RhAPPcast

In this episode of RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers, host Amanda Mixon and Bonnie Smeryage, NP, explore the real-world impact of X-linked hypophosphatemia (XLH) through a powerful patient perspective. Featuring Shannon Sharp, a patient ambassador with Kyowa Kirin, this discussion dives into the genetic basis, diagnostic challenges, and lifelong burden of XLH—a rare, chronic metabolic bone disorder characterized by renal phosphate wasting. Learn how XLH symptoms such as bone pain, muscle weakness, fractures, and joint stiffness can mimic common rheumatologic conditions, often leading to misdiagnosis. This episode highlights the critical role of family history, genetic testing, and fasting serum phosphorus in identifying XLH, while also emphasizing the importance of compassionate, patient-centered care when discussing sensitive topics like family planning. Gain valuable clinical insights into disease progression, surgical considerations, and quality-of-life challenges, along with practical strategies to improve diagnosis and management. Whether you're a rheumatology provider, advanced practice provider (APP), or healthcare professional, this episode offers essential education on recognizing and supporting patients with XLH.

Explore the safety profile of tirzepatide in this clinician-focused medication review led by Bharati Bhardwaja, PharmD, a rheumatology clinical pharmacist at Kaiser Permanente Colorado. This video provides a comprehensive overview of common adverse effects associated with tirzepatide, including gastrointestinal symptoms such as nausea, diarrhea, constipation, abdominal pain, and decreased appetite, as well as other reactions like injection site reactions, fatigue, and hair loss. The discussion also highlights important drug interaction considerations, including the need to adjust doses of insulin or sulfonylureas to reduce hypoglycemia risk, and the impact of delayed gastric emptying on the absorption of medications with narrow therapeutic windows, such as warfarin. Special attention is given to potential considerations with mycophenolate mofetil and oral hormonal contraceptives, along with guidance on monitoring and alternative strategies. Additionally, this review covers key safety considerations for pregnancy and lactation, emphasizing the importance of risk-benefit discussions and appropriate discontinuation when necessary. Designed for healthcare professionals managing patients with metabolic and rheumatologic conditions, this video delivers practical insights to support safe prescribing, minimize adverse effects, and optimize patient outcomes with tirzepatide therapy. Explore more expert-led education and medication reviews on the Content Rheum and stay up to date with the latest clinical insights in rheumatologic care.

Learn the recommended starting dose and titration strategy for tirzepatide in this medication review featuring Jennifer Mylod, DNP, from Arizona Arthritis & Rheumatology Associates in Phoenix, Arizona. This video provides a practical, clinician-focused overview of how to initiate tirzepatide at 2.5 mg once weekly to improve gastrointestinal tolerability and patient adherence, followed by a structured dose escalation approach. Viewers will gain insight into the standard titration schedule—advancing in 2.5 mg increments every 4 weeks up to a maximum of 15 mg—as well as how to individualize treatment based on patient response and side effect profile. The discussion highlights common adverse effects such as nausea, vomiting, diarrhea, and constipation, along with strategies to manage these symptoms, including slower titration, dose adjustments, and patient counseling on diet, hydration, and meal size. This review also explores key clinical outcomes associated with tirzepatide, including glycemic control, weight reduction, and appetite regulation, while emphasizing that not all patients require maximum dosing to achieve meaningful benefits. Special considerations for older adults, patients with gastrointestinal sensitivity, renal impairment, or those on concomitant insulin or sulfonylureas are also addressed to help clinicians minimize risk and optimize safety. Whether you're managing patients with type 2 diabetes or obesity, this video delivers actionable guidance on how to personalize tirzepatide therapy, improve tolerability, and support long-term treatment success. Explore more expert-led education and medication reviews on Content Rheum and stay up to date with the latest clinical insights in metabolic and rheumatologic care.

Stay up to date with the latest advancements in psoriatic arthritis treatment in this journal club review featuring Jessica Farrell, PharmD, from Albany Medical Center. This video explores a Phase 3 SOLSTICE clinical trial evaluating the efficacy and safety of guselkumab in patients with active psoriatic arthritis who had an inadequate response to a prior TNF inhibitor. The discussion highlights key clinical outcomes, including ACR20, ACR50, and ACR70 response rates, minimal disease activity, and psoriasis improvement, demonstrating that guselkumab significantly outperformed placebo across multiple endpoints. Importantly, the review examines dosing strategies, comparing every-4-week versus every-8-week regimens, and explains why increased dosing frequency did not lead to superior outcomes—offering valuable insights into pharmacokinetics and receptor saturation in IL-23 inhibition. Designed for healthcare professionals managing complex psoriatic arthritis cases, this video provides practical, evidence-based guidance on biologic sequencing after TNF failure, real-world applicability of clinical trial data, and how to optimize treatment strategies for improved patient outcomes. For more expert-led education, visit the Content Rheum and stay up to date with the latest clinical insights in rheumatologic care.

In this educational FAQ video, Wendy Simmons, PA-C from Carolina Arthritis Associates, shares expert insights on hypophosphatasia (HPP)—a rare genetic metabolic bone disorder that is frequently underrecognized in rheumatology practice. With over 25 years of experience in rheumatology and specialization in osteoporosis, she highlights how HPP is characterized by low alkaline phosphatase levels and impaired bone mineralization, leading to chronic pain, fractures, and reduced quality of life. This comprehensive discussion explores why patients with HPP are often misdiagnosed with more common conditions such as fibromyalgia, osteoarthritis, neuropathies, or even psoriatic arthritis, and emphasizes the importance of recognizing overlapping, cross-specialty symptoms. Wendy outlines key clinical pearls to help advanced practice providers and healthcare professionals improve early diagnosis, including the importance of obtaining a detailed childhood history, dental history (early tooth loss with intact roots), and careful interpretation of alkaline phosphatase lab values across adult and pediatric ranges. She also discusses hallmark fracture patterns such as metatarsal stress fractures and atypical femur fractures, as well as the significant diagnostic delay—often averaging over a decade—that many patients experience. This video serves as a practical guide for clinicians to better identify HPP, avoid common diagnostic pitfalls, and ultimately improve patient outcomes through earlier recognition and appropriate management. Perfect for rheumatology APPs, physician assistants, nurse practitioners, and clinicians interested in rare bone diseases, osteoporosis, and metabolic disorders, this video reinforces the importance of a thorough clinical history, targeted lab evaluation, and heightened awareness of hypophosphatasia in everyday practice. For more expert-driven APP education, visit the RhAPP Content Rheum or access resources through the RhAPP ACE app.

Explore the mechanism of action of tirzepatide in this comprehensive medication review led by Bharati Bhardwaja, PharmD, from Kaiser Permanente Colorado. This video breaks down how tirzepatide, a first-in-class dual incretin receptor agonist, targets both glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors to improve metabolic outcomes. Learn how this once-weekly injectable therapy is FDA-approved for improving glycemic control in patients with Type 2 Diabetes and for chronic weight management in adults with obesity or overweight with comorbidities, including its role in treating obstructive sleep apnea.This educational module provides a detailed, clinically relevant overview of tirzepatide’s effects across multiple organ systems. Discover how GLP-1 receptor activation reduces appetite, slows gastric emptying, enhances insulin secretion, and decreases glucagon release, while GIP receptor agonism further supports insulin regulation, improves tolerability, and enhances fat metabolism. The combined incretin effect results in improved insulin sensitivity, reduced inflammation in adipose tissue, decreased hepatic glucose production, and meaningful weight loss outcomes. Ideal for healthcare professionals and advanced practice providers, this video offers valuable insights into the pharmacology, therapeutic benefits, and real-world applications of tirzepatide in metabolic disease management. For more expert-driven APP education, visit the RhAPP Content Rheum or access resources through the RhAPP ACE app.

Danielle Gatti-Palumbo, PharmD reviews the phase 3 APEX trial evaluating Guselkumab in patients with active psoriatic arthritis (PsA), highlighting its role in reducing inflammation, improving clinical outcomes, and preventing structural joint damage. The discussion emphasizes the importance of early biologic intervention in a disease that can quickly lead to irreversible damage and disability. Results show that guselkumab significantly improved ACR response rates and inhibited radiographic progression by week 24 compared to placebo, with benefits seen across multiple disease domains including joints, skin, nails, and physical function. With a favorable safety profile and durable efficacy, this IL-23 inhibitor represents a valuable treatment option for clinicians managing PsA and aiming to prevent long-term disease progression.

In this episode of RhAPPcast, host Amanda Mixon PA-C, is joined by Wendy Simmons, PA-C, they explore the diagnostic challenges of hypophosphatasia (HPP), a rare genetic metabolic bone disease that is frequently overlooked or misdiagnosed. Mixon and Simmons discuss key clinical red flags, including persistently low alkaline phosphatase, fracture patterns, dental history, and musculoskeletal pain that can mimic more common conditions such as osteoporosis or fibromyalgia. The conversation highlights the underlying biology of HPP, common diagnostic pitfalls, and the real-world burden of delayed diagnosis across the lifespan. This episode is designed to sharpen clinical reasoning, improve awareness of hypophosphatasia in rheumatology practice, and support earlier, more accurate diagnosis to improve patient outcomes.

In this Journal Club Review, Eileen Lydon, NP, a rheumatology provider at NYU Hospital, discusses the challenges of diagnosing hypophosphatasia (HPP) in adults, based on a 2023 Osteoporosis International publication from the HPP International Working Group. HPP is a rare genetic metabolic bone disease characterized by low alkaline phosphatase levels and highly variable, non-specific symptoms such as fractures, chronic musculoskeletal pain, and premature tooth loss—often leading to delayed or missed diagnosis. This video highlights key findings from a large literature review that identified major and minor diagnostic criteria to improve recognition of adult HPP. Clinicians will learn how to apply these criteria in practice and better differentiate HPP from conditions like osteoporosis. Designed for rheumatology providers and advanced practice providers, this overview emphasizes the importance of early identification to improve patient outcomes. For more rheumatology education, explore the Content Rheum and the RhAPP ACE app.

In this educational video, Shannon Ghizzoni, a physician assistant at Columbus Arthritis Center, explores the impact of weight reduction on disease activity and treatment outcomes in Psoriatic Arthritis. This discussion highlights the strong connection between obesity—particularly visceral fat—and increased inflammation in patients with psoriatic arthritis and psoriasis. Learn how excess adipose tissue contributes to a pro-inflammatory state by elevating cytokines such as Tumor Necrosis Factor alpha, Interleukin-6, and Interleukin-17—key drivers of joint inflammation, enthesitis, and skin manifestations. The video also explains how obesity may reduce the effectiveness of biologic therapies like TNF inhibitors, making weight management a critical component of comprehensive care. Additionally, this module reviews the link between psoriatic arthritis and Metabolic Syndrome, emphasizing the role of central obesity and metabolic dysfunction in worsening disease burden. A featured 2019 clinical study demonstrates that significant weight loss—achieved through a very low-calorie diet—led to meaningful improvements in disease activity, including reduced joint counts, lower CRP levels, improved psoriasis severity, and enhanced physical function. Notably, patients achieving minimal disease activity nearly doubled, with sustained benefits observed up to 24 months. This video underscores the importance of integrating weight reduction strategies alongside pharmacologic therapy to optimize outcomes in psoriatic arthritis. Discover how lifestyle interventions can create a synergistic effect with disease-modifying treatments to improve long-term patient outcomes. For more expert-driven rheumatology education, visit the RhAPP platform, explore the Content Rheum, or download the RhAPP ACE App for on-the-go learning. #PsoriaticArthritis #Rheumatology #ObesityAndInflammation #APPeducation #BiologicTherapy #TNFinhibitors #MetabolicSyndrome #ContentRheum #RhAPP

In this FAQ video, Jeremy Morgan, NP, from Access Solutions Rheumatology in Tulsa, Oklahoma, discusses the neuromuscular and functional burden of hypophosphatasia (HPP), a rare and often underdiagnosed metabolic bone disease. While severe forms may present in infancy, many patients with milder HPP go unrecognized until adolescence or adulthood, experiencing chronic bone pain, joint pain, enthesitis, and recurrent foot fractures. These symptoms are frequently misdiagnosed as growing pains, fibromyalgia, or osteoporosis, leading to delayed diagnosis and inappropriate management. Patients with HPP often face significant functional limitations, including difficulty standing or walking for extended periods, reduced mobility, and challenges in daily activities, career choices, and social engagement. Dental complications, such as frequent cavities and tooth loss, further impact quality of life. This video highlights the importance of early recognition, accurate diagnosis, and appropriate management strategies for HPP, providing valuable insights for rheumatology providers and advanced practice providers. For more expert-driven rheumatology education, visit the RhAPP Content Rheum and the RhAPP ACE app.

In this episode of RhAPPcast, Amanda Mixon, PA-C, and Laura Hoover, PharmD, break down the clinical use of intravenous immunoglobulin (IVIG) in rheumatology. They explore how IVIG works to modulate the immune system, where it is most effective—particularly in dermatomyositis and polymyositis—and its role as a second- or third-line option in refractory autoimmune conditions. The discussion highlights practical considerations for advanced practice providers, including weight-based dosing, infusion strategies, and the importance of premedication and hydration to reduce adverse effects. Key safety risks such as thrombosis, renal complications, and infusion reactions are reviewed, along with strategies to minimize these risks. The episode also addresses common challenges with insurance approval and patient access, offering real-world tips to navigate these barriers. With additional insights on subcutaneous options, brand differences, and monitoring considerations like IgA levels, this episode provides a concise, practical guide to safely and effectively incorporate IVIG into rheumatology care. #IVIG #Rheumatology #AutoimmuneDisease #APPs #ClinicalEducation #Immunology

In this journal club review module, Danielle Gatti Palumbo, PharmD, explores a post hoc analysis of a phase 3 clinical trial evaluating the efficacy of Guselkumab in biologic-naive patients with severe psoriatic arthritis (PsA). The discussion breaks down how guselkumab performs across multiple PsA disease domains, including joint involvement, skin and nail disease, enthesitis, dactylitis, and patient-reported outcomes. Psoriatic arthritis is a complex, multi-domain inflammatory condition that significantly impacts quality of life, making effective and durable treatment strategies essential for long-term disease control. The analysis highlights rapid and sustained improvements with guselkumab, with joint symptom relief seen as early as week 2 and broader disease activity improvements by week 8, maintained through 2 years. Across multiple severity cohorts, patients treated with guselkumab were significantly more likely to achieve and maintain low disease activity compared to placebo, with consistent efficacy across both every-4-week and every-8-week dosing regimens. These findings reinforce the importance of early biologic intervention and support guselkumab as a strong first-line treatment option for patients with severe PsA. Visit the RhAPP Content Rheum and the RhAPP ACE app for more rheumatology education.

In this FAQ, Libby Allen, a rheumatology nurse practitioner, explains how obesity impacts psoriatic arthritis outcomes and why it plays a critical role in disease severity and treatment response. Obesity is known to increase pro-inflammatory cytokines such as TNF-alpha (TNFA), IL-6, and IL-1B, creating a chronic low-grade inflammatory state that directly worsens psoriatic arthritis. This inflammation activates key immune pathways, including the IL-23 and IL-17 axis, which are central to psoriatic arthritis pathogenesis and progression. Patients with both obesity and psoriatic arthritis often experience poorer outcomes, including higher disease activity scores (DAPSA), increased joint pain, and reduced likelihood of achieving low disease activity or remission. Obesity also contributes to reduced effectiveness of conventional DMARDs and biologic therapies, making disease management more challenging. In addition to systemic inflammation, increased adiposity places mechanical stress on joints, further worsening pain and functional limitations. This video highlights the complex relationship between metabolic dysfunction and immune response, emphasizing that obesity is not just a comorbidity but a key driver of more severe psoriatic arthritis and diminished therapeutic response. Understanding this connection is essential for improving patient outcomes and optimizing treatment strategies in rheumatology. For more educational content, visit the RhAPP content rheum or explore the RhAPP ACE app.

In this educational FAQ video, Jeremy Morgan, NP, of Access Solutions Rheumatology in Tulsa, Oklahoma, explores the key skeletal and dental manifestations associated with hypophosphatasia (HPP), a rare metabolic bone disease that is often under recognized in clinical practice. This overview highlights important dental findings such as recurrent cavities, early tooth loss, frequent fillings, crowns, and root canals, which may serve as early indicators of HPP. On the musculoskeletal side, patients commonly present with chronic foot pain, shin pain, enthesitis, and frequent stress fractures—often going unnoticed due to persistent discomfort. Many individuals are misdiagnosed with conditions like fibromyalgia or osteoporosis at a young age, and notably, treatment with bisphosphonates may worsen bone health in patients with HPP. This video provides valuable clinical insights for rheumatology providers and advanced practice providers to help improve early recognition, avoid misdiagnosis, and optimize management of hypophosphatasia. For more rheumatology-focused education, visit the RhAPP Content Rheum and RhAPP ACE app.

In this episode of RhAPPcast, host Amanda Mixon, PA-C, is joined by Christina Hanson, FNP-C, to explore the growing intersection between rheumatology and gastroenterology, focusing on shared immune pathways and the evolving role of subcutaneous biologic therapies in immune-mediated inflammatory diseases (IMIDs). The conversation highlights how advances in subcutaneous (SubQ) biologics for inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, are improving patient convenience, adherence, and quality of life while offering comparable efficacy to traditional IV infusions. This expert discussion dives into key clinical considerations such as induction versus maintenance strategies, patient selection, safety, and real-world implementation of SubQ therapies. The episode also emphasizes the importance of multidisciplinary collaboration between rheumatology and GI providers, especially when managing patients with overlapping conditions like psoriatic arthritis and axial spondyloarthritis. Listeners will gain practical insights on optimizing treatment decisions, enhancing patient education, and leveraging a shared “toolbox” of therapies to better manage complex, multi-system disease. For more expert-driven education and cross-specialty insights, subscribe to RhAPPcast and visit RhAPP.org, the Content Rheum & the RhAPP ACE app.

Stay up to date on the latest advances in giant cell arteritis (GCA) management with this Fireside Chat episode featuring expert insights from Naomi Amudala, NP, and Dr. Peter Merkel. Hosted by Amanda Mixon, PA-C, this discussion breaks down the two-year SELECT-GCA trial data, highlighting the efficacy and safety of upadacitinib as a steroid-sparing therapy in patients with GCA. Learn how long-term outcomes impact clinical decision-making, including strategies for sustained remission, glucocorticoid tapering, relapse prevention, and real-world patient management. This episode is designed for rheumatology advanced practice providers and clinicians seeking to better interpret clinical trial data and apply it in practice, with a focus on balancing treatment benefits, safety considerations, and patient-specific risk factors. Explore key takeaways on JAK inhibitors, long-term disease control, and evolving therapeutic approaches in vasculitis care. For more rheumatology education, podcasts, and expert-led content, explore the Content Rheum and the RhAPP ACE app.

In this video, rheumatology physician assistant Amanda Mixon, PA-C, discusses the critical role of MRI in identifying axial involvement in psoriatic arthritis. While clinicians often focus on peripheral joint and skin symptoms, up to 20–40% of patients may have axial disease, which can sometimes be the presenting feature. Key symptoms such as inflammatory back pain, nighttime discomfort, and morning stiffness that improves with activity should prompt further evaluation. Amanda highlights how MRI enables early detection of inflammatory changes like sacroiliitis that may not appear on X-rays, making it an essential tool for accurate diagnosis. Early identification of axial involvement supports a domain-based treatment approach, helping clinicians select the most appropriate therapy and improve patient outcomes. For more rheumatology education and APP-focused resources, visit the RhAPP Content Rheum and RhAPP ACE app. #PsoriaticArthritis #AxialPsA #MRIImaging #Rheumatology #APPeducation #Sacroiliitis #InflammatoryBackPain

Obesity can significantly impact immune system function and contribute to chronic inflammation. In this educational segment, rheumatology nurse practitioner Libby Allen, ARNP, FNP, explains how obesogenic diets alter the gut microbiome and trigger inflammatory pathways that increase cytokines such as TNF-alpha and IL-6, placing the immune system in a persistent low-grade inflammatory state. The discussion also highlights the role of leptin, a hormone produced by fat cells that regulates appetite and immune signaling. In obesity, elevated leptin levels can disrupt normal metabolic signals and promote immune dysregulation, which may worsen inflammatory and autoimmune conditions such as rheumatoid arthritis, psoriatic arthritis, and psoriasis. For more rheumatology education and APP-focused learning, visit the RhAPP Content Rheum or the RhAPP ACE app.

Power Doppler ultrasound is transforming how clinicians detect subclinical enthesitis in conditions like psoriatic arthritis (PsA) and spondyloarthritis (SpA). In this educational segment, Audrey Gibson, PA-C explains how Power Doppler imaging can identify active inflammation at tendon and ligament insertion sites by visualizing increased blood flow—often before symptoms appear on physical exam. This technology helps clinicians uncover hidden disease activity, risk-stratify patients with psoriasis who may develop psoriatic arthritis, and monitor response to biologic therapies. By detecting inflammation earlier, Power Doppler ultrasound supports more proactive treatment decisions and improved long-term outcomes for patients with inflammatory arthritis. For more rheumatology education and APP-focused clinical insights, visit the RhAPP website or explore the RhAPP ACE app. #Rheumatology #PsoriaticArthritis #Spondyloarthritis #Enthesitis #Ultrasound #APPeducation

In this episode of RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers, host Amanda Mixon sits down with rheumatology PA Heather Mambretti to explore the clinical significance of low alkaline phosphatase (ALP) and why this often overlooked lab value may signal important genetic conditions such as hypophosphatasia (HPP). The conversation highlights how persistently low ALP can be a key clue in patients presenting with vague musculoskeletal symptoms, unexplained fractures, dental abnormalities, or chronic fatigue—symptoms frequently encountered in rheumatology clinics. Heather explains how clinicians should approach the diagnostic workup, including trending ALP levels over time, reviewing dental and family history, evaluating radiographic findings, and considering ALPL gene testing when hypophosphatasia is suspected. The episode also provides practical guidance for rheumatology clinicians and advanced practice providers on integrating low ALP awareness into routine clinical assessments, avoiding missed diagnoses, and recognizing that adult hypophosphatasia may be more common than previously thought. Listeners will learn how identifying genetic causes of low ALP can improve patient outcomes, guide appropriate management, and even help uncover undiagnosed cases within families. This discussion offers valuable insights for rheumatology providers involved in bone health, osteoporosis evaluation, and the investigation of unexplained musculoskeletal complaints. For more rheumatology education visit the Content Rheum or the RhAPP ACE app. #Rheumatology #Hypophosphatasia #LowALP #BoneHealth #Osteoporosis #GeneticDisorders #RheumatologyAPP #MedicalEducation #MusculoskeletalHealth

In this FAQ video, Will Saalfeld, NP, reviews the clinical efficacy of switching to guselkumab after an inadequate response to a TNF inhibitor in psoriatic arthritis. The discussion highlights key trial data from DISCOVER-1 and COSMOS, real-world outcomes, and improvements in joint and skin disease, including ACR20 response rates, low disease activity, and remission through one year. Safety, durability, and the rationale for IL-23 pathway targeting are also reviewed to support evidence-based treatment decisions in TNF-experienced patients.

In this episode of RhAPPcast, host Amanda Mixon, PA-C, leads a 2026 Fireside Chat exploring the intersection of rheumatology and gastroenterology. Joined by Kim Orleck, PA-C (GI APP), and Wendy Simmons, PA-C (Rheumatology APP), the panel discusses the shared inflammatory pathways linking Crohn’s disease, ulcerative colitis, psoriatic arthritis, and ankylosing spondylitis, with a focus on the gut–joint–skin axis and the IL-23, IL-17, and TNF pathways. The conversation highlights early screening for overlapping immune-mediated inflammatory diseases (IMIDs), recognizing subclinical gut inflammation, and selecting cross-indication therapies such as JAK inhibitors and IL-23 inhibitors based on disease severity, comorbidities, and cardiovascular risk. Listeners will gain practical insights into biomarker use (including fecal calprotectin), second-line treatment strategies after TNF failure, and the importance of real-time collaboration between rheumatology and GI providers to optimize patient outcomes. For more educational content, visit the Content Rheum, RhAPP ACE app, or RhAPP.org.

In this episode of RhAPPcast, Amanda Mixon and Wendy Simmons explore how guselkumab may help protect joints and slow structural damage in psoriatic arthritis, an important goal in long-term disease management. The discussion reviews clinical trial data, radiographic progression, and real-world considerations for using this IL-23 inhibitor in patients with active psoriatic arthritis, especially those at risk for irreversible joint damage, skin disease, and overlapping inflammatory conditions. Listeners will also hear practical insights on patient selection, treatment goals, safety considerations, and how to talk with patients about preventing permanent joint damage before it occurs. This episode is a helpful resource for rheumatology clinicians and advanced practice providers looking to better understand the role of guselkumab in psoriatic arthritis treatment and long-term joint preservation. For more educational content, visit RhAPP.org, Content Rheum or the RhAPP ACE app. #PsoriaticArthritis #Guselkumab #Rheumatology #IL23 #JointDamage #Biologics #PsA #RheumatologyAPP #RhAPPcast #MedicalEducation

In this FAQ video, Iris Zink, MSN, ANP-BC, RN-BC, shares practical strategies for discussing weight management with patients living with psoriatic arthritis. She outlines how obesity drives systemic inflammation, increases disease activity, and raises cardiovascular risk, and explains why addressing BMI should be part of routine rheumatology care. This episode explores patient-centered communication techniques, the role of anti-inflammatory nutrition and whole-food approaches, and how to incorporate conversations about GLP-1 medications, diabetes screening, and cardiovascular risk reduction into everyday practice. Designed for rheumatology clinicians and advanced practice providers, this video offers real-world tips to improve outcomes in psoriatic arthritis through compassionate, proactive weight management discussions.

In this updated medication review video module, Brandon Ko, DNP, and Pediatric Chair of RhAPP, reviews the recent FDA approval of guselkumab for juvenile psoriatic arthritis (JPsA) in children ages 6 and older weighing more than 40 kg. He covers dosing, mechanism of action as an IL-23 inhibitor, and how the approval was based on extrapolated data from pediatric plaque psoriasis (PROTOSTAR) and adult psoriatic arthritis (DISCOVER-1) trials demonstrating strong efficacy and a favorable safety profile. The video also explains how guselkumab fits into the current JPsA treatment landscape alongside TNF inhibitors, abatacept, ustekinumab, secukinumab, and JAK inhibitors, with key considerations including uveitis risk, inflammatory bowel disease implications, paradoxical TNF-induced psoriasis, and safety profile. This overview provides practical guidance for pediatric rheumatology providers tailoring biologic therapy for children with juvenile psoriatic arthritis. For more rheumatology education, visit the RhAPP Content Rheum or the RhAPP ACE app.

In this comprehensive medication review, Lisa Asfahani, PA-C, a rheumatology physician assistant with over 14 years of clinical experience, explores the rates of anti-drug antibody development to guselkumab in patients with psoriatic arthritis. Guselkumab, an IL-23 p19 monoclonal antibody inhibitor, is approved for the treatment of plaque psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn’s disease. This video breaks down the mechanisms of immunogenicity, how anti-drug antibodies can reduce treatment efficacy, and their potential role in secondary loss of response and adverse drug reactions. Lisa reviews key data from peer-reviewed studies, including findings on neutralizing antibody rates, ELISA assay detection methods, and long-term safety and efficacy outcomes in biologic-naïve patients. Learn how therapeutic drug monitoring, specialized antibody assays, consistent dosing strategies, and potential concomitant immunosuppressive therapy may help mitigate immunogenicity risks. Whether you manage psoriatic arthritis, psoriasis, or inflammatory bowel disease, this evidence-based overview provides practical insights to support confident biologic prescribing and long-term disease control in rheumatology practice. Visit the RhAPP Content Rheum or RhAPP ACE app for more educational resources.

In this educational FAQ, Heather Mambretti, PA-C, a rheumatology physician assistant and RhAPP faculty and board member, explains the critical role of tissue-nonspecific alkaline phosphatase (TNSALP) in hypophosphatasia (HPP). TNSALP is an essential enzyme involved in bone and tooth mineralization, as well as vitamin B6 transport into cells. Mutations in the ALPL gene, which encodes TNSALP, lead to reduced enzyme activity, accumulation of mineralization substrates, and defective bone formation. This video reviews how inactivating ALPL gene variants—of which more than 450 have been identified—contribute to the clinical spectrum of hypophosphatasia, including differences in autosomal recessive and autosomal dominant inheritance patterns. Severe forms such as perinatal and infantile HPP are often associated with autosomal recessive mutations, while milder presentations may follow a dominant pattern. Clinicians will gain a clear understanding of the pathophysiology of HPP, the genetic variability behind disease expression, and why bone, liver, and kidney involvement are common. For more rheumatology-focused education, visit RhAPP.org, download the RhAPP ACE App, and explore additional expert content on the Content Rheum. #Hypophosphatasia #HPP #TNSALP #ALPL #Rheumatology #BoneMineralization #GeneticDisorders #AdvancedPracticeProviders #RhAPP #RheumEducation

In this Medication Review, Lisa Asfahani, PA-C, shares practical laboratory monitoring recommendations for guselkumab across psoriasis, psoriatic arthritis, and inflammatory bowel disease. The discussion reviews FDA-approved indications, dosing basics, and what labs to check before and after initiating therapy, including TB screening and liver function monitoring. Designed for rheumatology, dermatology, and GI clinicians, this overview offers clear, real-world guidance to support safe and effective use of IL-23 inhibition in clinical practice.

In this episode of RhAPPcast, the official podcast of rheumatology advanced practice providers, we explore the complex and often underrecognized relationship between psoriatic arthritis and obesity. Host Amanda Mixon, PA-C, President of RhAPP, is joined by distinguished RhAPP faculty member and rheumatology nurse practitioner Iris Zink for an in-depth, real-world discussion on how obesity functions as an inflammatory driver in psoriatic arthritis and influences disease severity, treatment response, and long-term outcomes. The conversation examines the immunologic mechanisms linking adiposity to chronic inflammation, including the role of cytokines such as TNF and IL-17, and how obesity amplifies disease across key domains like peripheral arthritis, enthesitis, dactylitis, skin disease, and axial involvement. Drawing from both current evidence and decades of clinical experience, the speakers discuss why weight assessment should be considered an essential component of psoriatic arthritis evaluation and how to approach this topic in a patient-centered, non-stigmatizing way. For more rheumatology education, check out the Content Rheum on RhAPP.org or explore more education on RhAPP ACE 2.0.

In this video, Kimberly Orleck, PA-C, senior director of advanced practice providers at United Digestive and board member of GHAPP, provides a comprehensive review of the efficacy and safety data supporting guselkumab in the treatment of moderate to severely active ulcerative colitis and Crohn’s disease. Drawing from pivotal clinical trials, including QUASAR for ulcerative colitis and GALAXI and GRAVITY for Crohn’s disease, she walks through induction and maintenance dosing strategies, rapid onset of symptomatic improvement, and key clinical, endoscopic, and long-term remission outcomes. The discussion highlights early separation from placebo, durable remission through one and two years, and consistent efficacy in both biologic-naïve and biologic-experienced patients. Safety data across studies demonstrate a well-tolerated profile with adverse event rates comparable to placebo and no new safety signals identified. With both IV and subcutaneous induction options available for Crohn’s disease and flexible maintenance dosing for both indications, this overview places guselkumab within the evolving treatment landscape and current clinical guidelines for inflammatory bowel disease. For more information, please visit RhAPP.org, the Content Rheum or the RHAPP ACE 2.0 app.

In Part 3 of the Across the Rheum podcast series, Dr. Sergio Schwartzman concludes the three-part discussion on the IL-23 paradigm in psoriatic arthritis (PsA) with a deep dive into clinical utility, treatment positioning, and real-world decision-making. Building on prior episodes that covered immunologic mechanisms and comparative trial data, this final installment focuses on how IL-23 inhibitors are being integrated into modern PsA treatment algorithms.Joined by Jessica Farrell, PharmD, and Dr. Monica Schwarzman, the discussion explores where IL-23 inhibitors fit relative to methotrexate, TNF inhibitors, and IL-17 inhibitors, with thoughtful analysis of treatment persistence, safety profiles, radiographic progression, and comorbidity considerations, including inflammatory bowel disease. The episode also addresses evolving practice patterns, payer access considerations, and why many clinicians are moving toward earlier use of targeted biologic therapy in appropriate patients.Additional insights include the role of radiographic progression prevention, interpretation of modified Sharp scores, and future directions in PsA care—such as axial psoriatic arthritis, combination biologic therapy, difficult-to-treat disease, and emerging oral and long-acting agents.Subscribe to Across the Rheum for ongoing expert-led discussions on evolving therapies in rheumatology.

Hypophosphatasia (HPP) is a rare genetic bone disorder that is often overlooked in adults, leading to years of misdiagnosis and ineffective treatment. In this episode of RhAPPcast, host Amanda Mixon, PA-C is joined by nurse practitioner Jeremy Morgan to explore how HPP presents in adulthood and why it is frequently missed in rheumatology practice. The discussion reviews common musculoskeletal features such as chronic bone pain, enthesitis, stress fractures, and functional limitations, along with conditions HPP is often mistaken for, including osteoporosis, fibromyalgia, and seronegative rheumatoid arthritis. Special attention is given to persistently low alkaline phosphatase (ALP) levels and why they should prompt further evaluation rather than being dismissed. This episode provides practical guidance on recognizing red flags, using additional laboratory testing such as fasting phosphorus and vitamin B6, and supporting patients through a long and often frustrating diagnostic journey. Learn more rheumatology education on the RhAPP Content Rheum or through the RhAPP ACE app.

Delayed diagnosis in psoriatic arthritis (PsA), spondyloarthritis (SpA), and inflammatory bowel disease (IBD) can lead to irreversible damage and prolonged patient suffering. In this FAQ episode, host Audrey Gibson, PA-C reviews validated screening tools that help clinicians identify these conditions earlier and determine when referral to rheumatology or gastroenterology is warranted. The discussion highlights practical screening strategies for frontline providers, including the Psoriasis Epidemiology Screening Tool (PEST) for identifying PsA risk in patients with psoriasis, as well as referral criteria for spondyloarthritis based on inflammatory back pain features and ASAS recommendations. Key red flags such as early-onset chronic back pain, morning stiffness, extra-articular symptoms, and family history are reviewed. For gastrointestinal symptoms, the episode explores how tools like CalProQuest and alarm features such as chronic diarrhea, rectal bleeding, anemia, and weight loss can help distinguish IBD from functional GI disorders. This FAQ offers practical guidance to shorten diagnostic delays, support timely referrals, and improve long-term outcomes. Learn more on the RhAPP Content Rheum or in the RhAPP ACE App.

In this FAQ video, Audrey Gibson, PA-C, reviews validated screening tools used to identify psoriatic arthritis, spondyloarthritis, and inflammatory bowel disease and when to refer patients to rheumatology or gastroenterology. The discussion covers practical tools such as PEST for PsA, ASAS referral criteria for SpA, and red flag–based screening for IBD, including CalProQuest. Designed for primary care, dermatology, and specialty providers, this overview highlights how early screening can reduce diagnostic delays and improve patient outcomes.

In Part 2 of the Across the Rheum podcast series, host Dr. Sergio Schwartzman continues the three-part discussion on the IL-23 paradigm in psoriatic arthritis (PsA). This episode takes a focused, clinical look at the currently available IL-23 inhibitors, reviewing their mechanisms of action, structural differences, dosing strategies, and FDA-approved indications across psoriasis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis. Joined again by Jessica Farrell, PharmD, and Dr. Monica Schwarzman, the conversation examines p19 vs p40 IL-23 inhibition, compares key clinical trial efficacy data in both psoriasis and psoriatic arthritis, and discusses how these data may inform real-world treatment decisions. The episode also explores class switching, limitations of cross-trial comparisons, and the evolving role of head-to-head studies in rheumatology. This episode is designed for rheumatology clinicians and APPs seeking practical insight into how IL-23 inhibitors are differentiated and positioned in modern PsA management. Stay tuned for Part 3, where the series concludes with clinical positioning and real-world application of IL-23–directed therapies.

In this Journal Club episode, Holly Reid, APN, CPNP, MS reviews the 2023 Osteoporosis International article, Hypophosphatasia Diagnosis: Current State of the Art and Proposed Diagnostic Criteria for Children and Adults, which offers long-needed clarity around diagnosing hypophosphatasia (HPP). HPP is a rare inherited metabolic bone disease that is frequently misdiagnosed or significantly delayed in both pediatric and adult patients, often leading to inappropriate treatment and poor outcomes. This discussion breaks down why early recognition matters and how rheumatology providers can play a critical role in identifying patients—even when they are not the primary treating clinician.The episode provides a practical overview of HPP pathophysiology, including the role of tissue-nonspecific alkaline phosphatase (TNSALP), the accumulation of key substrates such as inorganic pyrophosphate and pyridoxal-5-phosphate, and how these defects lead to impaired bone and tooth mineralization. We review the wide spectrum of clinical manifestations across children and adults, from rickets, growth failure, and premature tooth loss in pediatrics to osteomalacia, fractures, chondrocalcinosis, and chronic musculoskeletal pain in adults.For more education on HPP visit the RhAPP Content Rheum or download the RhAPP ACE app.

Brandon Ko, APRN, DNP, a pediatric rheumatology nurse practitioner at the University of New Mexico and Pediatric Chair for RhAPP, reviews the potential role of guselkumab in juvenile psoriatic arthritis. This medication review explores the current FDA submission for pediatric use, the clinical rationale behind extrapolating adult psoriatic arthritis data, and supporting safety and efficacy findings from pediatric plaque psoriasis studies. The discussion highlights where guselkumab may fit among existing treatment options for juvenile psoriatic arthritis, including TNF inhibitors, IL-17 inhibitors, JAK inhibitors, and other biologics, while addressing key considerations such as disease severity, treatment sequencing, and uveitis risk. Designed for rheumatology APPs and clinicians, this overview provides timely insight into emerging pediatric treatment options and what FDA approval could mean for patient care.

Welcome to the premiere of Across the Rheum, the official podcast of Rheum Connect, where cutting-edge science meets real-world clinical insight in rheumatology. Hosted by renowned rheumatologist Dr. Sergio Schwartzman, this new educational podcast launches with a three-part series exploring The Interleukin-23 (IL-23) Paradigm in Psoriatic Arthritis. In Episode 1, the series sets the foundation with an in-depth discussion of IL-23 immunology and its role in the pathophysiology of psoriatic disease. Joined by expert guests Jessica Farrell, PharmD, and Dr. Monica Schwarzman, listeners gain a structured understanding of the IL-23/Th17 pathway, cytokine signaling, and how these mechanisms translate into targeted therapeutic strategies for psoriatic arthritis and related immune-mediated diseases. Designed for rheumatologists, advanced practice providers, pharmacists, and clinicians involved in inflammatory arthritis care, this episode examines why IL-23 has emerged as a critical therapeutic target, the scientific rationale behind selective inhibition, and how evolving immunologic insights are shaping modern treatment decisions. The discussion also highlights key distinctions between IL-23– and IL-17–driven disease, implications for axial involvement, and the future of precision therapy in psoriatic arthritis. This episode is cross-hosted on Arthros and the RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers, with sincere thanks to RhAPP for their continued partnership. Educational support for this activity is provided by Johnson & Johnson. Subscribe to Across the Rheum to continue the series in Episode 2, where the conversation shifts to a detailed review of currently available IL-23 inhibitors, clinical trial data, and practical positioning in today’s rheumatology treatment landscape.

In this episode of RhAPPcast, host Amanda Mixon, President of RhAPP, is joined by pediatric rheumatology specialist and RhAPP board member Brandon Ko to spotlight hypophosphatasia (HPP) in children—an underrecognized inherited metabolic bone disorder that is frequently missed in clinical practice. The conversation reviews perinatal, infantile, and childhood-onset HPP, highlights subtle early warning signs like failure to thrive, delayed milestones, craniosynostosis, bone pain, recurrent fractures, and premature loss of primary teeth with intact roots, and explains why persistently low alkaline phosphatase (ALP) is a key diagnostic red flag. Designed for rheumatology APPs and primary care clinicians, this episode offers practical steps to improve recognition, differentiate HPP from conditions like JIA and pain amplification syndromes, and support earlier evaluation and referral for appropriate testing.

In this episode of RhAPPcast, host Amanda Mixon, President of RhAPP, is joined by rheumatology PA Audrey Gibson for an in-depth discussion on IL-23 inhibitors and what differentiates them in real-world rheumatology practice. The conversation reviews the IL-23/Th17 pathway, current approved IL-23 inhibitors for psoriatic arthritis, and key considerations around efficacy, safety, durability, and patient selection, including comorbid psoriasis and inflammatory bowel disease. Designed for rheumatology APPs, this episode also explores practical expectations for treatment response, emerging clinical trial data, and how IL-23 inhibitors fit into a domain-based approach to managing psoriatic disease.

In this FAQ, Brandon Ko, APRN, a pediatric rheumatology nurse practitioner and RhAPP Pediatric Chair, provides a practical overview of hypophosphatasia (HPP) across the lifespan and explains why this rare inherited metabolic bone disorder is often missed in clinical practice. The discussion reviews pediatric and adult presentations of HPP, including subtle skeletal symptoms, premature tooth loss with intact roots, stress fractures, osteomalacia, and early-onset pseudogout, and highlights persistently low alkaline phosphatase as a key diagnostic red flag. Designed for APPs and clinicians, this concise video outlines when to suspect HPP, how to begin the evaluation, and why early recognition is critical in both pediatric and adult rheumatology settings.

In this journal club review, clinical pharmacist Danielle Gatti Palumbo, breaks down a March 2025 study examining how guselkumab’s unique Fc-domain interactions with CD64-positive, IL-23–producing myeloid cells enhance its potency in neutralizing IL-23 signaling. The discussion explores the immunologic role of IL-23 in inflammatory diseases such as psoriasis, psoriatic arthritis, and inflammatory bowel disease, compares Fc-domain differences between IL-23 inhibitors, and highlights key in vitro findings using flow cytometry, live-cell imaging, and co-culture assays. This concise overview helps APPs and clinicians better understand emerging mechanisms that may influence therapeutic efficacy and treatment selection in IL-23–driven inflammatory conditions.

In this focused educational video, Heather Mambretti, PA-C, a rheumatology APP with over 12 years of experience and a faculty and board member for RhAPP, explains how hypophosphatasia (HPP) is diagnosed and highlights the key laboratory markers clinicians should not overlook. The discussion reviews the hallmark finding of persistently low serum alkaline phosphatase (ALP), additional supportive labs, characteristic clinical features in adult patients, and the role of imaging and genetic testing in confirming an HPP diagnosis. Designed for APPs and clinicians, this overview emphasizes practical strategies for identifying adult-onset hypophosphatasia, differentiating it from other musculoskeletal conditions, and improving diagnostic confidence in real-world rheumatology practice.

In this video, Lindsay Tom, PA-C, takes a focused look at the emerging connection between CD64 and IL-23 across inflamed joint, skin, and gut tissue. Drawing from real-world immunology and disease-state research, she explores why this pathway matters in immune-mediated inflammatory conditions such as psoriasis, psoriatic arthritis, and inflammatory bowel disease. The discussion highlights how CD64-expressing myeloid cells may influence inflammatory signaling, how this relationship shows up differently across tissues, and why these insights are shaping the way clinicians think about disease activity and treatment selection. This concise overview offers valuable perspective for APPs and clinicians looking to better understand the immunologic drivers behind these complex conditions and the therapies designed to target them. Visit the RhAPP Content Rheum or the RhAPP ACE 2.0 app for more rheumatology education.

In this educational rheumatology video, physician assistant Lindsay Tom, PA-C, from the Northern Virginia Center for Arthritis, provides a clear and clinically relevant overview of CD64, also known as FC gamma receptor I, and its role in immune system function. The discussion explores how CD64 is expressed on myeloid lineage cells such as monocytes, macrophages, and dendritic cells, and how it contributes to innate immunity by binding IgG antibodies and triggering phagocytosis and pro-inflammatory cytokine release, including TNF-α. The video also explains CD64’s role in adaptive immunity through antigen processing and presentation to T cells, leading to immune activation and immunologic memory. Importantly, this overview highlights how dysregulated or excessive CD64 activation may contribute to chronic inflammation, tissue damage, and antibody-mediated autoimmune diseases—making it a key concept for clinicians managing inflammatory and rheumatic conditions. This video is part of ongoing educational content designed for advanced practice providers seeking a deeper understanding of immunologic pathways relevant to rheumatology care.

In this short video, pediatric rheumatology advanced practice providers Brandon Ko, APRN, DNP, C-PNP, and Brandi Goble, PNP, share their personal journeys into pediatric rheumatology and discuss the critical role APPs play in expanding access to care—especially in rural and underserved communities. They highlight the challenges of entering a highly specialized field with limited formal training, the importance of mentorship, and how RhAPP and the Step Up to Rheumatology curriculum have helped build community, education, and confidence for pediatric rheumatology APPs nationwide. This conversation offers insight into workforce gaps, real-world training pathways, and the growing impact of APPs in pediatric rheumatology care.

In this video, Audrey Gibson, PA-C, a rheumatology physician assistant with nearly two decades of clinical experience, breaks down the unique dual mechanism of action of guselkumab and its role in targeting IL-23–driven inflammation. The discussion explores how this fully human monoclonal antibody selectively binds the IL-23 p19 subunit to inhibit downstream inflammatory signaling, while also engaging CD64 on inflammatory monocytes through its Fc region, addressing IL-23 at its source. Designed to clarify the science behind dual-acting IL-23 inhibition, this overview provides practical insight for clinicians managing immune-mediated rheumatic diseases and highlights emerging therapeutic strategies in modern rheumatology care.

In this FAQ, William Saalfeld, NP, breaks down why the modified van der Heijde–Sharp (mvdH-S) score remains the most widely used radiographic method in psoriatic arthritis (PsA) clinical trials. He highlights how the score delivers the strongest combination of reliability, sensitivity to change, and validation, making it ideal for detecting small but meaningful structural progression over typical trial timelines. Learn how its consistent use across randomized controlled trials—including recent NEJM studies—supports cross-trial comparability, regulatory acceptance, and its role as a trusted structural endpoint linked to long-term physical function and disability in PsA.

Discover how the APEX trial raised the bar in understanding structural damage risk in psoriatic arthritis. In this quick FAQ video module, William Saalfeld, NP, breaks down why APEX was designed differently from DISCOVER-2, what made its patient population unique, and how these changes help us better evaluate progression and treatment impact. If you want a clearer, faster way to understand the science behind PsA trial design, this is the perfect overview. Learn more on the RhAPP website or through the RhAPP ACE App.