Introductions

[00:00:00] Tiffany: Welcome to AI Arthritis Voices 360, the podcast solving today's most pressing issues in the AI arthritis community. We invite you all to the table, where together we face the daily challenges of autoimmune and autoinflammatory arthritis. Join our fellow patient co-hosts as they lead discussions in the patient community, as well as consult with stakeholders world.

To solve the problems that matter most. Whether you are a loved one, a professional working in the field, or a person diagnosed with an AiArthritis disease, this podcast is for you. So pull up a chair and take a seat at the table.

Welcome to AI Arthritis Voices 360. This is the official talk show for the International Foundation for Autoimmune Autoinflammatory Arthritis or AiArthritis for short. My name is Tiffany Westrich- Robertson. I'm the CEO of the organization and also a person living with the diseases. I have a diagnosis of axial spondyloarthritis and well couple other things on there. And as always, I'm not alone here. So if you're watching on video, which you can now because we have all of them on our YouTube channel, but if you're not, you don't know. I'm not alone. So I'm gonna introduce via audio here too, my friend who I just adore. Rochelle Lentini. Hi Rochelle.

[00:01:36] Rochelle: Hi. So good to be here. 

[00:01:39] Tiffany: Yay. So Rochelle is also with Purple Players Foundation and I'm gonna let her introduce the organization, which might give you a little bit of a glimpse into what we're talking about today. 

[00:01:52] Rochelle: So yes, thank you so much, Tiffany. And as you said, I'm with the Purple Players Foundation and we are a nonprofit that focuses on providing supports and resources for individuals, really, specifically children and young adults who have chronic illness.  As you'll find out in this journey that we're going to talk about with juvenile arthritis. My son was diagnosed with juvenile arthritis at a young age, and we went through a lot, realizing how hard it is, we decided to start the foundation, so we really focus on where can we fill some gaps that aren't being filled through other organizations. 

[00:02:36] Tiffany: Great explanation, and I've been a fan of this foundation. How long have you all been up and running now? 

[00:02:45] Rochelle: We became official September of 2018.

JIA Communication Project Introduction & Overview

[00:02:48] Tiffany: Okay. I remember we were talking about when you were starting to form it and I just remember thinking, well this is gonna be a foundation that AiArthritis is certainly going to wanna collaborate with because I know all of the great work, you and Parker and your family in general has have done for the community and I can't think of too many more other people who are as knowledgeable as you are in this topic with the topic being about juvenile arthritis and the journey, which you sort of alluded to Rochelle. AiArthritis applied for grant to help with a missing gap that we identified, and that's one of the things that Purple Playas Foundation and AiArthritis have in common.

We like to zero in on those missing gaps, which means places that maybe there needs to be additional resources or a different way of doing things to some, a different thing to address so that we can come up with improved outcomes, really. And we had been talking to a lot of families at our organization and realize there's still such a problem with the communication when it comes to the journey.

The journey from onset to seeing, if you can even get into a pediatric rheumatologist and all of the steps in between. And we started doing some interviews that Rochelle participated in, in sort of our investigation into the need of this and realized there was also a subgroup with those who had enthesitis-related or Juvenile Spondyloarthritis, Juvenile Psoriatic Arthritis where this enthesitis or the inflammation that happens in the, where the tendons and the bone connect are is often misunderstood and kind of lumped in under arthritis, and that could deter the path. There was some hypermobility that was talked about, just things that there are different segments of the juvenile arthritis, juvenile idiopathic arthritis umbrella in particular but then there's also things that are similar challenges. 

So we decided we were gonna try to get a grant to zero in on those communication patterns. What could we do to creatively come up with some tools where families and kids and everyone in between that can use as ways to bring up conversations with their doctor, which is a little different then traditional shared decision making tools and in a creative way. So we're coming up with ways, whether it's social media posts, or TikTok or videos or traditional shared decision making tools. We're kind of running the gamut here, and we're gonna turn to you all to help us build those out, which makes it pretty cool.

So Rochelle, I'm gonna turn it back over to you and get us kind of started on this conversation. We wanted to talk a little bit about why we're doing this, that delay to get to the right doctor, the pediatrician, to the rheumatologist, and everything in between. And I'm gonna turn it over to you cause you started in the beginning, before we started recording, saying this brought back some memories for you.

[00:06:08] Rochelle: It most certainly did. You know my child is now a young adult, so he's 23 years old and I am sure a lot has changed since he was diagnosed to how, how things are with protocols around juvenile arthritis today. However, I do think this communication piece spans across time, so I'm really, really glad that we're addressing it because I don't think it's something people talk about a lot. I really think about, especially when you ask me to speak on this topic, that families hold their child as their most precious gifts. And if something isn't going well for their child, they're obviously gonna want to seek support and answers. And if it's medically related, you really trust that the medical professionals are gonna know what's best for your child.

What you alluded to is that those communication breakdowns can cause additional stress, worry, sometimes even make you feel like you must have gotten something wrong in your explanation to the doctor because they can't figure things out. But the journey of juvenile arthritis in particular, sometimes it's really difficult, many people who know our family know that this journey started for my son at eight years old. Well, it wasn't for a lack of trying to get help, but it took us a year and seven months to get a diagnosis. It took multiple specialists. It took multiple ER trips that the doctor, our primary would say, go to the ER.

So it wasn't like we were self saying oh, we gotta go to the ER maybe they'll have the answer. It was our own doctor saying, get in the car, take him to the ER right now. So you get to the ER and magically symptoms start disappearing before the doctor comes and that happens for, you know, we hear that from a lot of families. So the need for this is real, I think even today. One of the issues that I believe contributes to this communication issue is that pediatricians are your first line of treatment. Some pediatricians have a background knowledge in rheumatological issues, but some don't. You know, they may have only just briefly touched on it, so you know, their mind is gonna go to what they know and what they know is this child's growing. They might have growing pains. This child is probably doing activities that are physically related, maybe they injured themselves. You know, children often are in sports oh, it might be a sports injury. So they automatically think to send you for treatment or, maybe I should say radiology, to try to exclude those things because those are the things that would be obvious in young children. 

Communication Breakdowns & Advocating

[00:09:27] Tiffany: And that really, you did such a good job of just framing exactly what the remainder of this show is gonna be about, and that is really putting this topic on the table, telling you a little bit about maybe warning signs or issues with the communication that we're trying to address and some action items where you can get involved if you are a person who is involved in juvenile arthritis, your family, your maybe a young adult, you've recently gone through these communication challenges, you are vital to helping us create the tools to fill these missing gaps. So at the end of the show, we will swing back and let you know how you can get involved in that.

But first, let's dive back into the problem that Rochelle started talking about in this initial communication breakdown. And I think you really hit the nail on the head when you talked about well, the doctor told me to go to the ER. So we went to the ER and I think what you and I, Rochelle, have really been zeroing in in our own internal meetings on this project, cause we're collaborating on it, is the need to create some kind of guidance for families to ask questions back.

Or why am I going to the ER? What am I going to achieve at the ER? What if nothing happens at the ER? Because what we are realizing. From just talking with other families is that, that's where that derailment happens then. Oh well, okay. We're gonna send you the physical therapist. Oh, we're gonna send you to orthopedic. Oh, and then what are, you're following the doctor path. You're following the profession which is, which is correct. Right. We're not suggesting in any way, shape, or form, you shouldn't listen to your doctor. But we need to also be aware if there's signs of X, Y, and Z and you're sent to a physical therapist, orthopedic doctor, ER, and you're not getting the answers you need, we wanna come in and help you. There's the missing gap right there. 

[00:11:25] Rochelle: Yeah. You know, it's funny because a lot of what we're trying to help families with, and when I say we're you and I and many others in the field that have somehow been touched by chronic illnesses, autoimmune issues. You're also dealing with personalities. So part of the communication derailment happens because of both sides. It's not us doing anything wrong or the doctor's doing anything wrong, it's us and our personalities and the way we learn to communicate and whether we're a fight or flight kind of individual.

And so I think by creating some sort of guidance for families to help make decisions about what is best for their child is really critical. Parents may have to get out of their comfort zone because you may have to advocate for your child. When you're not even in, in a place where you're comfortable advocating for yourself.

Children don't have that voice, especially when they're really young, so you're the person.

Recognize Symptoms that are Unique to YOUR Situation

[00:12:38] Rochelle: I think that some of the things that start happening for families as they start seeing additional symptoms rise up. So sometimes what happens is, is you know, one symptom will happen for one family as a first symptom, but it may not be the first symptom that happens for another. And so that's very confusing for both sides, the families and the doctors. But the common things that come up and they don't necessarily come up in the same order for every child is you may see very big change in fatigue, like the child is more tired in little itty bitty kids you might see them using a different motor pattern when they move. Either their gross motor or their fine motor might not be as precise as it used to be, because they're favoring something that hurts. They may not be able to communicate it in words, but in their actions, you're seeing this shift happen in how they take steps or how they get up off the ground, or even in a little bit older kids, maybe even how you, they're doing their homework and how they're positioning themselves.

You know, they may not think to voice it or may not have the words. So you as a parent, you have to look for things. Not that I'm saying you're looking for an illness, but you gotta be in tune with your child. Children sometimes will develop rashes and you know, there's different types of juvenile arthritis. Not to complicate things, but you know, some children may develop facial rashes. Some children might develop a rash that is raised or not raised. Some kids, and this was the case for us, you know, they would develop a rash that would move around their body. Like, how bizarre is that? Right? And you're trying to tell somebody No, that rash was just there. I, I swear it was.  So, you know, that's one of the big signs too, is to look for that. So stiffness, fatigue. Rashes, of course, if they say they're in pain or they point to a joint that's in pain, you know, maybe feel it. Is it warm to the touch? Is it swollen? Sometimes it might feel a little squishy around the edges, so you know, you might wanna take photos.

Yes, take notes, because like I said, we'd get to the ER and the symptoms would be gone. Where if you could show them the photo, it, it helps in the diagnosis and of course swelling is another thing that you'll see happen. 

[00:15:12] Tiffany: Yeah. I just wanted to really reiterate what you just said about the jumping rash, cause it can be the same with the joints or the enthesitis, the, the tendon pain, it's like and it can come and go for no apparent reason, which makes it extremely strange compared to an injury where usually you remember, but I, and even as adults with onset, we get, oh, you must have hurt yourself at the gym or whatever. So that theme carries through. But I can definitely see how in the children, oh, you were in the playground, or you were, you know, playing around with your friends and you got injured. But if that injury comes and goes and jumps into other locations, that's also a sign. 

It's Okay to Ask Questions

[00:16:05] Rochelle: Very much so. And you know, I, in the beginning of our journey, I was never one to say, could you explain to me why such and such is happening? So for instance, they would run so many labs and they would send us for x-rays and some things.

I mean, in the beginning, nothing would show up. And so I think it's fair to say to a doctor, what are these labs for? What are you looking at? What, what do they mean? Because that's not our world as a parent you don't know. You know, what is a CRP? You know, what is, I mean, there's just so many. What does the ferritin mean? What is the, you know, so I think feeling okay that, that's a fair question to ask a doctor, could you please show me even if they're normal, like what is, what does that do in the body?

Like, why would you even be running these labs?

Tips for Scheduling Lab Work

[00:17:04] Rochelle: The other thing that families don't know until they've been in the journey a long time, it's kind of like those, oh, if only I would've known. You know, you get the lab sheet, right? And you're, you're saying to the doctor, these things are happening and then you have to schedule the lab and your kid's got a busy life because they're in school or they might be in sports or whatever. So you're trying to figure out when to schedule it. 

Schedule it when your child has symptoms, because sometimes the labs only show disease activity when the child is actually in a flare. So if they're not in a flare and you go on a good day when your kid isn't feeling so bad, there may not be enough information for the doctor. 

[00:17:40] Tiffany: How would somebody handle that if, I mean you have to wait three months or what have you to get into the doctor and maybe we don't know the answer to this. I'm just kind of throwing it out there and then it's like, well, here's the day. Because I know that does happen often. It happens with me too. It's like, well, shoot. I felt terrible last week and now I feel great, but this is the only time I could get into the rheumatologist. I think as we move on, I don't know if you have advice for that. It's something we could explore.

[00:18:08] Rochelle: I think you have to feel comfortable asking your pediatrician. Because I mean, if we're an adult or a young adult, maybe it's your primary, but you know, asking for labs is pretty easy for them. They just put it into a quest for hand your lab sheet. The thing that I think if you have fleeting symptoms, your kid's gonna have them come and go. You hold onto it and then on a bad day, go with that lab sheet. 

[00:18:34] Tiffany: Good advice. Yeah, good advice. And in saying that, I'll take the opportunity to also throw out there, but just because the blood work comes back negative doesn't mean there's nothing wrong. 

[00:18:47] Rochelle: That's the thing that's probably the most confusing for everybody, even when you've been in this for a long time. Someone can be very, very sick and have great labs.

Understanding Provider Limitations

[00:19:10] Tiffany: And it sort of ties back to what you said a little while ago, Rochelle, about, especially if it's a general practitioner, a pediatrician, an ER doctor, these are professions that know a little about a lot of things, or they know a certain degree about. A lot of things, but they're, that's why there are people called specialists, right?

Because, then you go to a person who knows more about a certain subset. So depending on how much education the person received in their training, or how many patients they actually see with these, that's going to influence their ability to detect it, refer. Yeah, think of that and unfortunately we are still seeing too many doctors who say, well, I don't need to refer you because your blood work is fine. You don't have anything. And that's something I know as, as organizations and with this project in the communication trail, we really want to hit home and kind of zero in on that and make sure that families are equipped to at least what to say if that happens and you still suspect that something's wrong.

[00:20:13] Rochelle: You may have to find a new pediatrician. If that happens, there is nothing wrong with moving on to someone else for answers. We, I mean, I don't have the answers for everything. You don't have the answers for everything, so I think it, it's okay to move on to another doctor and kind of along those lines, you can have no issue in your labs. You can have no issues even in an x-ray they send you for an X-ray. Right. 

[00:20:41] Tiffany: That's a very good point. 

[00:20:42] Rochelle: Yeah. But then they may start referring you to other specialists cuz they can't figure it out. Right. So for us it was, they referred him to neurology. and then they referred into oncology because some stuff did start coming up into the labs.

I think it's really important for families to understand who are new in trying to figure things out in this world, is that this disease processes or this umbrella, it's an exclusionary diagnoses too. Like you look for the evidence, but you also have to exclude what it could be. And so it's not uncommon to be sent to neurology, oncology, sports medicine, orthopedic, and, and you may even be sent to PT in the meantime. Go do this with PT to see if it gets better and all of that is legitimate. All of that is, you know, part of this journey that is incredibly hard because it sometimes doesn't show up right away in labs and, and in scans and things like that. 

[00:21:50] Tiffany: Yeah. And you can be diagnosed without having positive blood work, without having these x-rays, which were mentioned. There's different types of images, but X-rays are the default, right? Typically. Right. And unless there's really aggressive disease or it's been going on for a while, it's going to take a few years and in some cases they'll say 10 years to show up on an x-ray. So that's why it is a lot of doctors will start to push for something like an ultrasound or an MRI or something that, and even then it may not, the inflammation may not show up.

[00:22:28] Rochelle: I've heard from many, many families saying they went to orthopedics very well intended, looks at the swollen knee and, and puts the child in a cast, yes. For, which is like they're trying to stabilize knee, right? But you're actually stiffening that joint even more, and it's not until later that they realize, oh, it wasn't orthopedic. It was the fact that the child had fluid or whatever on their knee, or tended ligaments are swollen. So that happens and families should be aware of it.

The other thing is, is that if, you are fortunate to get to a pediatric rheumatologist in that line of specialists that you see, they're gonna still maybe send you to those other specialists. Because you know, one of the things that occurs is you can get arthritis in the eye, which I didn't know until we were on this journey. So you might end up at ophthalmology even to make sure that they check to see that your eyes are okay. Some areas don't even have a pediatric rheumatologist. Some states don't even have a pediatric rheumatologist, so you're seeing possibly an adult doctor or having to drop travel really far to see a specialist in this area. 

[00:23:42] Tiffany: And even speaking internationally wise, as our organizations international, we've been working a lot with groups and other countries and just to hear the shortage, we have a shortage here where we're headquartered in the United States and it's even more dire in other countries, and it, that's something, you know, it's probably too big for our scope in this project, but it's definitely something that, you know, we, we hope that we can address when it comes to what happens if your journey doesn't make it to a pediatric rheumatologist, but that would have to be a 360 at spinoff of this episode because that's a whole other can of worms that we're going to going to.

[00:24:26] Rochelle: Well and it's one of the reasons why we funded a pediatric rheumatology fellowship with Purple Playas. 

How All of This Ties Together with Our Project

[00:24:45] Tiffany: There you go. Definitely in need. So we talked about some of the kind of symptoms and blended into the journey, and that's really what we're going to sort of outline again for you as you're listening or watching, depending if you're looking at video or if you're listening to this into the traditional podcast form.

But we talked a little bit about the symptoms to look for, and we're going to also have a takeaway list. So you might find some more key and good information on the takeaways that will be linked to the show. But we talked about this sort of autoimmune autoinflammatory type of symptoms. The fatigue, and we gotta remember, these are systemic. This is full body, so it could be joints, it could be enthesitis, which is your tissues. It could be eyes, could be skin. So we have to kind of look at this as larger than just a joint. And I think that's really important. We talked about the injury and mistaking that, or the growing pains and the fact that you likely will get set to different specialists and that that's okay, but our goal is to help you with the communication at each of those subspecialties.

So that's part of the project that we're working on is in the journey, let's say you go to a physical therapist. I'm just using it as an example. What are some of the things you should be asking? What are some of the things that you could be proactive about? Why am I here? What is this therapy achieving?

We learned a lot in those early interviews that we've done for this project where I would, the families were telling me this and I say, well, the, the, the child would say, oh, I didn't think it was doing anything. And so I don't know if we're gonna continue. And so I asked them, well, what did the physical therapist tell you to expect? And they both looked at each other and were like, we never asked. And I said, but, and I, and they're like, I never even thought to ask that. So I think those are the kind of things that we are hoping to help with, right and address as we go on this journey.

Improving Communication with Your Child

[00:27:00] Tiffany: Rochelle, I'm gonna turn it back to you. We're just, just to kind of touch on anything else that you think are important points to mention as we're talking about this detour and these certain points in your journey. Things for, you know, people to look for, or any communication barriers that you wanted to point out. Just kind of bringing us home.

[00:27:08] Rochelle: You know, I think communication also includes your child. So, you know, I think you need to be mindful as a parent that you always include your child in that communication, in that back and forth with the doctors.

It ultimately is about your child. So even at preschool age, they should be able to point to what hurts. They should be able to ask questions if they have questions. I think, you know, you just have to take into account their age and their development level. The other thing is that labs only tell us part of the story, so sometimes you need to go into it deeper and I think it's okay to ask, like you were saying, why do I have to do an MRI? Or why do I have to do this swallow study? Like, what the heck? Why are you saying that? You know, like sometimes we just feel like that person's in charge. I'm gonna do what I'm going to, I'm gonna do what they're asking me to do. But I think the more information you have as a parent, it's also then easier for you to explain to your child, this is about to happen. This is what you're going to expect. This is how long, you know, might take, because you are kind of that go between with the child and you know, between the child and the specialist.

Preparing for the Long Game & Adjusting Expectations

[00:28:49] Rochelle: I remember very distinctly at one point I thought, you get a diagnosis, you get maybe some medicine, maybe some therapy and, and it's fixed like that is how I went into it. I was so excited when we got a diagnosis and that's because we had been waiting so long to try to figure it. I remember one day thinking, okay, we've gone from pills to shots to infusion room, and now I see no end in sight. I remember this one day in particular where I asked the doctor, could I talk to you in private? So my son was in the infusion room, still getting his infusion with the nurses, and we went into a different room. And I think it's okay to do that, to get clarity because you can be a little less guarded when your child's not in the room. And so that's part of the communication piece too. I cannot even begin to tell you what a changing point that was for me in a mental way.

So I remember sitting with a doctor, I literally asked all the things I was scared of. All the things I still didn't understand. We probably spoke for a good 20, 30 minutes and I said, how long is this gonna take? And I think she thought it was kind of a crazy question, but she said, you need to give me at least five years. And I was like, what? I I, I had no idea she was gonna say that. Yeah. I thought months, maybe a year. You need to gimme at least five years. And I said why that long? And she says, well, look how long it took you to get the diagnosis. We are chasing the disease. If I never would've asked to sit down and talk to her without my child, I never would've gotten that information.

So I think that's really important that families feel like they can do that. You need to warn them. You need to let them be able to say to you could reschedule a time, but you, you may need that time to ask those questions without your child. 

[00:30:54] Tiffany: Very, very good point. Very good. Thank you for sharing that. And my eyes went woo when you said five years, because I can only imagine what went through your head when you heard that.

[00:31:06] Rochelle: But it made me stop hounding her as much.  I mean it did. It did.

Final Thoughts & Wrap Up

[00:31:32] Tiffany: So, this has been, this episode is part of our talk show, which is named AiArthritis Voices 360, because now we put this topic on the table like we just did, Michelle and I just did, and we at our, our two organizations are working together again to really zero in on these journey communication pain points and what we kind of, tools we can create that are real easy to access, real easy to download, easy for kids to understand, relate to. That's why we're talking TikTok and you know, different images and in addition to some traditional here, print this out, bring it to your doctor. But I think the point in that is we're trying to, in addition to maybe give some education, The journey stops the, the hospitals, the ERs, et cetera, but to give tools to the families so that they can take charge of the communication rather than relying only on the communication to start from the doctor perspective. Is that a fair way? 

[00:32:28] Rochelle: It, it's definitely a team approach. I mean, you know, we're out of our comfort, comfort zone. We don't know the medical language. The doctor's in their comfort zone, they know the medical language. So we're gonna have to meet each other and make those decisions together. 

How to Participate in Our JIA Communication Project 

[00:33:01] Tiffany: Absolutely.  And so how can you help? If you are a person who is either going through this right now, you're, maybe you don't have a diagnosis, you think that you're on this journey, we wanna hear from you too. You're right there. You're in the communication right now. Or if you're a family who has gone through this, or you're a young adult who's recently gone through this, we wanna hear from you.

So you can go to AiArthritis.org/JIACommunication - all one word. We'll make sure that we link the episode to that link so that you can click on it. There is a survey. There's going to be a survey you can sign up for. So you click on there, you say, yes, I would love to participate, and then Rochelle and I, we will get in contact with you. We're gonna have a variety of ways that you can have a voice on this. We're looking for you to submit your stories, your experiences, barriers that you have gone through, and we're also gonna ask you to look at some of our prototype tools. So we'll create some drafts and we'll say, what do you think of this?

And then what and happen is together, you included will be able to help us create these end result communication tools as a community. And will they be perfect right out of the get-go? Probably not, but that's okay. It'll be a start and then we'll continue to work together and improve them and ideally, expedite detection, diagnosis better, you know, treatment plan and better outcomes as a, as a takeaway.

[00:34:22] Rochelle: And one other point, you know, to make is that there are some great tools out there and so maybe part of our tools is saying where to go get tools. 

[00:34:32] Tiffany: 100%. And there's some really great tools also in progress that are specific to shared decision making. And we do wanna make it very clear we are nowhere shape or form saying that ours are going to be the tools to use. There'll be one tool, like you said, one one of things out there, and we want to make sure that we share as many of the existing or soon to be tools as we can. So that is one of the goals as a project as well, is to be able to tell you what else is out there and then you can find, hopefully a combination of these will get you on the right track.

Contact Information & Links to Resources

[00:35:27] Tiffany: So in saying that, Rochelle tell everyone where they can find you and Purple Playas Foundation. 

[00:35:16] Rochelle: So Purple Playas is Purple Playas, P L A Y A S foundation.org. So purpleplayasfoundation.org. And if you go onto the homepage, scroll to the bottom, you can link to all of our social media. 

[00:35:33] Tiffany: Great. And to find us and all episodes of this talk show, you can go to aiarthritis.org if you wanna find the talk show, just back slash talk show.

And again, you can also find this project on our website. Click the link under the back slash - JIA Communication -  if you wanna sign up to participate and have your voice, or just to get notifications when the tools are available to use and to check back and learn about all of the other tools we find around the world that possibly could help you as well.

And while you're on there please always consider a donation. We appreciate your support to help us do what we do at our organization and you can find us on all of our social media channels at i f, which stands for the International Foundation, IFAiArthritis, and we are on Facebook, Twitter, TikTok, LinkedIn. I think we're coming up with Reddit here soon too. We're trying to get everywhere we can to expand the voice and for this project we created a Pinterest page just for this. So that was Rochelle's suggestion. So that is, that is up too. And we're gonna use that hopefully to get some more awareness about communication out there.

So Rochelle, thank you so, so much. I always enjoy my time with you. 

[00:36:54] Rochelle: It is a pleasure. 

[00:36:55] Tiffany: Appreciate you being here. So thank you everyone. We really hope that you have some valuable takeaways and for those interested, please pull up a seat at the table and have a voice because together we can change the stories of tomorrow.

AiArthritis Voices 360 is produced by the International Foundation for Autoimmune and Autoinflammatory Arthritis. Find us on the web at www.aiarthritis.org. Also, be sure to subscribe to this podcast and stay up to date on all the latest AiArthritis news and events.