Clinical Currents Podcast

In this episode, hosts Drs. Peter Gregory and Meredith Chiasson discuss systemic lupus erythematosus (SLE) with Dr. Alexandra Legge – adult rheumatologist at the QEII Health Sciences Centre, assistant professor in the Division of Rheumatology at Dalhousie University, and director of the Dalhousie Lupus Clinic.

Dr. Legge explains why lupus can be so challenging to recognize, including the wide variability in how it presents and the limitations of relying on pattern recognition alone. She explores clinical features that should raise suspicion for lupus, offers practical guidance on interpreting positive ANA results, and discusses how laboratory findings such as cytopenias, complement levels, ESR, and CRP can help clinicians determine when further investigation is warranted.

The conversation also examines organ involvement that can be easy to miss, including lupus nephritis and neuropsychiatric manifestations, as well as when suspected lupus requires urgent rheumatology assessment. Dr. Legge discusses strategies for minimizing the long-term harms of corticosteroid use and highlights recent advances in lupus treatment, including new biologic and cellular therapies and evolving approaches to lupus nephritis.

Listeners of this episode will gain insights into:

• Clinical features that should raise suspicion for lupus, including less-recognized constitutional presentations
• How to approach and interpret a positive ANA in patients with non-specific symptoms
• Practical laboratory investigations for suspected lupus and when additional testing is appropriate
• How ESR and CRP can behave differently in lupus – and when a markedly elevated CRP should raise concern for infection
• Organ manifestations that may require urgent investigation or rheumatology referral, including renal, hematologic and neuropsychiatric disease
• Strategies for reducing cumulative corticosteroid exposure and mitigating its long-term harms
• Recent advances in lupus treatment and the changing approach to lupus nephritis

Timestamps

• 04:16 – Why lupus can be challenging to diagnose early
• 06:21 – Early clinical features that should raise suspicion for lupus
• 11:24 – Making sense of a positive ANA
• 16:16 – Assessing non-specific symptoms and distinguishing lupus from other conditions
• 19:02 – Recognizing inflammatory arthritis in lupus
• 22:06 – ESR, CRP, and other helpful laboratory clues
• 26:00 – When to refer urgently to rheumatology
• 28:21 – A practical approach to the initial lupus workup
• 31:36 – Organ involvement: lupus nephritis, hematologic and neuropsychiatric manifestations
• 37:09 – Steroid stewardship and reducing long-term harm
• 41:18 – Recent advances in lupus treatment
• 44:16 – Changing approaches to lupus nephritis
• 46:31 – Key takeaways for internists

Resources mentioned in this episode:

· American College of Rheumatology Guideline for the Treatment of Systemic Lupus Erythematosus

· American College of Rheumatology Guideline for the Screening, Treatment, and Management of Lupus Nephritis

· American College of Rheumatology – Lupus information and resources

· Lupus Canada – Information and resources on systemic lupus erythematosus

Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

In this episode, hosts Drs. Peter Gregory and Meredith Chiasson sit down with Dr. Alethea Lacas – geriatrician, family physician, and member of the Division of Geriatrics at Dalhousie University and Nova Scotia Health – about frailty, the Clinical Frailty Scale (CFS), and the Palliative and Therapeutic Harmonization (PATH) Program.

Dr. Lacas explains how frailty differs from simply appearing frail, why understanding a patient's baseline function is essential, and how the Clinical Frailty Scale can help clinicians make more informed decisions about prognosis, treatment, and goals of care. She also explores the concept of the frailty cycle, discusses practical strategies for minimizing frailty progression during hospital admissions, and highlights the importance of integrating frailty-informed thinking into everyday clinical practice.

Importantly, the conversation also examines the PATH Program, including when referrals may be appropriate, how comprehensive frailty assessments can support shared decision-making, and why understanding "what matters most" to patients is central to delivering person-centred care.

Listeners of this episode will gain insights into:

• How to accurately assess frailty using the Clinical Frailty Scale
• Why baseline function and collateral history are critical when evaluating frailty
• The relationship between frailty, prognosis, and goals-of-care conversations
• Practical strategies to reduce frailty progression during hospitalization
• Appropriate referrals to the PATH Program and how it supports decision-making
• The 5Ms framework for caring for older adults: Multi-complexity, Medications, Mobility, Mind, and Matters Most

Timestamps

• 04:36 – Understanding frailty and the Clinical Frailty Scale
• 11:14 – Frailty and goals-of-care conversations
• 11:37 – The frailty cycle explained
• 21:33 – Introduction to the PATH Program
• 29:49 – The 5Ms framework
• 30:09 – "What Matters Most" in clinical decision-making
• 37:23 – Measuring success in frailty-informed care
• 40:00 – Key takeaways

Resources mentioned in this episode:

• Canadian Geriatrics Society 5Ms Poster and Clinical Resources: The Canadian Geriatrics Society - Geriatric 5Ms

• Clinical Frailty Scale (Dalhousie University / Dr. Kenneth Rockwood): Clinical Frailty Scale - Geriatric Medicine Research - Dalhousie University

• PATH (Palliative and Therapeutic Harmonization) Program information: Palliative & Therapeutic Harmonization Clinic (PATH clinic) | Nova Scotia Health

Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted. 

In this episode, Dr. Meredith Chiasson and Dr. Peter Gregory speak with Dr. Amanda Vinson – nephrologist and kidney transplant clinician-researcher with Nova Scotia Health and associate professor of medicine at Dalhousie University – about practical approaches to managing acute kidney injury (AKI).

Dr. Vinson shares how the approach to AKI has evolved, with a growing emphasis on early recognition, careful monitoring, and thoughtful follow-up. She outlines what to prioritize in the first 24 hours, when AKI should prompt further investigation or consultation, and how to navigate common challenges like fluid management and medication decisions.

The episode also highlights the importance of follow-up care, emphasizing that even mild or resolved AKI carries long-term risk and requires ongoing monitoring.

Listeners of this episode will gain insights into:

• · Key priorities in the first 24 hours of AKI management
• · When AKI is not following the expected course – and what to do next
• · Practical approaches to fluid management in complex patients
• · How to manage common medications in both acute and outpatient settings
• · Why AKI should be treated as a long-term risk factor

Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.