RhAPPcast

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.