Greek word erythros, meaning red, and that's a reference to the rashes that are often a part of this disease. This is another inflammatory autoimmune disease with lots of possible symptoms, depending on which parts of the body the immune

• 33:58Holly Frey?

  System is attacking. There is also neonatal lupus, which is a rare condition that occurs when a person's antibodies pass to their fetus through the placenta. Drug-induced lupus and discoid lupus Erythematosus, which affects mostly the skin. The term lupus vulgaris is also used to describe cutaneous tuberculosis.

• 34:20Tracy V. Wilson?

  So we're really focused on SLE here, but the use of the term lupus to describe a lot of different conditions goes way back in history. The first known use of the term lupus in medicine was in reference to a 10th century Catholic bishop named Araklius. He had an ulcerous condition that mainly affected the area around his buttocks, and this was described as lupus because it devoured his tissue the way that a wolf would.

• 34:52Holly Frey?

  The word lupus went on to be used to describe a lot of different rashes, ulcers, and even cancers for centuries. By at least the 13th century, this included using the term lupus to describe facial rashes and lesions specifically on the face. A malar rash, or rash shaped like a butterfly across a person's cheeks, is associated with SLE today, although other conditions, including rosacea, can cause similar rashes, and not everyone with SLE has this rash.

• 35:24Tracy V. Wilson?

  It can also look a little different depending on what a person's skin color is. Other typical symptoms of SLE include unexplained fevers, painful or swollen joints, and kidney problems. It can also lead to heart failure. And then there can be a range of additional symptoms as well that can really vary from person to person, including hair loss, chest pain, and pale or purple fingers and toes when somebody gets cold or is under a lot of stress. This is known as Raynaud's phenomenon. As with Crohn's disease and RA, SLE can cause recurring periods of illness and relative health, or flares and remission.

• 36:04Tracy V. Wilson?

  Treatments include non-steroidal anti-inflammatory drugs, corticosteroids, and DMards. And there are also various treatments that are focused on minimizing the skin irritation and rashes.

• 36:18Holly Frey?

  Of course, the broad use of the word lupus to describe things other than SLE complicates the conversation about exactly when SLE was first described. But beyond that, like the other diseases we've talked about today, SLE shares symptoms with other diseases and conditions. It wasn't until the 19th century that descriptions and definitions started to become more precise.

• 36:42Tracy V. Wilson?

  So in the 18-teens, Robert Willan and his mentee, Thomas Bateman, wrote a book called Delineations of Cutaneous Diseases. Willan died in 1812, and Bateman finished the book and published it in 1817. This book laid out a systemic way to categorize different skin diseases, along with engravings illustrating those diseases. Under tuberculous diseases, meaning diseases that cause tubercules, not necessarily tuberculosis specifically, they used the term lupus to describe rashes and lesions affecting specifically the face.

• 37:27Holly Frey?

  Over the course of the 19th century, doctors started drawing distinctions between types of lupus, with some conditions primarily affecting the skin, and others also involving other organs the way SLE does. The first detailed, modern description of SLE is usually cited as coming from French dermatologist Pierre Casenev in 1833. Casenev had a 60-year career as a doctor, and during that time, he also differentiated between discoid lupus and systemic lupus. And in 1847, he described the differences between lupus vulgaris, caused by tuberculosis, and what he called lupus eresmato.

• 38:09Tracy V. Wilson?

  Two years later, Viennese physician Ferdinand von Hebra described the butterfly-like rash that's seen as often characteristic of SLE today. Then in 1868, physician and surgeon Alexander John Balmanos Squire used the term vesportilio, or bat-like, to describe this same rash.

• 38:30Holly Frey?

  In 1872, Hungarian dermatologist Moritz Kaposz continued to refine definitions for lupus, including drawing a distinction between discoid lupus, primarily affecting the skin, and disseminated lupus, which was a systemic lupus that could sometimes be fatal. He described the other potential symptoms of this sometimes fatal systemic lupus as including swollen lymph nodes, joint pain, pain in the long bones, fever, and weight loss.

• 39:01Tracy V. Wilson?

  In 1879, Emile Vidal, who worked at Opital Saint Louis in Paris, further distinguished lupus arithmatosis from lupus vulgareus caused by tuberculosis. Later, Robert Koch's discovery of the tuberculosis bacillus in 1882 helped doctors conclusively diagnose lupus vulgareus as caused by TB. At that point, it quickly became clear that lupus vulgareus was far more common than lupus arithmatosis.

• 39:33Holly Frey?

  In 1894, Jay Payne delivered a postgraduate lecture in which he reported that quinine could be useful in the treatment of lupus, likely the earliest use of an antimalarial drug in the treatment of an autoimmune disease.

• 39:48Tracy V. Wilson?

  From this point, doctors continued to develop new methods for diagnosing SLE and for trying to treat it and manage its symptoms. Then in 1948, Malcolm McCallum Hargraves discovered what came to be known as the lupus arithmatosis cell, or LE cell.

• 40:08Tracy V. Wilson?

  It is also sometimes called the Hargraves cell. This is a cellular indication of an autoimmune process going on inside the body. This discovery apparently came about by happenstance. There was a hematologist at the Mayo Clinic who was drawing the blood from patients and treating it with an anticoagulant and then just walking over to the lab a few blocks away. This window of time to walk for the lab allowed the process that made these cells visible to take place. And without that little time window, it probably would not have been noticed. LE cells are specific types of white blood cells that have been engulfed by the denatured nuclear material from other cells.

• 40:53Tracy V. Wilson?

  And the presence of these cells can be indicative of SLE as well as of other autoimmune diseases.

• 41:02Holly Frey?

  As with RA and Crohn's disease, it does seem like lupus rates are increasing. But as with those, this is a global trend, not just in the US, although there is a lot of regional and demographic variation in how prevalent it is. But again, none of these diseases are post 20th century developments.

• 41:22Tracy V. Wilson?

  Kim, and I'm sorry, not sure how you got to be the Secretary of Health and Human Services, having not heard of juvenile diabetes, but that's where we are.

• 41:32Holly Frey?

  Well, it's like,

• 41:35Holly Frey?

  it's that thing that I've never heard of it, so it doesn't exist thing is just wild to me. There's so many things I've never heard of.

• 41:42Tracy V. Wilson?

  Yeah.

• 41:43Holly Frey?

  But they are real.

• 41:44Tracy V. Wilson?

  A lot of people never heard of spasmodic dysphonia until RFK Jr. became a public figure.

• 41:53Holly Frey?

  Yep.

• 41:54Tracy V. Wilson?

  While experiencing it.

• 41:56Holly Frey?

  Yep.

• 41:57Tracy V. Wilson?

  Anyway, I have some listener mail before we, you know, we're going to go on from this to record our Friday behind the scenes. I'm sure we'll have plenty more things to say.

• 42:10Tracy V. Wilson?

  This is from Kristen. The subject line of this email is Cecilia Payne Gopashkin and horrible handwriting. Kristen wrote, hi Holly and Tracy. When I listened to your Saturday classic episode on Cecilia Payne Gopashkin, I heard you mention your difficulty with handwriting and you're musing that maybe you should have been taught to write with your left hand. My son also has tremendous difficulty with handwriting and his schoolwork was greatly affected. He was failing everything. In sixth grade, we requested that the school test him for specific learning disabilities as a last resort because we were at our wits' end. As most of his trouble was in literature, I suspected he had dyslexia.

• 42:51Tracy V. Wilson?

  It turns out there is another SLD related to dyslexia called dysgraphia that is characterized by difficulty with handwriting. I often describe it to people unfamiliar with this condition, that if dyslexia is trouble getting written information into the brain, dysgraphia is trouble getting written information out of the brain. Of course, it's a lot more nuanced than that simple explanation. Since his diagnosis and subsequent IEP to allow him to give typed or oral answers and other support, he has completely turned his education around. In 10th grade now, he is an honors student, taking two AP math courses and honors wind ensemble. He plays tenor sax in the jazz band also. He says he wants to study science communication in college.

• 43:36Tracy V. Wilson?

  Just wanted to bring awareness to this SLD because not many people even know it exists. I sure hadn't heard of it until my son's diagnosis. Thank you for being a bright spot in these gloomy times and making me laugh four times a week. Kristen. Kristen has also included some pet tags. There is a 13-year-old golden retriever mix named Haas. There's a lab mix named Midnight, newly adopted little sister to Haas. Trip is the tripod ginger rescued from the side of the road as a kitten who thinks he is a haas. And then Rascal is a blue-smoked tabby found in an abandoned shed. And then Stella, born to a feral managed barn colony, but brought into the house for

• 44:21Tracy V. Wilson?

  health reasons as a small kitten. Stella is a tortie, so is obviously in charge. Oh, my goodness.

• 44:29Holly Frey?

  I think I got the one tortie that has no in charge-ness.

• 44:33Tracy V. Wilson?

  Yeah. Well.

• 44:35Holly Frey?

  None.

• 44:36Tracy V. Wilson?

  The Tordi, I used to have Sestina that was also never in charge.

• 44:40Holly Frey?

  Yeah, she was not a sassy cat.

• 44:42Tracy V. Wilson?

  She was not sassy. She desperately wanted to play with Villanelle when I got them both. And Villanelle did not want this at all. And she couldn't seem to retain that Villanelle was never going to want to play with her, which was sad. They eventually learned to tolerate each other well enough. Thank you so much for these pet pictures. My goodness. So cute. All of them. So cute. Thanks also for this email. I had heard of dysgraphia. Also dyscalculia, I think we have gotten some emails about before. Dyscalculia involving

• 45:22Tracy V. Wilson?

  struggles with mathematics. Some of these things are sort of, they can be connected to other things that are also going on. And sometimes they are, it's like this, this is the thing that the person is sort of experiencing. I have like family members who have struggles with different things that all relate to like the same motor planning issue in their mind that sort of evidences itself in multiple ways. And then I also, dyslexia in particular runs broadly in my family. Would I have been diagnosed with dysgraphia as a child? Who can say?

• 46:06Holly Frey?

  Yeah.

• 46:08Tracy V. Wilson?

  So thank you so much, Kristin, for this email and the pictures. If you would like to send us a note, we're at [email protected]. And you can subscribe to our show on the iHeartRadio app and anywhere else you get your podcasts.

• 46:30Tracy V. Wilson?

  Stuff You Missed in History Class is a production of iHeartRadio. For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

• 46:45Holly Frey?

  Wait, I came in for two things. How is this forty-seven dollars? All right, we're gonna need a plan here.

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• 47:01Holly Frey?

  Oh, that's actually really simple.

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• 47:17Speaker 01

  That sound? That's the National Squash League. Pro teams, the world's best players, and rallies so fast you'll forget to breathe. Season four is in full swing, and every match streams free on YouTube. Big hits, bigger rivalries, and a front row seat from wherever you are. Watch every match for free on YouTube. Search National Squash League and hit subscribe or follow live updates on Instagram at NSL.Sport.

• 47:45Holly Frey?

  She's been thinking about this sleepover all week, but I think about her food allergies all the time. Fortunately, her doctor prescribed Zolair, omalizumab. It's proven to significantly reduce allergic reactions if a food allergy accident happens. Zolair 150mg is a prescription medication used to treat food allergy in people one year of age and older to reduce allergic reactions due to accidental exposure to one or more foods. While taking Zolair, you should continue to avoid all foods to which you are allergic. Don't use if you are allergic to Zolair. Zolair may cause a severe, life-threatening allergic reaction called anaphylaxis. Tell your doctor if you ever had anaphylaxis. Get help right away if you have trouble breathing or if you have swelling of your throat or tongue. Zolair should not be used for the emergency treatment of allergic reactions, including anaphylaxis. Zolair is for maintenance use to reduce allergic reactions, including anaphylaxis, while avoiding food allergens.

• 48:31Holly Frey?

  Serious side effects such as cancer, fever, muscle aches and rash, parasitic infection, or hardened circulation problems have been reported. Please see Zolair.com. For full prescribing information, ask an allergist about Soler. This is an advertisement for Soler paid for by Genentech and Novartis. This is Shirley Strawberry from the Steve Harvey Morning Show. Buy smart, drive for less, and trade for more. That's Toyota affordability. And it starts with a great deal on an all-wheel-drive Camry, Corolla Cross, or a Corolla sedan with the latest features and tech. Or test drive a spacious Grand Highlander or adventure-ready RAV4. And with so many hybrid models available, you can enjoy longer trips without all the stops.

• 49:13Holly Frey?

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• 49:26Speaker 00

  This is an iHeart Podcast. Guaranteed Human.