In this episode, we explore malignant atrophic papulosis—also known as Degos disease—an extraordinarily rare microvascular disorder so uncommon that most clinicians will never see a single case. For decades, medical literature labeled it "uniformly fatal." Our guest, Dr. Lee Shapiro, encountered this reality when he began treating a rapidly deteriorating 16-year-old boy with no clear treatment path. Driven by urgency, he reached out to experts across the country, slowly piecing together clues that ultimately led to the first successful treatment of systemic Degos disease. Today, Dr. Shapiro is a leading advocate for patients, connecting a global community, promoting early recognition, and working tirelessly to expand access to life-saving therapies.

Learn more at The Degos Disease Foundation

Once the prescription is written, pharmacists like Katherine McCarthy step in—often becoming the steady guide patients rely on throughout their health journey. Specializing in the care of people with rheumatic diseases, Katherine tackles insurance barriers, supports patients through biosimilar transitions, and helps demystify complex medication regimens. Her work underscores just how pivotal pharmacists are in driving better outcomes in rheumatology.

This episode explores the evolving intersection of rheumatology and cognitive science, beginning with what initially drew researchers to investigate cognitive symptoms in patients with rheumatoid arthritis (RA). We discuss the prevalence and nature of patient-reported cognitive concerns, how these subjective complaints compare with objective neurocognitive testing, and what current studies reveal underlying inflammatory and neurobiological mechanisms. The conversation examines the cognitive effects of commonly used RA therapies, as well as modifiable contributors—including physical activity, sleep apnea, diet, and stress—that clinicians should assess in routine practice. We also consider when formal neuropsychological evaluation is warranted, how to counsel patients seeking to prevent cognitive decline, and the most pressing unanswered questions that remain in the field.