RhAPPcast

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.

In this final episode of our RhAPP, MAPP, GHAPP, and SDPA crosscast series, expert APPs from dermatology, gastroenterology, rheumatology, and obesity medicine break down the most important conversation of all—how to talk to patients about obesity and immune-mediated inflammatory diseases (IMIDs). This discussion focuses on real-world communication strategies, reducing stigma, motivational interviewing, shared decision-making, and setting small, achievable goals that improve outcomes. Learn how to approach sensitive weight-related conversations with empathy, build trust, and empower patients to better manage obesity and chronic inflammation in everyday practice.

In this cross-specialty episode of our RhAPP, GHAPP, MAPP and SDPA collaborative series, leading APPs from dermatology, gastroenterology, rheumatology, and metabolic medicine break down real-world strategies to improve outcomes for patients living with both obesity and immune-mediated inflammatory diseases (IMIDs). Building on earlier discussions about epidemiology and pathophysiology, this conversation focuses on practical, clinic-ready approaches—from shared decision-making and compassionate patient communication to interdisciplinary coordination, GLP-1 utilization, and lifestyle guidance. Learn how APPs across specialties are uniting to reduce systemic inflammation, personalize care, and translate education into meaningful action for patients with obesity and IMIDs.#IMID #ObesityMedicine #ObesityCare #ChronicInflammation #APPEducation #DermatologyPA #Gastroenterology #Rheumatology

In this episode of our crosscast series shared across RhAPPcast, GHAPPcast, and Dermcast, we explore the hidden costs of obesity in immune-mediated inflammatory diseases (IMIDs) and how excess adiposity drives poorer outcomes, reduced treatment response, and increased healthcare burden. Hosted by Amanda Mixon, PA-C, president of RhAPP, this discussion brings together expert APPs from rheumatology, dermatology, gastroenterology, and metabolic health to unpack the pathophysiologic link between obesity and IMID progression. Our panel breaks down how adipose tissue fuels systemic inflammation, why cytokines like TNF-α and IL-6 worsen disease activity in psoriasis, psoriatic arthritis, and IBD, and how obesity accelerates drug clearance and impacts biologic efficacy. We also examine clinical misconceptions, challenges with pharmacokinetics, and the real-world cycle of flares, surgeries, and increased healthcare utilization seen in this high-risk population. APPs will gain practical insight into addressing weight as part of comprehensive IMID care, improving patient conversations, and leveraging collaborative, cross-specialty management strategies. Stream this episode and the full series on RhAPPcast, GHAPPcast, and Dermcast, or access every installment through the RhAPP ACE 2.0 and GHAPP ACE 2.0 mobile apps for on-the-go learning. Stay tuned for our next episode, where we shift from mechanisms to action and discuss practical strategies APPs can use to improve outcomes for patients living with both obesity and IMIDs.