1 00:00:01,320 --> 00:00:04,240 Speaker 1: Welcome to Stuff You Missed in History Class, a production 2 00:00:04,400 --> 00:00:13,240 Speaker 1: of iHeartRadio. Hello and welcome. 3 00:00:12,920 --> 00:00:13,680 Speaker 2: To the podcast. 4 00:00:13,760 --> 00:00:16,520 Speaker 1: I'm Tracy V. Wilson and I'm Holly Frye. 5 00:00:17,120 --> 00:00:20,600 Speaker 2: On April twenty second of twenty twenty five, that is, 6 00:00:20,640 --> 00:00:24,520 Speaker 2: this year, the US Department of Health and Human Services 7 00:00:24,560 --> 00:00:28,840 Speaker 2: had a press conference about a plan to phase eight 8 00:00:28,960 --> 00:00:32,320 Speaker 2: synthetic food dies out of the US food supply by 9 00:00:32,320 --> 00:00:34,879 Speaker 2: the end of twenty twenty six. Now that that's like 10 00:00:34,920 --> 00:00:37,639 Speaker 2: a whole can of worms, it's not really what this 11 00:00:37,720 --> 00:00:40,319 Speaker 2: episode is about. We're not really going to get into it. 12 00:00:41,159 --> 00:00:45,400 Speaker 2: But at this press conference for this announcement, Secretary of 13 00:00:45,440 --> 00:00:48,639 Speaker 2: Health and Human Services Robert F. Kennedy Junior, gave a 14 00:00:48,720 --> 00:00:53,080 Speaker 2: speech in which he described a long list of diseases 15 00:00:53,120 --> 00:00:57,680 Speaker 2: and conditions as injuries, and he claimed he had never 16 00:00:57,760 --> 00:01:00,640 Speaker 2: heard of them when he was a kid. Now. Rfk 17 00:01:00,800 --> 00:01:03,280 Speaker 2: Junior was born in nineteen fifty four, so he was 18 00:01:03,360 --> 00:01:06,640 Speaker 2: kind of implying that these diseases weren't really around in 19 00:01:06,720 --> 00:01:09,080 Speaker 2: the fifties and the sixties, and that they are in 20 00:01:09,080 --> 00:01:14,320 Speaker 2: fact injuries caused by things like synthetic food dies. The 21 00:01:14,360 --> 00:01:18,280 Speaker 2: diseases and conditions that he named in this speech included narcolepsy, 22 00:01:18,920 --> 00:01:22,160 Speaker 2: which was first described in writing in sixteen twenty one. 23 00:01:22,200 --> 00:01:25,640 Speaker 2: We did a two part episode on narcolepsy in twenty fifteen. 24 00:01:26,680 --> 00:01:31,080 Speaker 2: Also included was what he called juvenile diabetes, which is 25 00:01:31,120 --> 00:01:34,760 Speaker 2: now called type one diabetes. That was, of course a 26 00:01:34,760 --> 00:01:38,759 Speaker 2: big part of our two parter on the discovery of insulin, 27 00:01:38,880 --> 00:01:42,720 Speaker 2: which came out in twenty twenty. Diabetes was first described 28 00:01:42,760 --> 00:01:45,920 Speaker 2: in the ebers Papyrus, which dates back to about fifteen 29 00:01:46,040 --> 00:01:50,680 Speaker 2: hundred BCE, so almost thirty five hundred years before RFK 30 00:01:50,920 --> 00:01:55,400 Speaker 2: Junior was born. If it's not obvious, I gotta be 31 00:01:55,520 --> 00:01:59,480 Speaker 2: in my bonnet about this speech. None of these diseases 32 00:01:59,520 --> 00:02:03,000 Speaker 2: from the beach are new, and while the prevalence of 33 00:02:03,080 --> 00:02:05,760 Speaker 2: some of them does seem to be increasing in a 34 00:02:05,800 --> 00:02:09,799 Speaker 2: lot of cases, that's a global trend, not something unique 35 00:02:09,840 --> 00:02:12,120 Speaker 2: to the United States and its food supply, and we 36 00:02:12,280 --> 00:02:16,720 Speaker 2: don't necessarily know the reasons behind this particular, any particular increase. 37 00:02:17,240 --> 00:02:22,960 Speaker 2: Some of it, though, is definitely more about expanded definitions 38 00:02:23,200 --> 00:02:27,839 Speaker 2: and better testing, diagnosis, and treatment than we had half 39 00:02:27,880 --> 00:02:30,600 Speaker 2: a century ago. Though also some of it is just 40 00:02:30,720 --> 00:02:35,680 Speaker 2: about people living longer and surviving things that would have 41 00:02:35,880 --> 00:02:40,800 Speaker 2: killed them in earlier eras, so I thought about doing 42 00:02:40,840 --> 00:02:45,040 Speaker 2: something called six Impossible episodes. Diseases RFKA Junior says he 43 00:02:45,080 --> 00:02:47,560 Speaker 2: has never heard of, but some of the things he 44 00:02:47,600 --> 00:02:50,120 Speaker 2: listed off weren't really diseases. They were more like generic 45 00:02:50,200 --> 00:02:53,280 Speaker 2: descriptions or whole categories. And also that seemed like too 46 00:02:53,360 --> 00:02:56,520 Speaker 2: much for one episode, so I narrowed this down to 47 00:02:56,880 --> 00:03:00,720 Speaker 2: three autoimmune diseases that he mentioned in this speech. They 48 00:03:00,760 --> 00:03:05,480 Speaker 2: are rheumatoid arthritis, lupus, and Crohn's disease. This is not 49 00:03:05,600 --> 00:03:08,160 Speaker 2: a thorough history of all of them. This is really 50 00:03:08,200 --> 00:03:14,519 Speaker 2: about when and where these diseases were first recognized and described. 51 00:03:15,360 --> 00:03:18,760 Speaker 1: So all three of these diseases have some things in common, 52 00:03:19,120 --> 00:03:22,280 Speaker 1: and rather than repeating those commonalities every time, we're going 53 00:03:22,320 --> 00:03:25,000 Speaker 1: to start with some of them. So As Tracy just said, 54 00:03:25,240 --> 00:03:28,639 Speaker 1: they are all autoimmune diseases, meaning they all involve the 55 00:03:28,639 --> 00:03:33,240 Speaker 1: body's immune system attacking healthy tissue, and there is no 56 00:03:33,440 --> 00:03:37,720 Speaker 1: one definitive, exact known cause for any of them. It's 57 00:03:37,880 --> 00:03:41,680 Speaker 1: likely a combination of genetic and environmental factors such as 58 00:03:41,800 --> 00:03:45,000 Speaker 1: exposure to things like pollution or tobacco smoke, as well 59 00:03:45,000 --> 00:03:48,839 Speaker 1: as possibly hormones. All three of these diseases are more 60 00:03:48,880 --> 00:03:52,400 Speaker 1: prevalent in women, in some cases much more prevalent in women. 61 00:03:53,200 --> 00:03:56,320 Speaker 1: It is also possible that viral infections may be involved 62 00:03:56,360 --> 00:03:59,760 Speaker 1: in triggering all of these illnesses, or triggering flare ups 63 00:03:59,760 --> 00:04:01,720 Speaker 1: of the illnesses after they've developed. 64 00:04:02,520 --> 00:04:06,360 Speaker 2: In terms of that genetic element, there is no single 65 00:04:06,520 --> 00:04:11,000 Speaker 2: gene or gene mutation that conclusively causes any of these 66 00:04:11,720 --> 00:04:15,840 Speaker 2: Rheumatoid arthritis, for example, has at least forty six different 67 00:04:15,960 --> 00:04:18,919 Speaker 2: genes that are known to contribute to it in some way. 68 00:04:19,760 --> 00:04:23,120 Speaker 2: These diseases all tend to run in families, but having 69 00:04:23,160 --> 00:04:26,200 Speaker 2: an immediate family member with one of them means that 70 00:04:26,279 --> 00:04:29,599 Speaker 2: a person is more likely to develop it, not that 71 00:04:29,680 --> 00:04:32,080 Speaker 2: they are guaranteed to develop it. 72 00:04:33,000 --> 00:04:36,000 Speaker 1: If one identical twin has one of these diseases, the 73 00:04:36,040 --> 00:04:38,960 Speaker 1: other twin is more likely to have it as well, 74 00:04:39,040 --> 00:04:42,159 Speaker 1: but the rate of both identical twins having the disease 75 00:04:42,640 --> 00:04:47,080 Speaker 1: is in anywhere close to one hundred percent. Studies vary somewhat, 76 00:04:47,120 --> 00:04:51,080 Speaker 1: but generally speaking, if one identical twin has rheumatoid arthritis, 77 00:04:51,400 --> 00:04:54,520 Speaker 1: the other twin develops it only about fifteen percent of 78 00:04:54,560 --> 00:04:58,279 Speaker 1: the time. With Crohn's disease, that number is thirty percent, 79 00:04:58,480 --> 00:05:02,520 Speaker 1: and it's less than fifty percent with lupus. Identical twins 80 00:05:02,560 --> 00:05:04,680 Speaker 1: have the same DNA, and if they grew up in 81 00:05:04,720 --> 00:05:07,880 Speaker 1: the same household, they would likely have very similar, if 82 00:05:07,920 --> 00:05:12,000 Speaker 1: not identical, environmental factors affecting their health. So the fact 83 00:05:12,040 --> 00:05:14,640 Speaker 1: that rate is nowhere near one hundred percent suggests that 84 00:05:14,680 --> 00:05:18,480 Speaker 1: it's more complicated and that there are other factors going on, 85 00:05:18,960 --> 00:05:21,840 Speaker 1: or that some elements are just random. 86 00:05:22,640 --> 00:05:26,280 Speaker 2: Social determinants of health probably play a part in these 87 00:05:26,279 --> 00:05:30,359 Speaker 2: diseases as well. Those are non medical factors like a 88 00:05:30,400 --> 00:05:35,000 Speaker 2: person's income, wealth, education, and where and how they grew up. 89 00:05:35,600 --> 00:05:39,280 Speaker 2: These social determinants may be connected to some of the 90 00:05:39,400 --> 00:05:42,560 Speaker 2: racial disparities that do exist for some of these diseases. 91 00:05:43,240 --> 00:05:47,599 Speaker 2: For example, rheumatoid arthritis is most prevalent in white women, 92 00:05:48,080 --> 00:05:54,240 Speaker 2: but in the United States, Black, Hispanic and Latina, Indigenous, Alaska, Native, Asian, American, 93 00:05:54,440 --> 00:06:00,920 Speaker 2: and Pacific Islander women are all disproportionately more likely to DEVELOPUS. 94 00:06:01,680 --> 00:06:08,400 Speaker 2: There's some suggestion that social determinants are connected to these disparities. Similarly, 95 00:06:08,720 --> 00:06:12,400 Speaker 2: Crohn's disease is less prevalent in the tropics, which has 96 00:06:12,480 --> 00:06:15,279 Speaker 2: led to a hypothesis that it might be connected to 97 00:06:15,560 --> 00:06:19,200 Speaker 2: exposure to sunlight or to a person's vitamin D levels. 98 00:06:20,120 --> 00:06:24,000 Speaker 1: There is also no one single diagnostic test for any 99 00:06:24,040 --> 00:06:28,480 Speaker 1: of these. They all require some combination of family history, 100 00:06:28,640 --> 00:06:33,440 Speaker 1: physical exams, lab work, and imaging or biopsies. So while 101 00:06:33,480 --> 00:06:36,719 Speaker 1: the diseases themselves are not new, some of the tools 102 00:06:36,800 --> 00:06:40,359 Speaker 1: used to detect them are. That also means getting a 103 00:06:40,440 --> 00:06:44,000 Speaker 1: diagnosis can be time and labor intensive, and in the US, 104 00:06:44,040 --> 00:06:47,400 Speaker 1: where we don't have universal health care, that means it's 105 00:06:47,440 --> 00:06:51,600 Speaker 1: also often very expensive. Each of these can also be 106 00:06:51,680 --> 00:06:55,640 Speaker 1: mistaken for other similar diseases, both in living people and 107 00:06:55,760 --> 00:06:59,400 Speaker 1: in the archaeological record, So all of this together means 108 00:06:59,440 --> 00:07:01,880 Speaker 1: that it could be really really tricky to tell when 109 00:07:02,000 --> 00:07:06,200 Speaker 1: humans first started experiencing these diseases, but in all of 110 00:07:06,240 --> 00:07:09,480 Speaker 1: them it was definitely before the twentieth century. 111 00:07:10,400 --> 00:07:14,480 Speaker 2: Of these three diseases, Crone's disease was the one that 112 00:07:14,680 --> 00:07:18,920 Speaker 2: was named and thoroughly described the most recently, so we 113 00:07:19,040 --> 00:07:23,320 Speaker 2: will start there. This is an inflammatory bowel disease that 114 00:07:23,400 --> 00:07:27,560 Speaker 2: causes symptoms like abdominal cramps, pain, and diarrhea, which can 115 00:07:27,600 --> 00:07:31,760 Speaker 2: be bloody. These can happen as flare ups with periods 116 00:07:31,760 --> 00:07:36,240 Speaker 2: of feeling relatively well in between those flare ups. As 117 00:07:36,280 --> 00:07:39,600 Speaker 2: this condition progresses, it can cause thickening and some of 118 00:07:39,640 --> 00:07:43,440 Speaker 2: the tissues of the digestive tract, as well as perforations 119 00:07:43,520 --> 00:07:48,840 Speaker 2: or fistulas in the intestinal tissue. It commonly affects the ilium, 120 00:07:49,080 --> 00:07:52,560 Speaker 2: which is the last part of the small intestine. 121 00:07:52,760 --> 00:07:56,200 Speaker 1: The severity of Crone's disease can vary from person to person, 122 00:07:56,480 --> 00:07:59,280 Speaker 1: and it can also vary over time and eventually cause 123 00:07:59,320 --> 00:08:04,119 Speaker 1: complications in other systems of the body. Treatments include diet 124 00:08:04,200 --> 00:08:10,840 Speaker 1: and lifestyle modifications, anti inflammatory drugs, corticosteroids, immune system suppressors, 125 00:08:11,240 --> 00:08:16,480 Speaker 1: monoclonal antibodies, and antibiotics. If infections develop, damage to the 126 00:08:16,520 --> 00:08:20,080 Speaker 1: intestine can lead to a need for surgery, and sometimes 127 00:08:20,120 --> 00:08:21,840 Speaker 1: more than one surgery. 128 00:08:22,320 --> 00:08:26,480 Speaker 2: Crohn's disease is not caused by stress or diet, but 129 00:08:26,640 --> 00:08:30,520 Speaker 2: both of those things can affect a person's symptoms, including 130 00:08:30,600 --> 00:08:34,400 Speaker 2: contributing to flare ups. Since the disease can affect a 131 00:08:34,440 --> 00:08:38,800 Speaker 2: person's ability to absorb nutrients, some people have to carefully 132 00:08:38,840 --> 00:08:41,600 Speaker 2: manage what they eat, and for some people that just 133 00:08:41,640 --> 00:08:45,480 Speaker 2: becomes kind of exhausting over time. This disease can also 134 00:08:45,559 --> 00:08:49,360 Speaker 2: be really life altering. The symptoms that it can cause 135 00:08:49,440 --> 00:08:53,400 Speaker 2: can be incredibly uncomfortable and embarrassing, and sometimes people have 136 00:08:53,440 --> 00:08:55,959 Speaker 2: a hard time leaving the house to do things they 137 00:08:56,080 --> 00:08:59,360 Speaker 2: enjoy or to travel during a flare because they might 138 00:08:59,400 --> 00:09:01,640 Speaker 2: not have acts us to a bathroom when they need it. 139 00:09:02,400 --> 00:09:05,240 Speaker 2: A lot of people with Crone's disease and with the 140 00:09:05,360 --> 00:09:09,360 Speaker 2: other autoimmune diseases that we're talking about today also talk 141 00:09:09,400 --> 00:09:12,640 Speaker 2: about how hard it can be socially, as their friends 142 00:09:12,720 --> 00:09:15,480 Speaker 2: and family members just assume that they're flaky or that 143 00:09:15,559 --> 00:09:18,800 Speaker 2: they don't care when they have to turn down invitations 144 00:09:18,920 --> 00:09:21,760 Speaker 2: or cancel their plans last minute. And they also talk 145 00:09:21,800 --> 00:09:25,160 Speaker 2: about things like bosses assuming that they are lazy or 146 00:09:25,280 --> 00:09:30,079 Speaker 2: unreliable rather than understanding the realities of their medical condition. 147 00:09:31,360 --> 00:09:35,120 Speaker 2: It's really tricky to know when people first started experiencing 148 00:09:35,200 --> 00:09:38,280 Speaker 2: Crone's disease, because there are a lot of different diseases 149 00:09:38,280 --> 00:09:41,679 Speaker 2: and conditions that can cause chronic diarrhea and abdominal pain. 150 00:09:42,640 --> 00:09:45,880 Speaker 2: Greek physician Aretaeus of Cappadocia, who lived in the first 151 00:09:45,920 --> 00:09:49,560 Speaker 2: century CE, described a young man who was having recurring 152 00:09:49,600 --> 00:09:53,280 Speaker 2: bouts of diarrhea and abdominal distress. But we don't have 153 00:09:53,360 --> 00:09:57,680 Speaker 2: a way to know whether this was Crone's disease. Specifically. Similarly, 154 00:09:57,880 --> 00:10:00,040 Speaker 2: Saxon King Alfred the Great, who lived in the the 155 00:10:00,160 --> 00:10:04,560 Speaker 2: ninth century, had recurring, debilitating abdominal pain in diarrhea, but 156 00:10:04,840 --> 00:10:08,880 Speaker 2: we don't know the exact cause. King Louis the thirteenth 157 00:10:08,880 --> 00:10:11,800 Speaker 2: of France died in sixteen forty three at the age 158 00:10:11,840 --> 00:10:17,520 Speaker 2: of forty two after experiencing recurring chronic diarrhea and other 159 00:10:17,640 --> 00:10:22,839 Speaker 2: abdominal issues for years. An autopsy was conducted after his death, 160 00:10:22,960 --> 00:10:26,520 Speaker 2: and that showed that he had perforations in his small intestine, 161 00:10:26,559 --> 00:10:30,920 Speaker 2: which can be indicative of crones, but he also had 162 00:10:30,960 --> 00:10:34,719 Speaker 2: signs of tuberculosis, which can lead to some similar abdominal 163 00:10:34,760 --> 00:10:35,760 Speaker 2: issues as well. 164 00:10:36,280 --> 00:10:40,920 Speaker 1: In seventeen sixty one, Italian anatomis Giovanni Battista Morgagni wrote 165 00:10:40,920 --> 00:10:44,360 Speaker 1: about a twenty year old man who had died. Morgagni 166 00:10:44,400 --> 00:10:47,720 Speaker 1: conducted an autopsy and found lesions in the man's large 167 00:10:47,720 --> 00:10:53,120 Speaker 1: and small intestines, including perforations and ulcerations, which again could 168 00:10:53,120 --> 00:10:58,120 Speaker 1: have been from Crohn's disease. A century later, Albert von Sachsen, Coburg, 169 00:10:58,160 --> 00:11:00,840 Speaker 1: Prince consort of Queen Victoria, died at the age of 170 00:11:00,840 --> 00:11:03,800 Speaker 1: forty two of what was described at the time as 171 00:11:03,880 --> 00:11:08,280 Speaker 1: typhoid fever, but modern researchers examining his medical records have 172 00:11:08,360 --> 00:11:11,960 Speaker 1: found evidence that he had some kind of chronic intestinal 173 00:11:12,000 --> 00:11:13,679 Speaker 1: disease that was like crones. 174 00:11:14,679 --> 00:11:19,200 Speaker 2: In eighteen seventy five, Samuel Wilkes and Walter Moxon published 175 00:11:19,200 --> 00:11:22,360 Speaker 2: a case report in which they described a young woman 176 00:11:22,400 --> 00:11:28,480 Speaker 2: who had died after experiencing severe bloody diarrhea. They performed 177 00:11:28,520 --> 00:11:31,720 Speaker 2: an autopsy and they found that she had ulcerations and 178 00:11:31,840 --> 00:11:36,760 Speaker 2: inflammations throughout her colon. This is often cited as the 179 00:11:36,800 --> 00:11:43,199 Speaker 2: first very clear clinical description of ulcerative colitis. Alterative colitis 180 00:11:43,200 --> 00:11:46,439 Speaker 2: and Crohn's disease are very similar, and they are generally 181 00:11:46,520 --> 00:11:51,480 Speaker 2: differentiated by exactly where in the digestive system the damage 182 00:11:51,520 --> 00:11:56,680 Speaker 2: is occurring. In nineteen thirty two, Burl Crone, Leon Ginsberg, 183 00:11:56,760 --> 00:11:59,839 Speaker 2: and Gordon D. Oppenheimer published a paper in the journal 184 00:12:00,080 --> 00:12:05,200 Speaker 2: the American Medical Association called regional iliitis a pathological and 185 00:12:05,240 --> 00:12:10,000 Speaker 2: clinical entity. They reported on fourteen patients who had what 186 00:12:10,040 --> 00:12:16,320 Speaker 2: they called regional iliitis. All fourteen had abdominal cramps, diarrhea, fever, 187 00:12:16,480 --> 00:12:19,199 Speaker 2: and weight loss, and they had been treated with surgery. 188 00:12:20,160 --> 00:12:23,600 Speaker 2: They all had evidence of fiscialiformation, and they were all 189 00:12:23,640 --> 00:12:27,320 Speaker 2: emaciated and anemic. At least half of them. 190 00:12:27,200 --> 00:12:31,199 Speaker 1: Had previously had their appendix removed, possibly because doctors had 191 00:12:31,240 --> 00:12:36,600 Speaker 1: mistaken their symptoms for appendicitis. The paper included radiological images 192 00:12:36,720 --> 00:12:40,679 Speaker 1: and ruled out abdominal tuberculosis as the cause of these issues. 193 00:12:41,559 --> 00:12:46,080 Speaker 2: These authors presented regional iliitis as a new disease, but 194 00:12:46,160 --> 00:12:49,480 Speaker 2: there had been several other papers published in the first 195 00:12:49,600 --> 00:12:53,640 Speaker 2: decades of the twentieth century that had also reported very 196 00:12:53,679 --> 00:13:00,720 Speaker 2: similar patterns of intestinal inflammation, perforations, and fiscialiformation. Even so, 197 00:13:00,880 --> 00:13:04,439 Speaker 2: though this is considered a landmark paper, and even though 198 00:13:04,480 --> 00:13:08,520 Speaker 2: the authors had used the name regional iliitis, soon people 199 00:13:08,559 --> 00:13:12,840 Speaker 2: were calling it Crone's disease after author Perl Crone. While 200 00:13:12,880 --> 00:13:17,560 Speaker 2: Crone was listed first among this paper's authors, that was 201 00:13:17,600 --> 00:13:20,600 Speaker 2: just because their names were alphabetical on the paper, he 202 00:13:20,720 --> 00:13:24,000 Speaker 2: actually preferred the name regional iliitis. 203 00:13:24,600 --> 00:13:27,920 Speaker 1: So Crone's disease got its name in nineteen thirty two, 204 00:13:28,280 --> 00:13:31,120 Speaker 1: but it's very likely that it existed long before that. 205 00:13:31,960 --> 00:13:35,320 Speaker 1: Its prevalence does seem to be increasing worldwide, not just 206 00:13:35,360 --> 00:13:37,800 Speaker 1: in the United States, but we really do not know 207 00:13:37,920 --> 00:13:38,959 Speaker 1: exactly why. 208 00:13:39,679 --> 00:13:42,839 Speaker 2: We will talk about rheumatoid arthritis after we take a 209 00:13:42,920 --> 00:13:55,880 Speaker 2: quick sponsor break. All three of the diseases that we're 210 00:13:55,880 --> 00:14:01,839 Speaker 2: talking about today are inflammatory autoimmune diseases. In rheumatoid arthritis 211 00:14:01,920 --> 00:14:05,840 Speaker 2: or RA, the inflammation is in the synovial membranes that 212 00:14:05,880 --> 00:14:10,960 Speaker 2: line the joints. This causes joint pain, swelling, and loss 213 00:14:10,960 --> 00:14:16,400 Speaker 2: of function. Other symptoms can include fatigue, fever, and weight loss. 214 00:14:17,120 --> 00:14:20,800 Speaker 2: This inflammatory process damages the joints over time, and it 215 00:14:20,840 --> 00:14:25,520 Speaker 2: can also damage other body systems. Rheumatoid Arthritis is the 216 00:14:25,560 --> 00:14:29,880 Speaker 2: most common chronic inflammatory joint disease in the world, and 217 00:14:30,000 --> 00:14:32,680 Speaker 2: in the United States it's the third most common type 218 00:14:32,680 --> 00:14:38,600 Speaker 2: of arthritis after osteoarthritis and gout. Juvenile RA also affects 219 00:14:38,720 --> 00:14:41,080 Speaker 2: children and can start an infancy. 220 00:14:41,720 --> 00:14:45,200 Speaker 1: As with Crohn's disease. The prevalence of rheumatoid arthritis does 221 00:14:45,240 --> 00:14:49,360 Speaker 1: seem to be increasing again globally, not just in the US, 222 00:14:49,440 --> 00:14:52,760 Speaker 1: although rates of RA vary dramatically from one part of 223 00:14:52,760 --> 00:14:56,360 Speaker 1: the world to another. Some of this apparent increase is 224 00:14:56,360 --> 00:15:00,960 Speaker 1: because of changing definitions, though the American College of Rheumatology 225 00:15:01,040 --> 00:15:05,360 Speaker 1: and the European Alliance of Associations for Rheumatology issued revised 226 00:15:05,360 --> 00:15:09,280 Speaker 1: definitions for RA in twenty ten, and these new definitions 227 00:15:09,320 --> 00:15:12,320 Speaker 1: focus on symptoms that are present at the earliest stages 228 00:15:12,360 --> 00:15:14,760 Speaker 1: of the disease, which was not the case before. 229 00:15:16,080 --> 00:15:19,680 Speaker 2: A range of treatments exists to help manage RA, and 230 00:15:19,720 --> 00:15:23,280 Speaker 2: a lot of them are targeting the symptoms. These include 231 00:15:23,360 --> 00:15:28,400 Speaker 2: over the counter pain relievers, steroids, and disease modifying anti 232 00:15:28,520 --> 00:15:34,440 Speaker 2: rheumatic drugs or d MARDs. Occupational therapy and lifestyle modifications 233 00:15:34,480 --> 00:15:37,240 Speaker 2: can be involved, and surgeries can as well. 234 00:15:38,320 --> 00:15:40,520 Speaker 1: D MARDs are part of the treatment for a lot 235 00:15:40,560 --> 00:15:43,760 Speaker 1: of autoimmune diseases, and many of them started out as 236 00:15:43,800 --> 00:15:48,560 Speaker 1: anti malaria drugs. In many cases, it's not fully understood 237 00:15:48,600 --> 00:15:51,800 Speaker 1: why these can be helpful for autoimmune diseases, but it 238 00:15:51,880 --> 00:15:54,920 Speaker 1: is likely connected to the way they affect the immune system. 239 00:15:55,800 --> 00:15:59,160 Speaker 1: One of them, hydroxychloroquine, became sought after in the early 240 00:15:59,240 --> 00:16:02,400 Speaker 1: days of the COVID nineteen pandemic after a paper was 241 00:16:02,400 --> 00:16:05,720 Speaker 1: published suggesting that it could be helpful for both treatment 242 00:16:05,840 --> 00:16:11,400 Speaker 1: and post exposure prophylaxis. Experts raised serious concerns about this 243 00:16:11,520 --> 00:16:17,120 Speaker 1: paper almost immediately. Among other things, it included only thirty 244 00:16:17,200 --> 00:16:22,320 Speaker 1: six people, and eventually that paper was retracted. The FDA 245 00:16:22,520 --> 00:16:27,240 Speaker 1: issued an emergency use authorization for hydroxychloroquin as a COVID treatment, 246 00:16:27,280 --> 00:16:31,360 Speaker 1: and then revoked that authorization just a couple of months later, 247 00:16:32,040 --> 00:16:36,280 Speaker 1: as it became increasingly clear that hydroxychloroquin did not treat 248 00:16:36,400 --> 00:16:41,080 Speaker 1: or prevent COVID, but by that point President Donald Trump 249 00:16:41,120 --> 00:16:44,600 Speaker 1: had called it a game changer, which had spiked huge 250 00:16:44,600 --> 00:16:48,680 Speaker 1: demand for it. Some people, including Robert F. Kennedy Junior, 251 00:16:49,240 --> 00:16:54,440 Speaker 1: continued to promote hydroxychloroquin as a COVID treatment for years 252 00:16:54,640 --> 00:16:57,600 Speaker 1: after it was shown not to work for that purpose. 253 00:16:58,400 --> 00:17:03,080 Speaker 1: Kennedy also spread the bay faceless conspiracy theory that hydroxychloroquine 254 00:17:03,200 --> 00:17:07,800 Speaker 1: and iverbectin were effective against COVID, but that the FDA 255 00:17:07,840 --> 00:17:10,560 Speaker 1: was barring people's access to them because it was in 256 00:17:10,600 --> 00:17:15,639 Speaker 1: cahoots with the vaccine industry. This is demonstrably untrue, and 257 00:17:15,880 --> 00:17:18,680 Speaker 1: all of this caused serious problems for people who were 258 00:17:18,800 --> 00:17:23,040 Speaker 1: using hydroxychloroquin to manage their RA or their loopus, which 259 00:17:23,080 --> 00:17:26,600 Speaker 1: we're going to talk about shortly, or other autoimmune diseases. 260 00:17:27,400 --> 00:17:31,720 Speaker 1: People could not get access to their necessary medication because 261 00:17:31,720 --> 00:17:34,199 Speaker 1: people who did not need it and were not going 262 00:17:34,280 --> 00:17:36,719 Speaker 1: to benefit from it, were taking it for something it 263 00:17:36,760 --> 00:17:40,760 Speaker 1: was not effective against. Some people with autoimmune diseases couldn't 264 00:17:40,800 --> 00:17:44,359 Speaker 1: get access to hydroxychloroquine anymore and had to start taking 265 00:17:44,440 --> 00:17:47,480 Speaker 1: other medications that were not as effective for them, or 266 00:17:47,520 --> 00:17:50,560 Speaker 1: weren't effective for them at all, or which had much 267 00:17:50,560 --> 00:17:55,120 Speaker 1: more pronounced and serious side effects. People can experience flare 268 00:17:55,200 --> 00:17:59,400 Speaker 1: ups when stopping hydroxychloroquine even if they're moving to other medications, 269 00:17:59,440 --> 00:18:03,240 Speaker 1: So these needless shortages demonstrably harmed people. 270 00:18:04,400 --> 00:18:08,600 Speaker 2: In terms of when people started experiencing RA. There is 271 00:18:08,800 --> 00:18:11,760 Speaker 2: more debate about that than about either of the other 272 00:18:11,800 --> 00:18:17,320 Speaker 2: two diseases we're talking about today. There are three overarching theories. 273 00:18:17,760 --> 00:18:21,320 Speaker 2: One is that RA is an ancient disease all around 274 00:18:21,320 --> 00:18:26,040 Speaker 2: the world which people have experienced for millennia. Another is 275 00:18:26,080 --> 00:18:30,080 Speaker 2: that RA didn't appear until far more recently, sometime in 276 00:18:30,119 --> 00:18:33,359 Speaker 2: the eighteenth century, and was triggered by something that was 277 00:18:33,480 --> 00:18:37,960 Speaker 2: part of the Industrial Revolution, like maybe something involving pollution 278 00:18:38,359 --> 00:18:43,560 Speaker 2: or industrial chemicals, something like that. But a third idea 279 00:18:43,760 --> 00:18:47,800 Speaker 2: is that RA was an ancient disease in the Americas 280 00:18:47,960 --> 00:18:52,280 Speaker 2: and then was introduced to Europe through exploration and colonization 281 00:18:52,600 --> 00:18:56,959 Speaker 2: starting after the fifteenth century. The idea here is that 282 00:18:57,000 --> 00:19:02,719 Speaker 2: there is more older archaeological evidence that suggestive of rheumatoid 283 00:19:02,840 --> 00:19:06,040 Speaker 2: arthritis in the Americas than there is in other parts 284 00:19:06,080 --> 00:19:09,000 Speaker 2: of the world. So maybe there was some kind of 285 00:19:09,119 --> 00:19:13,480 Speaker 2: disease trigger involved that Europeans did not encounter until that 286 00:19:13,560 --> 00:19:18,160 Speaker 2: exchanged with the Americas. Or maybe RA is related to 287 00:19:18,160 --> 00:19:23,480 Speaker 2: tobacco consumption or tobacco smoke. Tobacco is native to the Americas, 288 00:19:23,840 --> 00:19:27,520 Speaker 2: and it was introduced to Europe by Christopher Columbus's expeditions. 289 00:19:28,160 --> 00:19:31,040 Speaker 2: A counterpoint to that idea is that there's at least 290 00:19:31,160 --> 00:19:35,399 Speaker 2: some suggestion that ARA was present in Europe prior to 291 00:19:35,440 --> 00:19:36,800 Speaker 2: Columbus's voyages. 292 00:19:37,920 --> 00:19:41,560 Speaker 1: Supporters of each of these three hypotheses point to various 293 00:19:41,600 --> 00:19:45,760 Speaker 1: details to back up their claims. Like Greek physician Hippocrates 294 00:19:45,840 --> 00:19:48,840 Speaker 1: described a type of arthritis that appeared by the age 295 00:19:48,840 --> 00:19:51,560 Speaker 1: of thirty five and spread quickly from the feet to 296 00:19:51,640 --> 00:19:54,760 Speaker 1: the hands, then the elbows and knees, than the hips. 297 00:19:55,680 --> 00:19:59,640 Speaker 1: That sounds more like rheumatoid arthritis than osteoarthritis, which can 298 00:19:59,640 --> 00:20:03,080 Speaker 1: happen more than one joint but typically doesn't affect that 299 00:20:03,160 --> 00:20:06,080 Speaker 1: many joints in that many parts of the body that quickly. 300 00:20:07,080 --> 00:20:11,359 Speaker 1: Roman physicians Scribonius Largest also described a form of arthritis 301 00:20:11,520 --> 00:20:14,399 Speaker 1: that mostly affected women, and he did that around one 302 00:20:14,480 --> 00:20:19,920 Speaker 1: hundred BCE. Michael Celis's Chronographia, written in the eleventh century, 303 00:20:20,320 --> 00:20:24,680 Speaker 1: describes Roman emperor Constantine the ninth as experiencing a disease 304 00:20:24,720 --> 00:20:27,600 Speaker 1: that affected his feet, and then his hands, and then 305 00:20:27,640 --> 00:20:32,320 Speaker 1: his shoulders and then his whole body. Given medical understanding 306 00:20:32,400 --> 00:20:36,000 Speaker 1: at the time, it's described as humors attacking these parts 307 00:20:36,000 --> 00:20:36,680 Speaker 1: of his body. 308 00:20:37,840 --> 00:20:41,720 Speaker 2: There are also some possible examples of ra in works 309 00:20:41,760 --> 00:20:46,280 Speaker 2: of art from before the Industrial Revolution. One example is 310 00:20:46,359 --> 00:20:50,640 Speaker 2: Reuben's The Three Graces, which was painted in the sixteen thirties. 311 00:20:51,520 --> 00:20:55,000 Speaker 2: This painting features three nude women, and the one on 312 00:20:55,040 --> 00:20:57,840 Speaker 2: the far left has her hand on the upper arm 313 00:20:57,920 --> 00:21:01,680 Speaker 2: of the woman next to her. Her wrist is flexed 314 00:21:01,880 --> 00:21:05,080 Speaker 2: laterally and her fingers appear to be bent in a 315 00:21:05,119 --> 00:21:09,320 Speaker 2: way that resembles somebody whose hand has been damaged by ra. 316 00:21:10,560 --> 00:21:14,600 Speaker 2: This model may be Rubens's wife, Helena Formant, and there 317 00:21:14,680 --> 00:21:18,720 Speaker 2: are some other portraits of her that have similar depictions 318 00:21:18,760 --> 00:21:19,480 Speaker 2: of her hands. 319 00:21:20,560 --> 00:21:24,399 Speaker 1: All of this could be describing or depicting rheumatoid arthritis, 320 00:21:24,440 --> 00:21:27,040 Speaker 1: but we don't know for sure since there are also 321 00:21:27,280 --> 00:21:31,480 Speaker 1: other diseases and conditions that can cause joint damage. This 322 00:21:31,640 --> 00:21:34,359 Speaker 1: is also true of joint damage that's suggestive of RA 323 00:21:34,600 --> 00:21:39,400 Speaker 1: in the archaeological record. RA can leave evidence on the bones, 324 00:21:39,640 --> 00:21:44,760 Speaker 1: but so can other diseases, including ankylosing spondylitis or AS, 325 00:21:44,840 --> 00:21:48,840 Speaker 1: which primarily affects the spine. It wasn't until the twentieth 326 00:21:48,880 --> 00:21:53,520 Speaker 1: century that researchers started differentiating between RA and AS, which 327 00:21:53,600 --> 00:21:57,040 Speaker 1: led to some earlier RA findings in the archaeological record 328 00:21:57,320 --> 00:22:00,960 Speaker 1: being reinterpreted as AS or as some other condition. 329 00:22:02,359 --> 00:22:06,800 Speaker 2: By the seventeenth century, though, physicians in Europe were starting 330 00:22:06,840 --> 00:22:12,040 Speaker 2: to differentiate between different types of arthritis and different inflammatory 331 00:22:12,119 --> 00:22:16,960 Speaker 2: diseases and processes. For example, in sixteen seventy six, physician 332 00:22:17,080 --> 00:22:24,720 Speaker 2: Thomas Sydenham published Observationist Medicaid, which differentiated between rheumatism and gout. 333 00:22:25,359 --> 00:22:29,159 Speaker 2: Gout is an inflammatory arthritis that today we know is 334 00:22:29,240 --> 00:22:33,480 Speaker 2: caused by uric acid build up in the blood. Gout 335 00:22:33,600 --> 00:22:36,080 Speaker 2: often affects the big toe, but it can occur in 336 00:22:36,240 --> 00:22:40,760 Speaker 2: any joint. In the eighteenth century, William Heberdon the Elder 337 00:22:40,880 --> 00:22:46,760 Speaker 2: also described rheumatism and gout as two different diseases. In 338 00:22:46,840 --> 00:22:51,080 Speaker 2: seventeen eighty two, Joan Paterson of Iceland described a chronic 339 00:22:51,200 --> 00:22:54,560 Speaker 2: arthritis happening on both sides of the body that seemed 340 00:22:54,560 --> 00:22:58,000 Speaker 2: to be systemic. It was more prevalent in women, and 341 00:22:58,040 --> 00:23:00,720 Speaker 2: the incidents seemed to peak around the EA of forty. 342 00:23:01,760 --> 00:23:04,199 Speaker 1: This sounds a lot like ra but the person who 343 00:23:04,280 --> 00:23:08,200 Speaker 1: is usually cited as providing the first clear clinical description 344 00:23:08,320 --> 00:23:12,400 Speaker 1: of RARE is Augustine Jacob Lancre Beauvais. In eighteen hundred, 345 00:23:13,119 --> 00:23:15,600 Speaker 1: he was a twenty eight year old resident physician at 346 00:23:15,600 --> 00:23:19,560 Speaker 1: the Saint Pitrier Asylum in France. He described a set 347 00:23:19,600 --> 00:23:23,000 Speaker 1: of patients, most of them poor women, who had severe 348 00:23:23,080 --> 00:23:27,520 Speaker 1: joint pains not caused by osteo arthritis. He thought this 349 00:23:27,640 --> 00:23:29,680 Speaker 1: was a type of gout, and he called it gut 350 00:23:29,760 --> 00:23:33,520 Speaker 1: astanique primitive or primary asthenic gout. 351 00:23:34,400 --> 00:23:38,800 Speaker 2: In eighteen fifty three, French neurologist Jean Martine Charcaut wrote 352 00:23:38,800 --> 00:23:43,480 Speaker 2: a doctoral thesis in which he described arthritis, muscular atrophy, 353 00:23:43,640 --> 00:23:48,800 Speaker 2: and muscular and skeletal malformations. This condition, as he was 354 00:23:48,840 --> 00:23:52,639 Speaker 2: describing it, seemed to go into remission spontaneously, but that 355 00:23:52,760 --> 00:23:58,240 Speaker 2: it would recur. Six years later, English physician Alfred Berengarrett 356 00:23:58,280 --> 00:24:01,959 Speaker 2: wrote Treatise on the Nature of Gout and Rheumatic Gout, 357 00:24:02,359 --> 00:24:07,159 Speaker 2: which again differentiated between gout caused by excess uric acid 358 00:24:07,160 --> 00:24:10,760 Speaker 2: in the blood and what he called rheumatic gout, which 359 00:24:10,800 --> 00:24:14,560 Speaker 2: was a different thing. Garret's son, Archibald, also became a 360 00:24:14,600 --> 00:24:19,480 Speaker 2: doctor and coined the term rheumatoid arthritis and his Treatise 361 00:24:19,520 --> 00:24:22,919 Speaker 2: on Rheumatism and Rheumatoid Arthritis in eighteen ninety. 362 00:24:24,000 --> 00:24:26,439 Speaker 1: Archibald Garred was one of the people who thought there 363 00:24:26,520 --> 00:24:30,280 Speaker 1: was archaeological evidence of rheumatoid arthritis going back to the 364 00:24:30,359 --> 00:24:34,800 Speaker 1: ancient world. But in the twentieth century, American physician Charles 365 00:24:34,800 --> 00:24:37,320 Speaker 1: Short looked back at some of the same reports that 366 00:24:37,440 --> 00:24:40,960 Speaker 1: Archibald Geron had used and concluded that they were describing 367 00:24:41,000 --> 00:24:45,440 Speaker 1: a range of different diseases and conditions and not rheumatoid arthritis. 368 00:24:46,200 --> 00:24:52,159 Speaker 1: This included ankylosing, spondylitis, osteoarthritis, and gout, so Short argued 369 00:24:52,160 --> 00:24:55,160 Speaker 1: that are was a modern disease and not an ancient 370 00:24:55,200 --> 00:24:58,760 Speaker 1: one as we said earlier. There continues to be debate 371 00:24:58,800 --> 00:25:00,000 Speaker 1: on this today. 372 00:25:00,680 --> 00:25:02,760 Speaker 2: The debate is not about it starting in the nineteen 373 00:25:02,800 --> 00:25:06,879 Speaker 2: fifties and sixties, though all of the debate is centuries 374 00:25:06,880 --> 00:25:10,240 Speaker 2: earlier than that. We will have one more sponsor break, 375 00:25:10,240 --> 00:25:23,200 Speaker 2: and then we will talk about lupus. The last autoimmune 376 00:25:23,200 --> 00:25:27,520 Speaker 2: disease we're talking about is lupus. The word lupus is 377 00:25:27,680 --> 00:25:31,440 Speaker 2: part of the name of several diseases today, but when 378 00:25:31,480 --> 00:25:37,440 Speaker 2: people say lupus, they are usually talking about systemic lupus, erythematosis, 379 00:25:38,080 --> 00:25:43,119 Speaker 2: or sle I have heard people say the word arithmatosis 380 00:25:43,400 --> 00:25:47,439 Speaker 2: and arithmatosis a number of different ways of pronouncing that 381 00:25:47,600 --> 00:25:52,280 Speaker 2: last word regardless. It comes from the Greek word erythros, 382 00:25:52,400 --> 00:25:55,520 Speaker 2: meaning red, and that's a reference to the rashes that 383 00:25:55,560 --> 00:25:57,720 Speaker 2: are often a part of this disease. 384 00:25:58,760 --> 00:26:02,320 Speaker 1: This is another inflame amatory autoimmune disease, with lots of 385 00:26:02,400 --> 00:26:05,600 Speaker 1: possible symptoms, depending on which parts of the body the 386 00:26:05,600 --> 00:26:10,040 Speaker 1: immune system is attacking. There is also neonatal lupus, which 387 00:26:10,080 --> 00:26:13,000 Speaker 1: is a rare condition that occurs when a person's antibodies 388 00:26:13,400 --> 00:26:17,440 Speaker 1: passed to their fetus through the placenta. Drug induced lupus, 389 00:26:17,480 --> 00:26:22,720 Speaker 1: and discoid lupus arithmetosis, which affects mostly the skin. The 390 00:26:22,800 --> 00:26:27,159 Speaker 1: term lupus vulgaris is also used to describe cutaneous tuberculosis, 391 00:26:27,880 --> 00:26:31,200 Speaker 1: so we're really focused on sl here, but the use 392 00:26:31,280 --> 00:26:35,120 Speaker 1: of the term lupus to describe a lot of different 393 00:26:35,160 --> 00:26:39,960 Speaker 1: conditions goes way back in history. The first known use 394 00:26:40,040 --> 00:26:43,080 Speaker 1: of the term lupus in medicine was in reference to 395 00:26:43,200 --> 00:26:48,200 Speaker 1: a tenth century Catholic bishop named Eraclius. He had an 396 00:26:48,400 --> 00:26:53,240 Speaker 1: ulcerous condition that mainly affected the area around his buttocks, 397 00:26:53,320 --> 00:26:58,000 Speaker 1: and this was described as lupus because it devoured. 398 00:26:57,400 --> 00:26:59,960 Speaker 2: His tissue the way that a wolf wood. 399 00:27:00,480 --> 00:27:02,879 Speaker 1: The word loopis went on to be used to describe 400 00:27:03,040 --> 00:27:07,199 Speaker 1: a lot of different rashes, ulcers, and even cancers for centuries, 401 00:27:08,040 --> 00:27:10,680 Speaker 1: by at least the thirteenth century. This included using the 402 00:27:10,760 --> 00:27:15,080 Speaker 1: term loopis to describe facial rashes and lesions, specifically on 403 00:27:15,200 --> 00:27:18,600 Speaker 1: the face. A malar rash or rash shaped like a 404 00:27:18,640 --> 00:27:23,160 Speaker 1: butterfly across a person's cheeks is associated with SLE today, 405 00:27:23,320 --> 00:27:28,240 Speaker 1: although other conditions, including roseacea, can cause similar rashes, and 406 00:27:28,320 --> 00:27:31,280 Speaker 1: not everyone with SLE has this rash. 407 00:27:31,920 --> 00:27:33,840 Speaker 2: It can also look a little different depending on what 408 00:27:33,920 --> 00:27:38,320 Speaker 2: a person's skin color is. Other typical symptoms of SLE 409 00:27:38,600 --> 00:27:43,639 Speaker 2: include unexplained fevers, painful or swollen joints, and kidney problems. 410 00:27:44,080 --> 00:27:46,560 Speaker 2: It can also lead to heart failure, and then there 411 00:27:46,600 --> 00:27:49,240 Speaker 2: can be a range of additional symptoms as well that 412 00:27:49,320 --> 00:27:52,600 Speaker 2: can really vary from person to person, including hair loss, 413 00:27:52,720 --> 00:27:56,720 Speaker 2: chest pain, and pale or purple fingers and toes. When 414 00:27:56,720 --> 00:27:59,600 Speaker 2: somebody gets cold or is under a lot of stress, 415 00:27:59,680 --> 00:28:04,080 Speaker 2: this is known as Reynod's phenomenon. As with Crohn's disease 416 00:28:04,200 --> 00:28:08,879 Speaker 2: and ra, SLE can cause recurring periods of illness and 417 00:28:09,000 --> 00:28:14,440 Speaker 2: relative health or flares and remission. Treatments include non steroidal 418 00:28:14,520 --> 00:28:19,440 Speaker 2: anti inflammatory drugs, cordic asteroids, and d marts, and there 419 00:28:19,440 --> 00:28:22,879 Speaker 2: are also various treatments that are focused on minimizing the 420 00:28:22,960 --> 00:28:24,760 Speaker 2: skin irritation and rashes. 421 00:28:26,000 --> 00:28:28,520 Speaker 1: Of course, the broad use of the word lupus to 422 00:28:28,600 --> 00:28:33,280 Speaker 1: describe things other than SLE complicates the conversation about exactly 423 00:28:33,280 --> 00:28:37,359 Speaker 1: when SLE was first described. But beyond that, like the 424 00:28:37,400 --> 00:28:41,080 Speaker 1: other diseases we've talked about today, SLE share symptoms with 425 00:28:41,160 --> 00:28:45,400 Speaker 1: other diseases and conditions. It wasn't until the nineteenth century 426 00:28:45,440 --> 00:28:50,280 Speaker 1: that descriptions and definitions started to become more precise. So 427 00:28:50,560 --> 00:28:54,320 Speaker 1: in the eighteen teens, Robert Willin and his mentee, Thomas 428 00:28:54,360 --> 00:29:00,479 Speaker 1: Bateman wrote a book called Delineations of Cutaneous Diseases. Willin 429 00:29:00,600 --> 00:29:03,720 Speaker 1: died in eighteen twelve, and Bateman finished the book and 430 00:29:03,760 --> 00:29:07,760 Speaker 1: published it in eighteen seventeen. This book laid out a 431 00:29:07,840 --> 00:29:13,240 Speaker 1: systemic way to categorize different skin diseases, along with engravings, 432 00:29:13,400 --> 00:29:21,320 Speaker 1: illustrating those diseases under tuberculous diseases, meaning diseases that cause tubercules, 433 00:29:21,720 --> 00:29:27,600 Speaker 1: not necessarily tuberculosis. Specifically, they used the term loupis to 434 00:29:27,760 --> 00:29:35,160 Speaker 1: describe rashes and lesions affecting specifically the face. Over the 435 00:29:35,200 --> 00:29:39,479 Speaker 1: course of the nineteenth century, doctors started drawing distinctions between 436 00:29:39,600 --> 00:29:43,080 Speaker 1: types of loopus, with some conditions primarily affecting the skin 437 00:29:43,640 --> 00:29:47,320 Speaker 1: and others also involving other organs the way SLE does. 438 00:29:48,280 --> 00:29:52,520 Speaker 1: The first detailed modern description of sle is usually cited 439 00:29:52,840 --> 00:29:57,720 Speaker 1: as coming from French dermatologist Pierre Kazenev in eighteen thirty three. 440 00:29:58,560 --> 00:30:01,440 Speaker 1: Kasenev had a six xt year career as a doctor, 441 00:30:01,480 --> 00:30:05,520 Speaker 1: and during that time he also differentiated between discoid lupus 442 00:30:05,560 --> 00:30:09,440 Speaker 1: and systemic lupus, and in eighteen forty seven he described 443 00:30:09,440 --> 00:30:13,520 Speaker 1: the differences between lupus vulgaris caused by tuberculosis and what 444 00:30:13,640 --> 00:30:19,080 Speaker 1: he called lupus de res Matteau. Two years later, Viennese 445 00:30:19,160 --> 00:30:24,400 Speaker 1: physician Ferdinand von Hebra described the butterfly like rash that's 446 00:30:24,520 --> 00:30:28,920 Speaker 1: seen as often characteristic of sl today that In eighteen 447 00:30:29,000 --> 00:30:33,280 Speaker 1: sixty eight, physician and surgeon Alexander John Balmanos Squire used 448 00:30:33,320 --> 00:30:38,760 Speaker 1: the term vespertilio or bat like to describe the same rash. 449 00:30:39,120 --> 00:30:43,960 Speaker 1: In eighteen seventy two, Hungarian dermatologist Maurite's Caposi continued to 450 00:30:44,080 --> 00:30:49,040 Speaker 1: refine definitions for lupus, including drawing a distinction between discoid 451 00:30:49,080 --> 00:30:53,360 Speaker 1: lupus primarily affecting the skin, and disseminated lupus, which was 452 00:30:53,400 --> 00:30:57,760 Speaker 1: a systemic lupus that could sometimes be fatal. He described 453 00:30:57,760 --> 00:31:01,280 Speaker 1: the other potential symptoms of this sumtime times fatal systemic 454 00:31:01,320 --> 00:31:06,040 Speaker 1: lupus as including swollen lymph nodes, joint pain, pain in 455 00:31:06,120 --> 00:31:09,000 Speaker 1: the long bones, fever, and weight loss. 456 00:31:09,920 --> 00:31:13,760 Speaker 2: In eighteen seventy nine, Emil Vidal, who worked at Opitdal 457 00:31:13,880 --> 00:31:19,480 Speaker 2: san Lui in Paris, further distinguished lupus arithmetosis from lupus 458 00:31:19,560 --> 00:31:24,720 Speaker 2: vulgaris caused by tuberculosis. Later, Robert Coch's discovery of the 459 00:31:24,760 --> 00:31:30,600 Speaker 2: tuberculosis bacillis in eighteen eighty two helped doctors conclusively diagnose 460 00:31:30,840 --> 00:31:35,520 Speaker 2: lupus vulgaris as caused by TB. At that point, it 461 00:31:35,600 --> 00:31:39,360 Speaker 2: quickly became clear that lupus vulgaris was far more common 462 00:31:39,480 --> 00:31:41,160 Speaker 2: than lupus arithmatosis. 463 00:31:42,200 --> 00:31:46,160 Speaker 1: In eighteen ninety four, J. Pain delivered a postgraduate lecture 464 00:31:46,480 --> 00:31:49,000 Speaker 1: in which he reported that quinine could be useful in 465 00:31:49,040 --> 00:31:52,440 Speaker 1: the treatment of lupus, likely the earliest use of an 466 00:31:52,480 --> 00:31:55,800 Speaker 1: anti malarial drug in the treatment of an autoimmune disease. 467 00:31:56,760 --> 00:32:00,800 Speaker 1: From this point, doctors continued to develop new methods for 468 00:32:00,960 --> 00:32:04,480 Speaker 1: diagnosing slee and for trying to treat it and manage 469 00:32:04,520 --> 00:32:09,560 Speaker 1: its symptoms. Then, in nineteen forty eight, Malcolm McCallum Hargraves 470 00:32:09,920 --> 00:32:13,680 Speaker 1: discovered what came to be known as the lupus arithmetosis 471 00:32:13,720 --> 00:32:17,720 Speaker 1: cell or le E cell. It is also sometimes called 472 00:32:17,720 --> 00:32:22,280 Speaker 1: the Hargraves cell. This is a cellular indication of an 473 00:32:22,320 --> 00:32:27,160 Speaker 1: autoimmune process going on inside the body. This discovery apparently 474 00:32:27,280 --> 00:32:30,360 Speaker 1: came about by happenstance. There was a hematologist at the 475 00:32:30,400 --> 00:32:33,360 Speaker 1: Mayo Clinic who was drawing the blood from patients and 476 00:32:33,440 --> 00:32:36,400 Speaker 1: treating it with an anticoagulant and then just walking over 477 00:32:36,480 --> 00:32:39,880 Speaker 1: to the lab a few blocks away. This window of 478 00:32:39,960 --> 00:32:40,600 Speaker 1: time to. 479 00:32:40,680 --> 00:32:44,360 Speaker 2: Walk for the lab allowed the process that made these 480 00:32:44,440 --> 00:32:48,200 Speaker 2: cells visible to take place, and without that little time window, 481 00:32:48,440 --> 00:32:52,720 Speaker 2: it probably would not have been noticed. Lee cells are 482 00:32:52,880 --> 00:32:57,080 Speaker 2: specific types of white blood cells that have been engulfed 483 00:32:57,160 --> 00:33:01,200 Speaker 2: by the denatured nuclear material from US. Their cells and 484 00:33:01,280 --> 00:33:05,320 Speaker 2: the presence of these cells can be indicative of sl 485 00:33:05,760 --> 00:33:08,840 Speaker 2: as well as of other autoimmune diseases. 486 00:33:10,040 --> 00:33:13,480 Speaker 1: As with RA and Crohne's disease. It does seem like 487 00:33:13,560 --> 00:33:16,920 Speaker 1: lupus rates are increasing, but as with those this is 488 00:33:16,960 --> 00:33:20,000 Speaker 1: a global trend, not just in the US, although there 489 00:33:20,160 --> 00:33:23,240 Speaker 1: is a lot of regional and demographic variation in how 490 00:33:23,280 --> 00:33:27,640 Speaker 1: prevalent it is. But again, none of these diseases are 491 00:33:27,760 --> 00:33:30,320 Speaker 1: post twentieth century developments. 492 00:33:30,640 --> 00:33:33,320 Speaker 2: Kay man, I'm sorry, not sure how you got to 493 00:33:33,360 --> 00:33:36,160 Speaker 2: be the Secretary of Health and Human Services having not 494 00:33:36,200 --> 00:33:38,760 Speaker 2: heard of juvenile diabetes, but that's where we are. 495 00:33:40,000 --> 00:33:45,240 Speaker 1: Well, it's like it's that thing that I've never heard 496 00:33:45,280 --> 00:33:47,800 Speaker 1: of it so it doesn't exist. Thing is just wild 497 00:33:47,840 --> 00:33:50,720 Speaker 1: to me. There's so many things I've never heard of, Yeah, 498 00:33:50,760 --> 00:33:55,320 Speaker 1: but they are real. A lot of people never heard 499 00:33:55,360 --> 00:34:01,440 Speaker 1: of spasmodic dysphonia until RFK Junior became a public figure 500 00:34:01,720 --> 00:34:07,880 Speaker 1: yep while experiencing it. YEP. Anyway, I have. 501 00:34:09,400 --> 00:34:12,440 Speaker 2: Some listener mail before we you know, we're going to 502 00:34:12,520 --> 00:34:14,720 Speaker 2: go on from this to record our Friday behind the scenes. 503 00:34:14,719 --> 00:34:18,520 Speaker 2: I'm sure we'll have plenty more things to say. This 504 00:34:18,560 --> 00:34:21,880 Speaker 2: is from Kristen. This is the subject line of this 505 00:34:22,000 --> 00:34:26,920 Speaker 2: email is Cecilia Paying Gaposhkin in horrible handwriting. Kristin wrote, Hi, 506 00:34:27,040 --> 00:34:29,440 Speaker 2: Holly and Tracy. When I listened to your Saturday Classic 507 00:34:29,480 --> 00:34:32,480 Speaker 2: episode on Cecilia Paying Gaposhkin, I heard you mentioned your 508 00:34:32,480 --> 00:34:35,839 Speaker 2: difficulty with handwriting, and you're musing that maybe you should 509 00:34:35,840 --> 00:34:38,360 Speaker 2: have been taught to write with your left hand. My 510 00:34:38,440 --> 00:34:42,200 Speaker 2: son also has tremendous difficulty with handwriting, and his schoolwork 511 00:34:42,360 --> 00:34:46,240 Speaker 2: was greatly affected. He was failing everything in sixth grade. 512 00:34:46,239 --> 00:34:49,520 Speaker 2: We requested that the school test him for specific learning 513 00:34:49,560 --> 00:34:53,319 Speaker 2: disabilities as a last resort because we were at our 514 00:34:53,400 --> 00:34:56,920 Speaker 2: wits end as most of his trouble was in literature. 515 00:34:57,040 --> 00:35:00,520 Speaker 2: I suspected he had dyslexia. It turns out there is 516 00:35:00,560 --> 00:35:05,799 Speaker 2: another SLD related to dyslexia called dysgraphia that is characterized 517 00:35:05,800 --> 00:35:09,080 Speaker 2: by difficulty with handwriting. I often describe it to people 518 00:35:09,160 --> 00:35:12,520 Speaker 2: unfamiliar with this condition that if dyslexia is trouble getting 519 00:35:12,560 --> 00:35:17,120 Speaker 2: written information into the brain, dysgraphia is trouble getting written 520 00:35:17,160 --> 00:35:20,040 Speaker 2: information out of the brain. Of course, it's a lot 521 00:35:20,080 --> 00:35:24,080 Speaker 2: more nuanced than that simple explanation. Since his diagnosis and 522 00:35:24,200 --> 00:35:28,000 Speaker 2: subsequent IEP to allow him to give typed or oral 523 00:35:28,120 --> 00:35:31,560 Speaker 2: answers another support, he has completely turned his education around 524 00:35:31,880 --> 00:35:34,280 Speaker 2: in tenth grade. Now he is an honor student, taking 525 00:35:34,280 --> 00:35:38,880 Speaker 2: two ap math courses and honors wind ensemble. He plays 526 00:35:38,880 --> 00:35:41,279 Speaker 2: tenor sacks in the jazz band. Also, he says he 527 00:35:41,320 --> 00:35:44,560 Speaker 2: wants to study science communication in college. Just wanted to 528 00:35:44,560 --> 00:35:47,920 Speaker 2: bring awareness to this SLD because not many people even 529 00:35:47,920 --> 00:35:50,800 Speaker 2: know it exists. I sure hadn't heard of it until 530 00:35:50,800 --> 00:35:53,680 Speaker 2: my son's diagnosis. Thank you for being a bright spot 531 00:35:53,760 --> 00:35:56,600 Speaker 2: in these gloomy times and making me laugh four times 532 00:35:56,640 --> 00:36:01,200 Speaker 2: a week. Kristen Kristin has also included had some pet tags. 533 00:36:01,640 --> 00:36:05,040 Speaker 2: There is a thirteen year old Golden Retriever mix named Hass. 534 00:36:05,680 --> 00:36:10,400 Speaker 2: There's a Lab mix named Midnight, newly adopted little sister 535 00:36:10,480 --> 00:36:14,799 Speaker 2: to Hass. Trip is the Tripod ginger rescued from the 536 00:36:14,840 --> 00:36:16,960 Speaker 2: side of the road as a kitten who thinks he 537 00:36:17,200 --> 00:36:19,960 Speaker 2: is a hoss. And then Rascal is a blue smoke 538 00:36:20,080 --> 00:36:26,200 Speaker 2: tabby found in an abandoned shed. And then Stella born 539 00:36:26,280 --> 00:36:29,000 Speaker 2: to a feral managed barn colony, but brought into the 540 00:36:29,040 --> 00:36:32,160 Speaker 2: house for health reasons as a small kitten. Stella is 541 00:36:32,160 --> 00:36:34,400 Speaker 2: a torty, so is obviously in charge. 542 00:36:35,320 --> 00:36:39,040 Speaker 1: Oh my goodness, I think I got the one torty 543 00:36:39,080 --> 00:36:43,520 Speaker 1: that has no in chargedness. Yeah, well, it just has 544 00:36:43,600 --> 00:36:48,000 Speaker 1: none the tourty I used to have. Cestina was also 545 00:36:48,120 --> 00:36:50,160 Speaker 1: never in Yes, she was not a sassy cat. 546 00:36:50,280 --> 00:36:55,640 Speaker 2: She was not sassy. She desperately wanted to play with 547 00:36:55,800 --> 00:36:58,640 Speaker 2: Villanell when I got them both, and Villanell did not 548 00:36:58,760 --> 00:37:02,080 Speaker 2: want this at all. She couldn't seem to retain that 549 00:37:02,160 --> 00:37:04,359 Speaker 2: Villainel was never going to want to play with her, 550 00:37:05,520 --> 00:37:08,840 Speaker 2: which was said. They eventually learned to tolerate each other well enough. 551 00:37:10,800 --> 00:37:14,640 Speaker 2: Thank you so much for these pat pictures. My goodness, 552 00:37:14,680 --> 00:37:19,640 Speaker 2: so cute, all of them so cute. Thanks also for 553 00:37:19,719 --> 00:37:25,799 Speaker 2: this email. I had heard of dysgraphia also discalcula. I 554 00:37:25,840 --> 00:37:30,400 Speaker 2: think we have gotten some emails about before dyscalcula involving 555 00:37:30,600 --> 00:37:36,000 Speaker 2: struggles with mathematics. Some of these things are sort of 556 00:37:36,360 --> 00:37:39,480 Speaker 2: they can be connected to other things that are also 557 00:37:39,600 --> 00:37:43,600 Speaker 2: going on, and sometimes they are it's like that's this, 558 00:37:43,600 --> 00:37:47,360 Speaker 2: this is the thing that the person is sort of experiencing. 559 00:37:48,560 --> 00:37:52,520 Speaker 2: I have like family members who have struggles with different 560 00:37:52,600 --> 00:37:56,880 Speaker 2: things that all relate to like the same motor planning 561 00:37:56,960 --> 00:37:59,920 Speaker 2: issue in their mind that sort of evidences itself in 562 00:38:00,080 --> 00:38:00,800 Speaker 2: multiple ways. 563 00:38:00,880 --> 00:38:01,279 Speaker 1: And then I. 564 00:38:01,239 --> 00:38:08,759 Speaker 2: Also, dyslexia in particular runs broadly in my family. Would 565 00:38:08,840 --> 00:38:11,960 Speaker 2: I have been diagnosed with dysgraphia as a child who 566 00:38:12,000 --> 00:38:18,600 Speaker 2: can say yeah? So, thank you so much Kristen for 567 00:38:18,680 --> 00:38:22,239 Speaker 2: this email and the pictures. If you would like to 568 00:38:22,320 --> 00:38:25,520 Speaker 2: send us a note, We're at History Podcasts at iHeartRadio 569 00:38:25,640 --> 00:38:29,319 Speaker 2: dot com and you can subscribe to our show on 570 00:38:29,400 --> 00:38:32,520 Speaker 2: the iHeartRadio app and anywhere else you get your podcast. 571 00:38:38,040 --> 00:38:41,160 Speaker 2: Stuff you missed in History Class is a production of iHeartRadio. 572 00:38:41,480 --> 00:38:46,120 Speaker 2: For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, 573 00:38:46,239 --> 00:38:48,240 Speaker 2: or wherever you listen to your favorite shows.