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Summary
In episode 686 of the 40+ Fitness Podcast, host Coach Allan speaks with Dr. Julius Birnbaum, an associate professor of rheumatology at the University of Pittsburgh Medical Center. Dr. Birnbaum is described as the only physician in the US to have completed residencies in both internal medicine and neurology as well as a fellowship in rheumatology, a background that allowed him to pioneer a novel clinical program called the Neuro Rheumatology Clinic.
The conversation centers on Dr. Birnbaum's book, Living Well with Autoimmune Diseases: A Rheumatologist's Guide to Taking Charge of Your Health. He explains why autoimmune diseases are so difficult to diagnose, noting that the same condition can present very differently between individuals, and walks through how physicians funnel from a set of symptoms to objective markers in bloodwork or biopsies to reach a diagnosis.
Dr. Birnbaum also discusses specific conditions including lupus, fibromyalgia, and rheumatoid arthritis, the modern shift toward targeted biological treatments, and practical strategies for patients to advocate for themselves and improve their overall wellness.
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Key Takeaways
- Autoimmune diseases are hard to diagnose because the same disease presents differently across patients. Dr. Birnbaum notes one lupus patient may present with joint pain, another with a rash, and another with kidney disease.
- He frames the cause of autoimmune disease around three factors: a genetic predisposition, an environmental influence such as a virus that may cause no symptoms, and a multi-step cascade in which the immune system becomes confused and attacks the body.
- Patients should share narratives, not just symptoms. Describing joint pain in concrete terms (a fly fisherman struggling to bait a hook, a grandmother unable to hold her grandchild) helps the physician understand what is going on.
- Fibromyalgia is included in the book even though it is not an autoimmune disease because it lacks an identifiable pain generator (unlike rheumatoid arthritis, where the joints are the generator) and affects up to ten to twenty percent of patients with rheumatic diseases.
- Sleep and exercise both help fibromyalgia. Poor or apneic sleep prevents the restorative deep sleep needed for a pain-free life, and exercise induces endorphins; the type of exercise should be matched to the patient, such as walks or water aerobics for those with joint pain.
- Rheumatoid arthritis treatment has entered a golden era. Where medications once carpet-bombed the whole immune system, biological medications like tumor necrosis factor inhibitors now target specific pathways, so the mangled joints seen decades ago are now rare because time is joints and early treatment prevents irreversible destruction.
- Methotrexate can cause liver failure if combined with heavy alcohol use, one example of why patients should understand a treatment's side effects.
- His three wellness strategies are to recognize and treat depression (which causes far more than sadness, including pain, fractured sleep, and appetite changes), to optimize diet and sleep hygiene, and to practice self-advocacy and empowerment by challenging their physician on diagnosis and treatment decisions.
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Episode Notes
Podcast: 40+ Fitness
Episode: 686
Published: 2025-03-18
Host: Allan Misner (aka Coach Allan), author of The Wellness Roadmap
Guest(s): Dr Julius Birnbaum, an associate professor of rheumatology at the University of Pittsburgh Medical Center, Living Well with Autoimmune Diseases: A Rheumatologist's Guide to Taking Charge of Your Health
Listen & Subscribe: Apple Podcasts · Spotify · YouTube (audio only)
