Shows
RhAPPcastLive from RhAPP National: ILD & PH-ILD at the Rheum–Pulm CrossroadsJoin host Amanda Mixon, President of RhAPP, for a special episode of RhAPPcast, recorded live at the 6th Annual RhAPP Conference. In this conversation, Amanda is joined by Jessica Glennie, CNP, from the Cleveland Clinic, to explore the complex intersection of rheumatology and pulmonology, focusing on Interstitial Lung Disease (ILD) and Pulmonary Hypertension in ILD (PH-ILD). Together, they unpack how early recognition, multidisciplinary collaboration, and evidence-based management can improve outcomes for patients with connective tissue disease–related pulmonary complications. Tune in for expert insights, practical diagnostic tips, and highlights from one of the most engaging sessions of the RhAPP Na...
2025-11-0622 minRhAPPcastRhAPPcast: ANCA-Associated Vasculitis: Insights From the RhAPP National ConferenceJoin host Amanda Mixon, PA-C, live from the 6th Annual RhAPP National Conference in Denver, as she sits down with Naomi Amudala, CRNP, from Penn Medicine, to break down one of rheumatology’s most complex and life-threatening conditions: ANCA-associated vasculitis. In this insightful RhAPPcast episode, Amanda and Naomi explore the spectrum of AAV—including GPA, MPA, and EGPA—while unpacking early diagnostic clues, real-world treatment strategies, and emerging therapies like rituximab and avacopan. From recognizing red-flag symptoms such as renal involvement and pulmonary hemorrhage to reducing long-term steroid exposure, this conversation offers practical takeaways for advanced practice providers managing vascul...
2025-11-0317 minRhAPPcastRhAPPcast: Beyond Dryness: Key Takeaways from the Sjögren’s Symposium at RhAPP 2025Welcome to RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers. In this episode, hosted by Amanda Mixon, PA-C, current RhAPP President, we bring you exclusive highlights from the 6th Annual RhAPP National Conference. This episode features a powerful discussion with Betsy Kirchner, nurse practitioner at Cleveland Clinic and RhAPP co-founder. Together, Amanda and Betsy explore the evolving landscape of Sjögren’s disease, from underdiagnosis and quality-of-life challenges to breakthroughs in understanding B-cell involvement and the promise of emerging dual-action therapies. The conversation also underscores the importance of multidisciplinary care, early recognition of systemic symptoms, and how APPs can...
2025-10-2116 minRhAPPcastMedication Review: What is the Mechanism of Action of Methotrexate?In this video, clinical pharmacist and RhAPP faculty member Danielle Gatti Palumbo breaks down the mechanism of action of methotrexate, explaining how this folate antimetabolite works to inhibit DNA synthesis, reduce inflammation, and regulate immune response. Methotrexate is a folate antimetabolite that plays a crucial role in inhibiting DNA synthesis, repair, and cellular replication, making it a widely used treatment for autoimmune diseases and certain cancers. Its primary mechanism involves binding to and inhibiting dihydrofolate reductase (DHFR), which prevents the formation of reduced folate, a key component in DNA and RNA synthesis. This inhibition is why folic...
2025-07-0101 minRhAPPcastRhAPPcast: Understanding the TYK2/STAT Signaling Pathway in PsA: Clinical Implications and BeyondIn this episode of RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers (RhAPP), host Amanda Mixon, PA-C, dives into the evolving role of TYK2 inhibition in the treatment of psoriatic arthritis (PsA). Joined by special guest and PsA expert Eileen Lydon, NP, the episode unpacks the science behind the TYK2/STAT signaling pathway, how it differs from traditional JAK inhibition, and what this means for patient care. Together, Amanda and Eileen explore key cytokines like IL-12, IL-23, and type I interferons, and how selective TYK2 inhibitors such as deucravacitinib offer targeted modulation with a potentially improved safety profile.
2025-06-1924 minRhAPPcastMedication Review: Hydroxychloroquine Medication ReviewHydroxychloroquine is a cornerstone therapy in rheumatology, offering significant benefits for mild rheumatoid arthritis (RA) and lupus. In this video, Jessica Farrell, PharmD, clinical pharmacist in rheumatology at Albany Medical Center and faculty at Albany College of Pharmacy and Health Sciences, explores the dosing, safety, and clinical applications of hydroxychloroquine.Jessica Farrell explains the weight-based dosing strategy (5 mg/kg/day) to minimize the risk of retinal toxicity, discusses its crucial role in lupus management, and highlights its use during pregnancy, particularly in patients with anti-SSA and anti-SSB antibodies to help prevent neonatal heart block. She also shares...
2025-06-1703 minRhAPPcastFAQ: Steroid Tapering in Lupus Nephritis: Insights from the 2024 ACR GuidelinesIn this expert-led video, Stacey Johnson, NP-C, from the Montana Arthritis Center, breaks down the 2024 ACR Guidelines for Lupus Nephritis and highlights key treatment strategies—including hydroxychloroquine dosing, steroid pulse and taper regimens, and the role of triple therapy. Learn how to tailor treatment for Class III, IV, and V Lupus Nephritis using combinations like mycophenolate, belimumab, calcineurin inhibitors, and low-dose cyclophosphamide.These updated recommendations emphasize precision and safety, focusing on minimizing steroid exposure while maximizing disease control through multi-targeted immune therapy.For more rheumatology insights and clinical updates, visit the Content Rheum at RhAPP.or...
2025-05-2901 minRhAPPcastMedication Review: What is the Mechanism of Action of Deucravacitinib?In this video, Iris Zink, rheumatology nurse practitioner and clinic owner in East Lansing, Michigan, breaks down the mechanism of action of deucravacitinib, a first-in-class oral selective TYK2 inhibitor, and explains its role in managing psoriasis and psoriatic arthritis. With over 25 years of experience serving underserved populations, Iris uses memorable analogies to simplify the complex TYK2/STAT signaling pathway and help you understand the immunologic rationale behind TYK2-directed therapy.Learn how TYK2 selectively mediates cytokines like IL-12, IL-23, and Type I Interferons, and why allosteric inhibition at the regulatory domain reduces off-target effects compared to t...
2025-05-1909 minRhAPPcastRhAPPcast: Practical Application: Integrating the New ACR LN GuidelinesIn this episode of RhAPPcast, host Amanda Mixon, PA-C, is joined by Monica Richey, NP, and Danielle Gatti-Palumbo, PharmD, for a practical and engaging discussion on how to apply the 2023 ACR guidelines for lupus nephritis to real-world clinical practice. Together, they walk through a complex patient case, highlighting key decision points including when to order a kidney biopsy, how to interpret proteinuria and complement levels, and how to initiate and escalate treatment. The episode covers critical guidance on balancing disease control with long-term safety—especially in patients considering pregnancy—and offers insight into medication adherence strategies, monitoring protocols for agen...
2025-05-1639 minRhAPPcastMedication Review: What is the Real World Evidence of Guslekumab in PsAJoin Cassie Dolecki, PharmD, a Clinical Pharmacy Specialist in Rheumatology at Allegheny Health Network in Pittsburgh, Pennsylvania, as she explores the real-world effectiveness of Guselkumab in the management of psoriatic arthritis.This discussion highlights recent findings from the CorEvitas Psoriatic Arthritis and Spondyloarthritis Registry, which assessed six-month persistence and effectiveness rates in adult PsA patients. The study revealed that nearly 80% of patients continued Guselkumab treatment over six months, experiencing significant improvements in disease activity, including joint symptoms, skin manifestations, and patient-reported pain.Cassie also examines how these findings align with phase three clinical trial data...
2025-05-1401 minRhAPPcastFAQ: TYK2/STAT Pathway & Why TYK2 Therapy Works for Psoriasis and Psoriatic ArthritisJoin Iris Zink, a seasoned rheumatology nurse practitioner with over 25 years of experience, as she explains the TYK2/STAT signaling pathway and the immunologic rationale behind TYK2-directed therapy for treating psoriatic arthritis and psoriasis. This video breaks down how TYK2 inhibitors—like deucravacitinib—selectively target the regulatory domain of the TYK2 enzyme, distinguishing them from traditional JAK inhibitors and minimizing off-target effects.You'll learn how TYK2 plays a critical role in mediating pro-inflammatory cytokines such as IL-12, IL-23, and type I interferons, all of which contribute to the pathogenesis of autoimmune diseases. Iris uses vivid analogies to s...
2025-05-0906 minRhAPPcastRhAPPcast: Decoding IL-17: Comparing and Contrasting IL-17A and IL-17F InhibitionJoin Amanda Mixon, PA-C, President of RhAPP, as she hosts an insightful discussion with Will Saalfeld, NP, a leading rheumatology expert and RhAPP faculty member. In this episode, they break down the key differences between IL-17A and IL-17F inhibition and explore how these distinctions impact patient outcomes in rheumatology.IL-17A and IL-17F play central roles in inflammation and autoimmune disease, but their unique functions mean that blocking them can yield different clinical effects. Will explains the pathophysiology of these cytokines, their impact on diseases like psoriatic arthritis and axial spondyloarthritis, and how emerging...
2025-05-0726 minRhAPPcastMedication Review: What Are the Clinically Meaningful Differences Between Voclosporin and Other Calcineurin Inhibitors?In this video, Jessica Farrell, PharmD—clinical pharmacist at Albany Medical Center and professor at Albany College of Pharmacy and Health Sciences—explains the clinically meaningful differences between voclosporin and other calcineurin inhibitors, such as cyclosporine and tacrolimus, in the treatment of lupus nephritis. She highlights how voclosporin’s unique molecular structure leads to increased potency, faster elimination, and more stable pharmacokinetics. Unlike other calcineurin inhibitors, voclosporin offers more consistent oral bioavailability and does not require routine therapeutic drug monitoring. Dr. Farrell also reviews important distinctions in drug-drug interactions, particularly with mycophenolate, and notes that voclosporin may present a lower...
2025-05-0203 minRhAPPcastLeflunomide Medication ReviewIn this educational session, Jessica Farrell, PharmD, from Albany Medical Center and Albany College of Pharmacy and Health Sciences, provides key clinical pearls on Leflunomide, a lesser-discussed DMARD (disease-modifying antirheumatic drug) used in rheumatology. While not frequently prescribed for new patients, many individuals remain on Leflunomide long-term, making it essential to understand its pharmacokinetics, potential toxicities, and considerations for special populations.A unique aspect of Leflunomide is its enterohepatic recycling, which allows its active metabolite to persist in the body for an extended period—even years after discontinuation. In cases of toxicity (such as liver enzyme elevations or...
2025-05-0103 minRhAPPcastRhAPPcast: ACR Psoriatic Arthritis RhAPPUP Part 1Welcome to RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers (RhAPP). In this episode, host Amanda Mixon, PA-C, kicks off a three-part series exploring some of the most impactful updates in psoriatic arthritis (PsA) from the 2024 ACR Convergence meeting. Joining Amanda is Daric Mueller, PA-C, who shares expert insights on emerging therapies, including zazocitinib (TAK-279), a selective TYK2 inhibitor showing promising results in both joint and skin outcomes for PsA.Together, Amanda and Daric review key data from several abstracts—highlighting oral treatment options, the significance of dosage on efficacy, and the potential advantages of TYK2 in...
2025-04-3015 minRhAPPcastRhAPPcast: ACR Psoriatic Arthritis RhAPPUp Part 3Welcome back to RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers (RhAPP). In the final episode of our three-part series covering highlights from ACR Convergence 2024, host Amanda Mixon, PA-C, is joined once again by Daric Mueller, PA-C, to explore two more important abstracts shaping the future of psoriatic arthritis (PsA) care. This episode dives into new insights on treatment response and real-world outcomes that may help inform clinical decision-making.First, Daric breaks down a post-hoc analysis from the SPIRIT-H2H trial, comparing ixekizumab vs adalimumab in PsA patients with nail disease. The data suggest that nail...
2025-04-3014 minRhAPPcastRhAPPcast: The Relative Persistency and Effectiveness of Guselkumab in the Real-WorldIn this episode of RhAPPcast, Amanda Mixon, PA-C, President of RhAPP, sits down with Kyle George, PA-C, to explore the real-world impact of Guselkumab in Psoriatic Arthritis (PsA) management. As a leading IL-23 inhibitor, Guselkumab offers durable efficacy, strong persistence, and a favorable safety profile, making it a key option for biologic-naïve patients and those with TNF inhibitor failure.Clinical trials like VOYAGE, NAVIGATE, ECLIPSE, and DISCOVER highlight its effectiveness in improving joint and skin symptoms, while real-world data from the CorEvitas PsA and SpA Registry shows 72% of patients remain on Guselkumab after 12 months, compared to j...
2025-04-2822 minRhAPPcastMedication Review: What is the safety profile of voclosporin and how should it be monitored?Learn about the safety profile and monitoring requirements of voclosporin for lupus nephritis with Jessica Farrell, PharmD, an experienced rheumatology pharmacist and faculty member at the Albany College of Pharmacy and Health Sciences. In this video, Jessica Farrell explains what makes voclosporin—a second-generation calcineurin inhibitor—unique, including its increased potency, improved pharmacokinetic profile, and reduced need for therapeutic drug level monitoring compared to cyclosporine.Jessica Farrell discusses key considerations before initiating voclosporin in patients with lupus nephritis, such as baseline eGFR, blood pressure, and ongoing laboratory assessments. Discover the recommended monitoring schedule for renal function, urine prot...
2025-04-2403 minRhAPPcastJournal Club Review: Evaluating the Efficacy of Biologic With and Without MethotrexateJoin Danielle Gatti Palumbo, PharmD, a clinical pharmacist, RhAPP faculty member, and RhAPP Board member, as she breaks down a network meta-analysis evaluating the efficacy of biologics with and without methotrexate (MTX) in the treatment of psoriatic arthritis (PsA). This insightful journal club discussion highlights key findings on whether MTX is necessary as background therapy when initiating biologics.Methotrexate, while commonly used in PsA treatment, is not FDA-approved for PsA in the U.S., yet it is often required by insurance companies before biologic therapy. Clinical guidelines, including EULAR, ACR, and GRAPPA, recommend MTX for peripheral arthritis...
2025-04-2204 minRhAPPcastJournal Club Review: Voclosporin for Lupus Nephritis: Efficacy & Safety Insights from AURORA 1 & 2 TrialsJoin Jessica Farrell, PharmD, professor at the Albany College of Pharmacy and Health Sciences and clinical pharmacist at Albany Medical Center, as she breaks down the pivotal AURORA 1 and AURORA 2 clinical trials evaluating voclosporin for lupus nephritis. Learn how this second-generation calcineurin inhibitor demonstrated superior renal outcomes, including higher complete and partial renal response rates and faster time to improvement compared to placebo.Jessica discusses the long-term safety and efficacy findings from AURORA 2, highlighting the sustained renal benefits, lower risk of renal flares, and the drug’s manageable safety profile over three years of treatment. She also ad...
2025-04-1815 minRhAPPcastMedication Review: Voclosporin Dosing, Administration, Adjustments & InteractionsJoin Danielle Gatti Palumbo, Clinical Pharmacist at Northwell Health’s Division of Rheumatology in Long Island, New York, as she provides a comprehensive review of Voclosporin (Lupkynis), an FDA-approved calcineurin inhibitor (CNI) for the treatment of lupus nephritis. This discussion is essential for healthcare professionals, pharmacists, and patients seeking a deeper understanding of how Voclosporin enhances lupus nephritis management while optimizing safety and efficacy.Voclosporin is a next-generation calcineurin inhibitor that works by inhibiting T-cell activation, reducing the inflammatory response that leads to kidney damage in lupus nephritis. Unlike traditional CNIs like cyclosporine and tacrolimus, Voclosporin features a...
2025-04-1707 minRhAPPcastMedication Review: What is the Efficacy of Guselkumab Across the GRAPPA DomainsIn this expert breakdown, Cassie Dolecki, PharmD, a clinical pharmacy specialist in rheumatology at Allegheny Health Network in Pittsburgh, Pennsylvania, discusses the effectiveness of Guselkumab across the GRAPPA domains, drawing insights from the DISCOVER-2 trial and additional post-hoc analyses.As a phase 3 clinical trial, DISCOVER-2 evaluated Guselkumab in biologic-naïve patients with active PsA over two years, comparing 100 mg every 4 weeks and 100 mg every 8 weeks to placebo. At week 24, significantly more patients on Guselkumab achieved ACR20 response rates, demonstrating its superior ability to control inflammation and joint symptoms.A post-hoc analysis of DISCOVER-2 stratified patient r...
2025-04-1602 minRhAPPcastFAQ: Are IL-17 Inhibitors Efficacious in Treating the Nail-DIP Complex in PsA?In this expert discussion, Katie Springer, PA-C, a rheumatology specialist with Northwestern Medicine in Chicago, Illinois, explores the effectiveness of IL-17 inhibitors in managing the nail-DIP complex in psoriatic arthritis. Nail involvement in PsA is more than just a cosmetic concern—it is strongly linked to DIP joint disease and systemic enthesitis. The nail itself is now understood to be an enthesial site, which means nail disease in psoriasis can be a precursor to psoriatic arthritis. Patients often experience nail changes such as oil spots, pitting, and onycholysis, the latter of which can be misdiagnosed as a fungal infection. Th...
2025-04-0903 minRhAPPcastFAQ: What Are CNIs? Treating Lupus Nephritis with the Latest ACR GuidelinesIn this video, Lisa Asfahani, PA-C, shares clinical insights on the evolving role of calcineurin inhibitors (CNIs) in the treatment of lupus nephritis (LN), as outlined in the new 2024 ACR Guidelines. With over 11 years of experience in rheumatology at a private practice in Temecula, California, Lisa walks through the mechanism of action of CNIs—including how they inhibit IL-2 production by binding to cytoplasmic receptors like immunophilins, ultimately suppressing T-cell activity.She discusses common CNIs used in clinical practice, such as tacrolimus, cyclosporine, and the newer agent voclosporin. Voclosporin, in particular, is highlighted for its role in tr...
2025-04-0102 minRhAPPcastRhAPPcast: Elevating Care in LN: What the New ACR Guidelines Mean for Patients & How APPs can Apply ThemIn this essential episode of RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers, host Amanda Mixon, PA-C, is joined by lupus expert and RhAPP faculty member Monica Richey, NP, to discuss the latest ACR guidelines for lupus nephritis and what they mean for advanced practice providers (APPs). Together, they explore how these updated recommendations mark a significant shift in treatment—highlighting triple immunosuppressive therapy as a first-line approach and placing greater emphasis on early diagnosis, kidney preservation, and minimizing steroid exposure. Monica shares her real-world strategies for implementing guideline-driven care, including when to order a kidney biopsy, how to...
2025-03-2733 minRhAPPcastFAQ: How do IL-23 and IL-17 Inhibitors Differ in Clinical EfficacyJoin Audrey Gibson, PA-C, from the Arthritis Center of North Georgia, as she explores the latest clinical comparisons between IL-17 and IL-23 inhibitors in managing moderate-to-severe plaque psoriasis (PsO) and psoriatic arthritis (PsA).The ECLIPSE trial, published in The Lancet, compared Guselkumab (IL-23 inhibitor) vs. Secukinumab (IL-17 inhibitor) over 48 weeks. Guselkumab showed superior long-term efficacy, with 84% of patients achieving PASI 90 (90% skin clearance) compared to 70% with Secukinumab, both with similar safety profiles.The EXCEED trial compared Ixekizumab (IL-17) and Guselkumab (IL-23) over 24 weeks. Ixekizumab provided a faster onset of symptom relief, particularly in nail psoriasis, while...
2025-03-2503 minRhAPPcastJournal Club Review: Ixekizumab vs. Guselkumab in Plaque Psoriasis (12-Week Trial Results)Join Jessica Farrell, PharmD, a clinical pharmacist at Albany Med’s Division of Dermatology and professor at Albany College of Pharmacy and Health Sciences, as she explores a key head-to-head clinical trial comparing Ixekizumab (IL-17 inhibitor) vs. Guselkumab (IL-23 inhibitor) for moderate-to-severe plaque psoriasis. This British Journal of Dermatology study, published in December 2019, provides essential insights into efficacy, safety, and speed of response, making it a valuable resource for healthcare providers treating psoriasis.The study focused on patients with significant psoriasis severity, defined by Static Physician Global Assessment (sPGA) scores of 3 or higher, Psoriasis Area and Severity In...
2025-03-1905 minRhAPPcastMedication Review: What is Voclosporin and How Does it Work?Join Danielle Gatti Palumbo, Clinical Pharmacist at Northwell Health's Division of Rheumatology in Long Island, New York, as she provides an in-depth breakdown of the mechanism of action of Voclosporin (Lupkynis), a next-generation calcineurin inhibitor used in the treatment of lupus nephritis and other autoimmune diseases.Voclosporin plays a critical role in immune modulation by inhibiting calcineurin, a key enzyme responsible for activating T-cells. By blocking calcineurin activity, Voclosporin prevents the dephosphorylation of NFAT (Nuclear Factor of Activated T-cells), which is necessary for IL-2 transcription. This disruption reduces IL-2 production, lymphocyte proliferation, and surface antigen expression, ultimately...
2025-03-1401 minRhAPPcastFAQ: According to the New 2024 ACR Guidelines for LN, What Are the Treatment Goals For Patients With LN?The 2024 ACR guidelines introduce important updates for the screening, treatment, and monitoring of lupus nephritis, with a focus on preserving renal function, reducing chronic kidney disease morbidity, and minimizing medication-related toxicities. In this video, Lisa Asfahani, PA-C, a rheumatology expert with over 11 years of experience, breaks down these new recommendations. She discusses the importance of screening all lupus patients every 6 to 12 months, as 30-50% of SLE patients eventually develop lupus nephritis. The updated guidelines recommend renal biopsy for patients with significant proteinuria or unexplained impaired renal function. For Class 3 and Class 4 lupus nephritis, a triple immunosuppressive regimen...
2025-03-1303 minRhAPPcastJournal Club Review: Long-Term Safety of Guselkumab in Patients with Psoriatic DiseaseJoin Amber Hudgins, PharmD, a pharmacist specializing in rheumatology and specialty pharmacy at Novant Health in Winston-Salem, North Carolina, as she provides a concise yet insightful review of the long-term safety of Guselkumab in patients with psoriatic disease, including psoriasis and psoriatic arthritis.This discussion highlights a comprehensive integrated analysis of 11 Phase 2 and Phase 3 clinical studies, which pooled over 10,000 patient-years of follow-up data. The results reinforce Guselkumab’s favorable safety profile, demonstrating low rates of severe adverse events, infections, and malignancies, which remained consistent across diverse patient subgroups. Furthermore, adverse event rates during treatment were comparable to th...
2025-03-1202 minRhAPPcastRhAPPcast: Navigating Leflunomide Use in Pregnant Patients with Sjögren’s SyndromeJoin Danielle Gatti Palumbo, PharmD, a clinical pharmacist and RhAPP Board member, alongside Monica Richey, NP, a renowned rheumatology specialist and educator, as they discuss a challenging and unexpected clinical case live from the RhAPP National Conference in Nashville, Tennessee.This special RhAPPcast episode explores a real-world scenario of a patient who unexpectedly became pregnant while on leflunomide, highlighting the complexities of medication management in autoimmune diseases. Monica shares her initial reaction, the steps taken to initiate the cholestyramine washout protocol, and the multidisciplinary approach needed to ensure both maternal and fetal safety.Danielle provides...
2025-03-0415 minRhAPPcastFAQ: According to the New 2024 ACR Guidelines, How Do You Treat LN?Stacey Johnson, NP, a rheumatology specialist at Montana Arthritis Center, discusses key updates in the 2024 American College of Rheumatology (ACR) guidelines for lupus nephritis, with a strong emphasis on minimizing glucocorticoid exposure to prevent long-term complications.The updated guidelines focus on achieving a daily glucocorticoid dose of 5 mg or less within six months of initiating therapy. This approach aims to reduce steroid-related adverse effects such as osteoporosis, cardiovascular risks, and metabolic disturbances while maintaining disease control. To achieve this, clinicians must closely monitor disease activity and tailor tapering strategies to each patient’s individual needs.
2025-02-2801 minRhAPPcastFAQ: How Do You Interpret cDAPSA/DAPSA and MDA?Join Katie Springer, PA-C, a rheumatology specialist at Northwestern Medicine in Lake Forest, Illinois, as she dives into critical tools for measuring disease activity in psoriatic arthritis (PsA) and how they shape treatment strategies for improved patient outcomes.Accurate assessment of PsA requires disease-specific tools beyond traditional rheumatoid arthritis (RA) measures. The Disease Activity in Psoriatic Arthritis (DAPSA) score evaluates joint inflammation using tender and swollen joint counts, CRP levels, and patient-reported assessments. The clinical DAPSA (cDAPSA), an alternative version, removes CRP from the calculation, offering another method to track disease progression.For a comprehensive...
2025-02-2603 minRhAPPcastFAQ: How Do You Explain The Timing of Ixekizumab's Clinical Efficacy to Patients?Claudia Rivera Salas, DNP, a nurse practitioner at Pine Hollow Partners in East Lansing, Michigan, shares firsthand insights into the rapid efficacy of Ixekizumab in treating psoriasis and psoriatic arthritis. One of the most common questions patients ask is how quickly they can expect relief, and the answer is simple—fast.From the first injection, many patients begin to see significant improvement in their symptoms, including reduced inflammation, joint pain, stiffness, enthesitis, and dactylitis. By the three-month follow-up, clinical data aligns with real-world experiences, showcasing meaningful symptom relief. Claudia recounts patient stories of life-changing transformations—individuals who once...
2025-02-1901 minRhAPPcastFAQ: 2024 ACR Guidelines: Screening & Diagnosing Lupus Nephritis in SLE PatientsMonica Richey, NP, a seasoned rheumatology specialist with two decades of experience, provides an in-depth review of the 2024 lupus nephritis screening and diagnosis guidelines. As systemic lupus erythematosus (SLE) remains a leading cause of kidney-related complications, early detection and accurate diagnostic methods are essential for improving patient outcomes.This expert-led discussion explores the latest best practices for lupus nephritis screening, emphasizing why the spot protein-to-creatinine ratio has become the preferred diagnostic tool over the traditional 24-hour urine collection. The shift aims to provide a more efficient and practical approach to identifying early kidney involvement in SLE patients...
2025-02-1402 minRhAPPcastRhAPPcast: LN Updates Unpacked: Insights on New ACR GuidelinesIn this episode of RhAPPcast, Amanda Mixon, PA-C, President of RhAPP and a practicing physician assistant in Northern Colorado, is joined by Jennifer Mylod, NP, a seasoned rheumatology provider at Arizona Arthritis and Rheumatology Associates in Phoenix, Arizona, to discuss the latest American College of Rheumatology (ACR) guideline updates for lupus nephritis.With the first ACR guideline update since 2012, these new recommendations reflect advancements in therapeutics and a shift toward more targeted treatment approaches. The episode explores key changes, including updated recommendations for lower-dose glucocorticoids, the introduction of triple therapy strategies, and the importance of early intervention...
2025-02-1126 minRhAPPcastFAQ: How is Lupus Nephritis Defined?Join Amanda Mixon, PA-C, President of RhAPP and a practicing physician assistant in Northern Colorado, as she highlights the critical role of early detection and management in lupus nephritis. With up to 50% of lupus patients developing kidney involvement, proactive screening and timely intervention are essential to preventing severe complications, including end-stage renal disease (ESRD).Lupus nephritis results from autoantibody-driven kidney inflammation, leading to proteinuria, hypertension, and progressive kidney damage. Without proper management, up to 30% of patients face a 10-year mortality rate, while 10-20% may progress to ESRD. The latest American College of Rheumatology (ACR) guidelines emphasize routine...
2025-02-0702 minRhAPPcastFAQ: How Does Real-World Evidence Differ From Randomized Controlled TrialsJoin Jennifer Mylod, NP, from Arizona Arthritis and Rheumatology Associates in Phoenix, as she breaks down the differences between randomized controlled trials (RCTs) and real-world evidence (RWE) in assessing psoriatic arthritis treatments. While RCTs provide highly controlled data on efficacy and safety, RWE offers valuable insights into how treatments perform in everyday clinical practice.RCTs, like the Phase 3 COSMOS trial, are designed to eliminate bias by randomly assigning patients to treatment or placebo groups. In COSMOS, Guselkumab (Tremfya) showed significant improvements in joint and skin symptoms for PsA patients who had failed TNF inhibitors, establishing its efficacy...
2025-02-0503 minRhAPPcastFAQ: How Long Has It Been Since the Last ACR LN Guideline Updates, and Why Is This Significant?Join Amanda Mixon, PA-C, a physician assistant in Northern Colorado and President of RhAPP, as she unpacks the latest ACR guidelines for lupus nephritis. These updates mark a major shift in treatment, incorporating new therapies that enhance disease management while reducing medication toxicity.Previous guidelines relied heavily on high-dose steroids with mycophenolate mofetil (MMF) or cyclophosphamide for induction, followed by MMF maintenance. Now, with the approval of belimumab and voclosporin, treatment strategies emphasize a more targeted and sustained approach. These new options help preserve kidney function while limiting steroid exposure.The revised recommendations call for...
2025-01-3102 minRhAPPcastJournal Club Review: Effectiveness of Methotrexate and Leflunomide as Corticoid-Sparing DrugsIn this episode, Danielle Gatti Palumbo, PharmD, clinical pharmacist, RhAPP faculty member, and RhAPP Board member, explores a pivotal study evaluating the effectiveness of Methotrexate (MTX) and Leflunomide as steroid-sparing agents in Polymyalgia Rheumatica (PMR). Published in Rheumatology Advances in Practice, this multicenter observational study examines data from 23 rheumatology clinics across Argentina, shedding light on alternative treatment options for patients struggling with prolonged steroid use and associated side effects.Polymyalgia Rheumatica is traditionally managed with glucocorticoids, but long-term steroid use presents significant risks, especially in patients with diabetes, osteoporosis, or cardiovascular disease. The ACR and EULAR guidelines...
2025-01-2804 min
RhAPPcastRhAPPcast :The Clinical Utility of Guselkumab in Axial PsAIn this episode of RhAPPcast, Amanda Mixon, PA-C, President of Rheumatology Advanced Practice Providers (RhAPP), is joined by Audrey Gibson, PA-C, a seasoned rheumatology provider with nearly two decades of experience in private practice near Atlanta, Georgia. Together, they explore the latest clinical findings from the Discover trials, discuss the anticipated STAR trial (2025), and highlight how IL-23 inhibition is shaping Psoriatic Arthritis (PsA) treatment.With IL-23 inhibitors offering durable improvements in spinal pain, BASDAI scores, and ASAS responses, this episode focuses on how Guselkumab is addressing axial symptoms and inflammation in PsA patients, especially those with psoriasis...
2025-01-2220 min
RhAPPcastJournal Club Review: Efficacy & Safety of Ixekizumab ± Methotrexate in PsA (52-Week SPIRIT-H2H)Join Amber Hudgins, PharmD, CPP, as she unpacks the findings from the SPIRIT Head-to-Head Study, providing critical insights into biologic therapy selection for PsA management. How does Methotrexate (MTX) influence the efficacy of Ixekizumab (IXE) compared to Adalimumab (ADA) in biologic-naïve Psoriatic Arthritis (PsA) patients? The study highlights key differences in treatment response with and without methotrexate. Ixekizumab maintains consistent efficacy regardless of MTX use, making it a potential monotherapy option for PsA patients. In contrast, Adalimumab demonstrates improved efficacy when combined with methotrexate, suggesting that it may be more effective in patients who can tolerate M...
2025-01-1506 min
RhAPPcastFAQ: How Do You Interpret Radiographic Progression Using Modified-vdHS or mTSS?Join Kyle George, PA-C, a rheumatology expert in Idaho, as he breaks down two key radiographic scoring systems for psoriatic arthritis (PsA)—the Modified van der Heijde Sharp Score (mVHS) and the Modified Total Sharp Score (MTSS). These tools help clinicians assess structural damage, track disease progression, and guide treatment decisions.The mVHS score evaluates joint erosion, joint space narrowing, and periarticular changes, providing a comprehensive view of disease impact. Meanwhile, the MTSS score focuses specifically on bone erosions and joint space narrowing, offering a more targeted measure of progression. By understanding these scoring methods, providers can mo...
2025-01-0801 min
RhAPPcastMedication Review: What Is the Efficacy of Ixekizumab Across the GRAPPA and EULAR Domains?Join Jessica Farrell, PharmD, Clinical Pharmacist at Albany Medical Center’s Division of Rheumatology and Professor at Albany College of Pharmacy and Health Sciences, as she examines the efficacy of Ixekizumab (Taltz) across key GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) domains in treating psoriatic arthritis (PsA) and psoriasis.This discussion highlights how Ixekizumab performs across the diverse manifestations of PsA, including peripheral arthritis, axial disease, enthesitis, dactylitis, and both skin and nail psoriasis. Clinical data demonstrate its impact on ACR 20/50/70 scores, showing improvements in joint symptoms and axial disease response. Additionally, Ixekizumab ha...
2024-12-1607 min
RhAPPcastMedication Review: What Is the Safety Profile of Guselkumab in PsO and PsA?Join Cassie Dolecki, PharmD, BCPS, Clinical Pharmacy Specialist in Rheumatology at Allegheny Health Network in Pittsburgh, PA, as she reviews the comprehensive safety data of Guselkumab (Tremfya) in the management of psoriatic arthritis (PsA) and psoriasis.The Discover-2 trial provides critical insights into the safety of Guselkumab compared to placebo in biologic-naïve PsA patients, highlighting infection rates and adverse events. Long-term safety data spanning over 11,000 patient-years across multiple phase 2 and phase 3 trials reinforce the consistency of Guselkumab’s safety profile across diverse patient populations.This discussion breaks down key findings on the incidence of ser...
2024-12-1102 min
RhAPPcastFAQ: How Does Axial PsA Differ From AS Clinically, Genetically, and Radiographically?Join Kyle George, PA-C, a practicing physician assistant in Idaho, as he answers a frequently asked question: How does axial psoriatic arthritis (Axial PsA) differ from ankylosing spondylitis (AS) in clinical presentation, genetic associations, and radiographic findings?This session delves into critical distinctions between these conditions, including differences in joint involvement, disease progression, and imaging patterns. Genetic markers such as HLA associations and cytokine pathways—including IL-17A, TNF, and IL-10—are explored to better understand their roles in axial disease. Additionally, insights from post hoc analysis of the DISCOVER-1 and DISCOVER-2 trials highlight the efficacy of Guse...
2024-12-0402 minRhAPPcastJournal Club Review: 6-Month Guselkumab Effectiveness in PsA (Real-World CorEvitas Data)Join Jessica Farrell, PharmD, clinical pharmacist at Albany Medical Center’s Division of Rheumatology and faculty at Albany College of Pharmacy and Health Sciences, as she delves into real-world evidence on Guselkumab for psoriatic arthritis (PsA). In this session, she breaks down findings from a study published in Rheumatology and Therapy (August 2023) by Dr. Miscol, which evaluates the six-month persistence and multi-domain effectiveness of Guselkumab using data from the CorEvitas PsA and Spondyloarthritis Registry.The study followed PsA patients receiving Guselkumab 100 mg at weeks 0, 4, and then every 8 weeks, assessing disease activity at baseline and again at six mo...
2024-11-2003 min
RhAPPcastRhAPPcast: Navigating the Complexities: IL-17 Inhibitors and IBD RiskJoin Amanda Mixon, PA-C, President of RhAPP, and Candace Ryan, PA-C, as they explore the evolving discussion around IL-17 inhibitors and their potential impact on inflammatory bowel disease (IBD) in this episode of RhAPPcast.IL-17 inhibitors have revolutionized the treatment of psoriasis, psoriatic arthritis, and axial spondyloarthritis, offering targeted therapy for chronic inflammatory conditions. However, emerging data suggest that IL-17 inhibition may influence gut inflammation, raising important considerations for clinicians managing patients with concurrent or potential IBD. This discussion reviews the latest clinical trial data, meta-analyses, and real-world evidence to provide clarity on the relationship between IL-17...
2024-11-1331 minRhAPPcastFAQ: Why is Binding CD64+ Important When Discussing IL23 Directed TherapyJoin Heather Mambretti, PA-C, a rheumatology expert in Houston, Texas, and RhAPP member, as she explores the critical role of CD64-positive binding in IL-23 inhibition and its impact on autoimmune disease treatment.CD64, a high-affinity receptor expressed on myeloid lineage immune cells, plays a pivotal role in inflammatory signaling. IL-23, a key driver of inflammation in psoriatic arthritis, psoriasis, and inflammatory bowel disease, promotes pathogenic TH17 cell differentiation, contributing to chronic inflammation. Guselkumab (Tremfya) uniquely leverages a dual-binding mechanism, targeting both IL-23 and CD64-positive cells to enhance specificity and therapeutic efficacy.Insights from...
2024-11-0604 minRhAPPcastJournal Club Review: Upadacitinib Safety & Efficacy in Pediatric JIA (Phase-1 Interim Data)Join Ingrid Pan, PharmD, Pediatric Clinical Pharmacist at Children’s Hospital Colorado, as she reviews the latest findings from the Phase 1 trial of Upadacitinib (Rinvoq) in treating pediatric polyarticular course juvenile idiopathic arthritis (JIA). This interim analysis, published in Annals of the Rheumatic Diseases, explores the potential of JAK1-selective inhibition in pediatric rheumatology.This open-label, three-part Phase 1 study evaluated pharmacokinetics, safety, and efficacy in patients aged 2-18 across North America, Europe, and Asia. Results demonstrated promising clinical responses, with an ACR 30 response rate of 92% at Week 12, ACR 50 response of 90%, and ACR 70 response of 69%. Safety data indicated mi...
2024-11-0406 minRhAPPcastRhAPPcast: Lost Time: The Impact of Delaying Optimal Therapy in RA & SpA Patients Without Disease ControlIn this RhAPPcast episode, host Amanda Mixon, PA-C, welcomes Jeannette Hart, PA-C, a seasoned rheumatology provider and RhAPP faculty member, to explore the consequences of treatment delays and strategies for ensuring timely intervention. Delaying optimal treatment for rheumatoid arthritis (RA) and spondyloarthropathies (SpA) can lead to irreversible joint damage, disease progression, and diminished quality of life.This discussion covers the common barriers to early treatment, including limited specialist access, patient hesitancy, and insurance hurdles, as well as the long-term risks of delayed therapy. Identifying high-risk patients through clinical assessments, disease activity scores, and patient-reported symptoms is essential...
2024-11-0120 minRhAPPcastJournal Club Review: 5-Year Data on Switching Upadacitinib & Adalimumab in RAJoin Jessica Farrell, PharmD, Clinical Pharmacist at Albany Med’s Division of Rheumatology and Professor at Albany College of Pharmacy and Health Sciences, for an in-depth review of a pivotal study published in Rheumatology and Therapy (March 2024) by Fleischmann et al. This RhAPP Journal Club session explores long-term clinical outcomes and safety data for rheumatoid arthritis (RA) patients switching between Upadacitinib (Rinvoq) and Adalimumab (Humira), based on findings from the SELECT-COMPARE Phase 3 study.This analysis provides valuable insights into treat-to-target strategies in RA, particularly for patients who do not achieve optimal disease control with their initial therapy. Th...
2024-10-3008 minRhAPPcastFAQ: Definition of Remission in Rheumatoid Arthritis & Likelihood with Advanced TherapiesJoin Stacey Johnson, NP-C, as she explains the two primary remission criteria for rheumatoid arthritis (RA) recommended by the American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (EULAR). These guidelines define remission using two key approaches: the Boolean-based definition and the Index-based definition.The Boolean 2.0 criteria evaluate four key factors: tender joint count, swollen joint count, patient global assessment, and CRP levels. Meanwhile, the Index-based definitions rely on the Simplified Disease Activity Index (SDAI) at ≤ 3.3 and the Clinical Disease Activity Index (CDAI) at ≤ 2.8 to determine remission status.Recent updates to the...
2024-10-2502 minRhAPPcastMedication Review: How is Guselkumab dosed in PsO, PsA, and IBDJoin Danielle Gatti Palumbo, PharmD, clinical pharmacist at Northwell Health, Division of Rheumatology in Long Island, New York, as she provides an in-depth review of Guselkumab (Tremfya®) and its use in treating moderate-to-severe plaque psoriasis and active psoriatic arthritis (PsA).Guselkumab is FDA-approved for psoriasis and PsA and can be used alone or in combination with methotrexate or leflunomide. The standard dosing schedule consists of a 100 mg subcutaneous injection at Week 0 and Week 4, followed by maintenance dosing every 8 weeks.Before initiating treatment, thorough pre-screening is essential, including TB screening, hepatitis B and C testing, and b...
2024-10-2301 minRhAPPcastRhAPPcast: Navigating Remission in Rheumatoid Arthritis: Approaches, Advances, Impact, and InsightsWelcome to RhAPPcast, the official podcast for Rheumatology Advanced Practice Providers (RhAPP). In this episode, Amanda Mixon, PA-C, RhAPP President, sits down with Wendy Simmons, PA-C, to explore the evolving landscape of rheumatoid arthritis (RA) treatment and the journey toward sustained remission.Achieving remission in RA requires a multifaceted approach, incorporating clinical assessment tools such as tender and swollen joint counts, patient-reported outcomes, and inflammatory markers like CRP. The evolution of RA therapies—from early disease-modifying agents like gold injections to today’s biologics and JAK inhibitors—has dramatically reshaped patient outcomes.This episode delves into t...
2024-10-1831 minRhAPPcastFAQ: Variability in JAK Inhibition Specificity & Its Clinical ImplicationsJoin Dr. Claudia Rivera Salas, DNP, NP-C, a rheumatology nurse practitioner in East Lansing, Michigan, as she explores the variability in JAK enzyme inhibition across available JAK inhibitors and the potential clinical implications of these differences. JAK inhibitors have significantly advanced the treatment of autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, and inflammatory bowel disease. However, not all JAK inhibitors function the same way, and their differences in targeting specific JAK enzymes impact both their efficacy and side effect profiles.The Janus kinase (JAK) family includes four key enzymes: JAK1, JAK2, JAK3, and TYK2. These enzymes...
2024-10-1603 minRhAPPcastRhAPPcast: CD64+ Binding Description, Relevance, and Potential Clinical ImplicationsWelcome to RhAPPcast, the official podcast for Rheumatology Advanced Practice Providers (RhAPP). In this episode, Amanda Mixon, PA-C, RhAPP President, sits down with William Saalfeld, NP, to discuss the evolving science of IL-23 inhibition and CD64 binding in psoriatic arthritis (PsA), psoriasis, and inflammatory bowel disease (IBD).CD64 upregulation plays a significant role in immune cell activation and inflammation in rheumatic diseases. IL-23 is a key driver of chronic inflammation in the joints, skin, and gut, fueling disease progression in PsA, psoriasis, and IBD. The latest advancements in targeted therapy reveal how IL-23 inhibitors, such as Guselkumab...
2024-10-1619 minRhAPPcastFAQ: What Is the Difference Between Biosimilars and Generics?Join Kyle George, PA-C, a rheumatology specialist in Idaho, as he clarifies the fundamental differences between biosimilars and generic drugs—an essential topic for both healthcare providers and patients navigating treatment options.Generic drugs are chemically synthesized and identical to their brand-name counterparts in active ingredients, dosage, and administration. They undergo FDA approval based on pharmacokinetic and pharmacodynamic bioequivalence, ensuring the same efficacy and safety profile as the original drug.Biosimilars, on the other hand, are derived from living cells and are highly similar—but not identical—to biologic reference products. Due to their complex nature...
2024-10-1402 minRhAPPcastFAQ: What is the Safety Profile of Ixekizumab in PsA and axSpaWendy Simmons, PA-C, a rheumatology specialist at Carolina Arthritis Associates in Wilmington, North Carolina, explores the safety profile of Ixekizumab, a biologic therapy for psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA). With over 26 years of clinical experience, Wendy provides essential insights into potential risks, patient monitoring, and long-term safety considerations for those receiving this treatment.While Ixekizumab is generally well-tolerated, common side effects include injection site reactions, upper respiratory infections, nausea, and fungal infections. More serious risks, such as tuberculosis (TB), bacterial and viral infections, and neutropenia (low neutrophil counts), require careful monitoring. Additionally, some patients may...
2024-10-0903 min
RhAPPcastMedication Review: What Is the Safety Profile of Upadacitinib Across Indications?Join Jessica Farrell, PharmD, a clinical pharmacist at Albany Med's Division of Rheumatology and professor at Albany College of Pharmacy and Health Sciences, as she reviews a critical study on the safety of upadacitinib across multiple indications.Patient concerns about medication safety remain a major barrier to initiating biologics and targeted synthetic therapies. This study, published in RMD Open in February 2023, evaluates over 15,000 patient-years of upadacitinib exposure in rheumatoid arthritis, psoriatic arthritis, and atopic dermatitis, providing crucial real-world safety insights.Findings revealed consistent rates of treatment-emergent adverse events across all disease populations, with slightly higher...
2024-10-0710 minRhAPPcastFAQ: Provide Immunologic Rationale For IL23 Directed Therapy in PsA, PsO, and IBD.Join Heather Mambretti, PA-C, a rheumatology specialist in Houston, Texas, as she explores the critical role of IL-23 in autoimmune disease pathogenesis and how IL-23 inhibitors have revolutionized treatment strategies for psoriasis, psoriatic arthritis (PsA), and inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis.IL-23 is a key cytokine produced by dendritic and macrophage cells, driving TH17 cell differentiation and fueling chronic inflammation. In psoriasis and PsA, dysregulated IL-23 signaling promotes TH17 proliferation, leading to increased IL-17A and IL-17F production—major contributors to inflammation in skin and joints. In IBD, IL-23 plays a si...
2024-10-0203 minRhAPPcastRhAPPcast: Biosimilars and The Patient PerspectiveWelcome to RhAPPcast, the official voice of Rheumatology Advanced Practice Providers (RhAPP). In this special episode, Amanda Mixon, PA-C, RhAPP President, sits down with Kris, a patient who shares his firsthand experience transitioning from adalimumab (Humira) to a biosimilar after years of stability on biologic therapy.Kris opens up about his journey with rheumatoid arthritis, from diagnosis to achieving remission with biologic treatment. He discusses his initial concerns about switching to a biosimilar, the misconceptions he encountered, and what the transition was like in the real world. He also highlights the importance of patient-provider communication and how...
2024-09-3022 minRhAPPcastMedication Review: How Is Upadacitinib Dosed Across Rheumatologic Indications?Join Kyle George, PA-C, a rheumatology physician assistant in Idaho, as he reviews the dosing recommendations for Upadacitinib (Rinvoq) across rheumatology, gastroenterology, and dermatology.Upadacitinib is a selective JAK1 inhibitor used for a range of immune-mediated diseases. In adult patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and non-radiographic axial spondyloarthritis (nr-axSpA), the recommended dose is 15 mg once daily in an extended-release tablet formulation.For pediatric patients with juvenile idiopathic arthritis (JIA) and PsA, dosing is weight-based using a 1 mg/mL solution:10-20 kg: 3 mg twice daily20-30...
2024-09-1901 minRhAPPcastFAQ: Provide Immunologic Rationale for JAK-Directed Therapy in Rheumatic DiseaseJoin Dr. Claudia Rivera Salas, DNP, NP-C, a rheumatology nurse practitioner in East Lansing, Michigan, as she explores the immunologic rationale behind JAK-STAT pathway inhibition in rheumatic and inflammatory diseases.The JAK-STAT pathway plays a crucial role in cytokine signaling and immune regulation. Dysregulation of this pathway is a key driver of chronic inflammation in autoimmune diseases, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and non-radiographic axial spondyloarthritis (nr-axSpA). Beyond rheumatology, JAK inhibitors are also transforming the treatment landscape in dermatology and gastroenterology, with applications in atopic dermatitis, alopecia areata, lupus, hidradenitis suppurativa, psoriasis...
2024-09-1706 minRhAPPcastMedication Review: Describe the Mechanism of Action of UpadacitinibJoin Ingrid Pan, PharmD, a pediatric clinical pharmacist at Children’s Hospital Colorado, as she explores the mechanism of action of Upadacitinib (Rinvoq), a Janus kinase (JAK) inhibitor used in the treatment of rheumatologic and autoimmune conditions.Upadacitinib is a selective JAK1 inhibitor, designed to target cytokine signaling pathways involved in inflammation, immune regulation, and disease progression. By blocking JAK1 signaling, it modulates key immune responses, including cytokine and interferon activity, lipid metabolism, and blood cell development. Compared to broader JAK1/2/3 inhibitors, selective JAK1 inhibition was developed with the goal of reducing risks such as cytopenias and ot...
2024-09-1301 minRhAPPcastFAQ: Provide Immunologic Rationale For IL17-Directed Therapy in PsA, AS, and nr-axSpAJoin Kyle George, PA-C, a rheumatology specialist in Idaho, as he examines the immunologic basis for IL-17 inhibition in treating psoriatic arthritis (PsA), ankylosing spondylitis (AS), and non-radiographic axial spondyloarthritis (nr-axSpA).IL-17A, a pro-inflammatory cytokine produced by TH17 cells, plays a crucial role in driving chronic inflammation in spondyloarthropathies. Elevated IL-17 levels in affected joints and tissues are strongly associated with disease severity in PsA and axial SpA. By promoting neutrophil recruitment and activation, IL-17 contributes to the persistent inflammation, pain, and structural damage characteristic of these conditions.Unlike broad-spectrum immunosuppressants...
2024-09-1101 minRhAPPcastFAQ: Describe the IL17-Induced Inflammatory CascadeJoin Robert Laugherty, PA-C, JD, a rheumatology specialist with over 16 years of experience, as he explores IL-17, a key cytokine involved in immune defense and chronic inflammatory diseases. IL-17 plays a critical role in host protection against extracellular bacteria and fungi, while its dysregulation contributes to autoimmune conditions such as psoriatic arthritis, ankylosing spondylitis, and rheumatoid arthritis.IL-17 is a family of six proteins (IL-17A to IL-17F) that function downstream of IL-23, activating epithelial cells, fibroblasts, and keratinocytes to release inflammatory cytokines and recruit neutrophils. This cascade amplifies immune responses through key signaling pathways, including...
2024-09-0402 minRhAPPcastFAQ: Describe JAK-STAT Signaling in InflammationJoin Heather Mambretti, PA-C, a rheumatology specialist with over 12 years of experience in the Houston Metro area, as she provides an in-depth look at the JAK-STAT signaling pathway—a fundamental mechanism in immune regulation and chronic inflammation. This pathway plays a crucial role in autoimmune diseases such as rheumatoid arthritis, psoriasis, psoriatic arthritis, and inflammatory bowel disease.The JAK-STAT pathway is a key signaling cascade that allows cytokines to regulate immune responses. The process begins when cytokines bind to their respective receptors, triggering the activation of Janus kinases (JAKs). Once activated, JAKs phosphorylate signal transducer and activator of...
2024-09-0401 minRhAPPcastFAQ: What Does It Mean for a Biosimilar to Be Interchangeable and Why Is That Important?Join Kyle George, PA-C, a rheumatology specialist in Idaho, as he explores the critical role of interchangeable biosimilars in modern healthcare. Biosimilars are biologic medical products that closely resemble FDA-approved reference biologics, demonstrating no clinically meaningful differences in safety, efficacy, or potency. However, not all biosimilars receive the interchangeability designation—so what does that mean, and why is it important?Interchangeable biosimilars undergo additional switching studies to confirm that patients can transition seamlessly between the biosimilar and its reference product without concerns about reduced efficacy or increased risks. This designation allows for pharmacy-level substitution in certain states, im...
2024-09-0202 minRhAPPcastJournal Club Review: Long-Term Efficacy and Safety of GuselkumabJoin Amber Hudgins, PharmD, a pharmacist specializing in rheumatology and specialty pharmacy at Novant Health in Winston-Salem, North Carolina, as she provides a concise yet insightful review of the long-term safety of Guselkumab in patients with psoriatic disease, including psoriasis and psoriatic arthritis.This discussion highlights a comprehensive integrated analysis of 11 Phase 2 and Phase 3 clinical studies, which pooled over 10,000 patient-years of follow-up data. The results reinforce Guselkumab’s favorable safety profile, demonstrating low rates of severe adverse events, infections, and malignancies, which remained consistent across diverse patient subgroups. Furthermore, adverse event rates during treatment were comparable to th...
2024-08-2803 minRhAPPcastMed. Review Video Module: What is Non-Responder Imputation and How is it Utilized in Clinical TrialsJoin Danielle Gatti Palumbo, PharmD, a clinical pharmacist at Northwell Health’s Division of Rheumatology in Long Island, New York, as she explains the concept of non-responder imputation (NRI), a widely used statistical method in clinical trials for handling missing data.Non-responder imputation assumes that participants with missing data are classified as non-responders to treatment. This conservative approach helps maintain trial integrity, prevent bias, and provide a more rigorous evaluation of treatment efficacy. The method is particularly relevant in rheumatology clinical trials, where patient dropout rates can be high.The FDA often endorses NRI as a...
2024-08-2102 minRhAPPcastRhAPPcast: Biosimilars Unveiled - Empowering APPs for Better Patient ConversationsWelcome to RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers (RhAPP). In this episode, Amanda Mixon, PA-C, President of RhAPP, is joined by Kyle George, PA-C, to explore the world of biosimilars and how APPs can confidently educate patients about these treatments.As biosimilars gain traction in rheumatology, understanding their role in clinical practice is essential. This discussion breaks down what biosimilars are, how they compare to reference biologics in terms of safety and efficacy, and addresses common misconceptions patients may have when switching to a biosimilar. The conversation also touches on the growing influence of...
2024-08-1927 minRhAPPcastMedication Review: Describe The Mechanism of Action of IxekizumabChristy Vath, PA-C, from Seattle Rheumatology in Washington, provides a concise yet insightful overview of the mechanism of action of Ixekizumab, a targeted IL-17A inhibitor designed for the treatment of autoimmune diseases, including psoriasis (PSO), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA).Ixekizumab is a humanized monoclonal antibody that selectively targets IL-17A, a key pro-inflammatory cytokine involved in the pathogenesis of psoriatic and spondyloarthritic conditions. By inhibiting IL-17A, Ixekizumab helps to reduce inflammation, prevent tissue damage, and alleviate symptoms associated with these chronic conditions. The discussion also covers the role of IL-17A inhibition...
2024-08-1401 minRhAPPcastFAQ: What is The Role of IL23/IL17 Axis in Rheumatic DiseaseJoin Katie Springer, PA-C, from Northwestern Medicine in Lake Forest, Illinois, as she explores the critical role of the IL-23/IL-17 axis in immune-mediated inflammatory diseases, including psoriatic arthritis and psoriasis.This session provides a comprehensive look at how IL-23 and IL-17 contribute to the pathogenesis of autoimmune conditions, driving chronic inflammation in the skin, joints, and entheses. Understanding the IL-23/IL-17 pathway is key to optimizing targeted therapies for autoimmune disease management.IL-23 is a pro-inflammatory cytokine produced by dendritic cells and macrophages, stimulating TH17 cell differentiation and leading to IL-17A and IL-17...
2024-08-0702 minRhAPPcastRhAPPcast: The IL23/IL17 Cascade and Implications in the Pathogenesis of PsA, PsO, and IBDAmanda Mixon, PA-C, President of RhAPP, is joined by Christy Vath, PA-C, an expert in immunology and rheumatology, to explore the IL-23/IL-17 pathway and its impact on chronic inflammatory diseases. This episode of RhAPPcast dives into how the IL-23 and IL-17 cytokines drive inflammation in psoriatic arthritis, psoriasis, and inflammatory bowel disease, shedding light on how targeted therapies are reshaping treatment approaches.IL-23 is a key driver of the inflammatory cascade, fueling Th17 cells to produce IL-17A and IL-17F. These cytokines contribute to inflammation in the skin, joints, and gut, making them critical therapeutic...
2024-07-1723 minRhAPPcastThe 2024 RhAPP National Conference in Nashville, TNGet ready for an exclusive preview of the 2024 RhAPP National Conference in Nashville, Tennessee, happening from September 26-28, 2024! In this special episode of RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers (RhAPP), host Amanda Mixon, PA-C, RhAPP President, is joined by Wendy Simmons, PA-C, Kyle George, PA-C, and Brandon Ko, DNP—three esteemed board members— to break down everything you need to know about this premier rheumatology event.Tune in as we explore exciting conference updates, must-attend sessions, cutting-edge research presentations, and unparalleled networking opportunities for advanced practice providers (APPs) in rheumatology. Whether you’re a season...
2024-07-1033 minRhAPPcastFAQ: Describe The IL23/IL17 AxisJoin Katie Springer, PA-C, a rheumatology specialist at Northwestern Medicine in Lake Forest, Illinois, as she presents an in-depth exploration of the IL-23/IL-17 axis, a key driver of chronic inflammation in autoimmune diseases such as psoriatic arthritis, psoriasis, and inflammatory bowel disease (IBD). This session is essential for rheumatology APPs and healthcare providers seeking to enhance their understanding of cytokine signaling and its implications for targeted immunotherapy.In this discussion, Katie explains how IL-23, a heterodimeric cytokine composed of IL-23 p19 and IL-12/23 p40, plays a crucial role in immune system dysregulation. She examines how IL-23...
2024-07-0302 minRhAPPcastJournal Club Review: Differentiation of Therapeutic Antibodies Targeting Interleukin (IL)-23Join Amber Hudgins, PharmD, a clinical pharmacist at Novant Health in Winston-Salem, North Carolina, presents an in-depth analysis of IL-23 inhibitors, as she discusses key findings from an ACR 2022 abstract comparing Guselkumab and Risankizumab in the treatment of psoriatic disease. This session is essential for rheumatology APPs, pharmacists, and clinicians aiming to refine their understanding of IL-23 inhibition and its impact on psoriasis and psoriatic arthritis management.In this discussion, Amber explores the differences between Guselkumab and Risankizumab, detailing how their unique mechanisms of action influence therapeutic efficacy. She examines Guselkumab’s CD64 binding compared to Risankizumab’s mu...
2024-06-2004 minRhAPPcastMedication Review: Describing the Mechanism of Action of GuselkumabJoin Danielle Gatti Palumbo, PharmD, a clinical pharmacist at Northwell Health’s Division of Rheumatology in Long Island, New York, as she provides an in-depth analysis of Guselkumab, a monoclonal antibody that targets IL-23 to treat immune-mediated inflammatory diseases. This session is essential for rheumatology and gastroenterology APPs, pharmacists, and healthcare providers looking to enhance their understanding of targeted immunotherapy for conditions such as psoriasis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis.In this video, Danielle explores the role of IL-23 in driving chronic inflammation and autoimmune disease, explaining how TH17 activation contributes to the pathogenesis of p...
2024-06-1302 minRhAPPcastFAQ: Define, compare, and contrast humoral and cell-mediated immunity.In this educational FAQ video, Katie Springer, PA-C, from Northwestern Medicine at Lake Forest Hospital, Illinois, provides a clear and concise breakdown of humoral and cell-mediated immunity—two essential components of the adaptive immune system.Humoral immunity, driven by B cells and antibodies, plays a critical role in neutralizing extracellular pathogens, preventing infections, and building long-term immune memory. In contrast, cell-mediated immunity relies on T cells to target intracellular threats, including viruses and cancerous cells. Katie also explores how the IL-23/IL-17 pathway influences immune responses, contributing to autoimmune diseases such as psoriasis and inflammatory arthritis....
2024-06-0603 minRhAPPcastRhAPPcast Spotlight: Clinical Cornerstones with Lindsay Tom, PA-CJoin RhAPPcast for an enlightening episode featuring Lindsay Tom, PA-C, as we highlight the latest Spotlight: Clinical Cornerstones segment from RhAPP’s quarterly newsletter. Hosted by Amanda Mixon, PA-C, president of Rheumatology Advanced Practice Providers (RhAPP), this discussion delves into osteoporosis care and the essential role that rheumatology providers play in diagnosing, managing, and preventing bone loss and fractures in high-risk patients.Lindsay Tom shares insights from her compelling piece, "From Joints to Bones: The Crucial Role of Rheumatology Providers in Osteoporosis Care." Osteoporosis, a chronic and progressive bone disease that leads to fragility fractures, is a ma...
2024-05-2921 minRhAPPcastRhAPPcast Spotlight: Clinical Cornerstones with Cayla Alexander, DNP, ARNPJoin RhAPPcast for an insightful episode featuring Cayla Alexander, DNP, ARNP, as we highlight the latest Spotlight: Clinical Cornerstones segment from RhAPP’s quarterly newsletter. Hosted by Amanda Mixon, PA-C, president of Rheumatology Advanced Practice Providers (RhAPP), this discussion explores Axial Spondyloarthritis (axSpA)—a chronic inflammatory condition that primarily affects the spine and sacroiliac joints, leading to pain, stiffness, and reduced mobility.Dr. Cayla Alexander shares her unique perspective in her thought-provoking piece, "Axial Spondyloarthritis: At the Intersection of Clinician and Patient," examining the challenges of early diagnosis, treatment barriers, and the evolving role of advanced practice prov...
2024-04-2932 minRhAPPcastBreathing New Life: HRCT and PFTs in ILD with Corinne Young of APAPPJoin RhAPPcast for an essential deep dive into the intersection of rheumatology and pulmonology, featuring Corinne Young, MSN, FNP-C, FCCP, president of the Association of Pulmonary Advanced Practice Providers (APAPP). Hosted by Amanda Mixon, PA-C, president of Rheumatology Advanced Practice Providers (RhAPP), this episode explores the crucial role of high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) in diagnosing and managing interstitial lung disease (ILD)—a complex group of disorders that cause lung scarring and respiratory complications, particularly in patients with autoimmune conditions like rheumatoid arthritis (RA), systemic sclerosis (scleroderma), and Sjögren’s syndrome.Interstitial lung...
2024-04-0235 minRhAPPcastSpotlight: Clinical Cornerstones, Mary Elliott, PA-CJoin RhAPPcast for an insightful episode featuring Mary Elliott, PA-C, as part of RhAPP’s Clinical Cornerstones Spotlight series. Hosted by Amanda Mixon, PA-C, this conversation delves into Mary’s transition from primary care to rheumatology, offering valuable insights for healthcare providers navigating career shifts. Learn about the key challenges, learning curves, and best practices in adopting a rheumatology-focused approach to patient care. Whether you're an APP, rheumatology professional, or medical student, this episode provides essential knowledge on career growth, patient management, and clinical expertise in rheumatology. Tune in to RhAPPcast, the leading podcast for adva...
2024-02-0745 minRhAPPcastLeading the Way: Dr. John Cush on Rheumatology LeadershipIn this insightful episode of RhAPPcast, host Amanda Mixon, PA-C, sits down with Dr. Jack Cush, a leading rheumatologist and the program chair of Rheum Now Live 2024. With decades of experience in rheumatology, Dr. Cush shares his perspective on leadership in this rapidly evolving specialty. Together, they explore what it takes to guide and inspire the next generation of rheumatology providers, the importance of staying ahead in an ever-changing medical landscape, and the role of education and advocacy in shaping the future of the field. Whether you're an experienced clinician or an early-career APP, this conversation offers...
2024-01-1736 minRhAPPcastDiscussing Biosimilars With PatientsIn the twelfth and final episode of the GHAPP & RhAPP biosimilar podcast series, host Gabriella McCarty, NP, sits down with Jamie Brogan, NP, for an essential discussion on how to effectively communicate with patients about biosimilars. As biosimilars continue to reshape treatment options in gastroenterology and rheumatology, advanced practice providers must be prepared to educate patients, address concerns, and foster confidence in these therapies.Throughout the conversation, Gabriella and Jamie explore the challenges of discussing biosimilars with patients and the best methods to explain their role in treatment. They dive into common misconceptions, including patient hesitancy about...
2023-12-1326 minRhAPPcastThe Nocebo EffectWelcome to our eleventh episode of the GHAPP & RhAPP biosimilar podcast series! Our host Amanda Mixon, PA-C, engages in an insightful conversation with Naomi A. Amudala, CRNP, MSN, diving into a crucial topic in biosimilar adoption: The Nocebo Effect.As biosimilars continue to reshape treatment options in gastroenterology and rheumatology, understanding the nocebo effect—where negative patient expectations contribute to perceived or real adverse effects—becomes essential for advanced practice providers (APPs).Throughout this episode, Amanda and Naomi explore, the science behind the nocebo effect and how it differs from the placebo effect. Key research find...
2023-12-0820 minRhAPPcastVoices for Change: Madelaine Feldman, MD of CSRO on Advocacy in RheumatologyJoin host Amanda Mixon, PA-C, in an insightful episode of RhAPPcast, featuring Madelaine Feldman, MD, a leading rheumatologist and passionate advocate. Together, they explore the vital role of advocacy in rheumatology, addressing the challenges patients and providers face, from access to treatment to navigating policy changes.Dr. Feldman introduces the Coalition of State Rheumatology Organizations (CSRO), a powerful group dedicated to advancing policies that improve rheumatology care. She shares how RhAPP members can get involved, make an impact, and advocate for better patient outcomes and healthcare policies.Whether you're an APP, physician, or healthcare professional...
2023-11-3028 minRhAPPcastThe Practical Use of Biosimilars in Gastroenterology APP PracticeIn the tenth episode of the GHAPP & RhAPP Biosimilar Podcast Series, host Gabriella McCarty, NP-C, welcomes Sharon Dudley-Brown, PhD, FNP-BC, FAAN, FAANP to explore the practical use of biosimilars in gastroenterology APP practice.They begin by reviewing key takeaways from the AGA Biosimilars Roundtable Meeting Report and the Crohn’s & Colitis Foundation Biosimilar Position Statement, which provide guidance on biosimilar safety, efficacy, and implementation in IBD treatment.Sharon shares insights on biosimilars in Crohn’s disease and ulcerative colitis, discussing their effectiveness, safety, and patient outcomes. They examine how APPs can lead patient education, navigate insu...
2023-11-0822 minRhAPPcastThe Practical Use of Biosimilars in Rheumatology APP PracticeIn the ninth episode of the GHAPP & RhAPP Biosimilar Podcast Series, host Amanda Mixon, PA-C, welcomes guest Daric Mueller, PA-C, for an engaging discussion on the practical use of biosimilars in rheumatology APP practice. As biosimilars continue to reshape treatment options for rheumatic diseases, understanding their application in clinical settings is essential for advanced practice providers (APPs) looking to optimize patient care.The conversation kicks off with an exploration of the American College of Rheumatology (ACR) White Paper on Biosimilars, which serves as a guiding document for rheumatology providers navigating the evolving landscape of biologic therapy. Amanda...
2023-10-3022 minRhAPPcastThe Benefits of BiosimilarsThe latest episode of the GHAPP & RhAPP Biosimilar Podcast Series, hosted by Gabriella McCarty, NP, welcomes guest expert Gwen Cassidy, NP, for an in-depth discussion on the far-reaching benefits of biosimilars. As biosimilars continue to shape the future of rheumatology and gastroenterology, their impact on cost savings, patient access, healthcare system sustainability, and even medical innovation cannot be overstated.The conversation opens with a critical discussion on affordability. Biosimilars offer significant cost reductions compared to their reference biologics, making life-changing treatments more accessible to patients. A 2022 report from the Association for Accessible Medicines highlighted that the average...
2023-10-1119 minRhAPPcastManaged Care and BiosimilarsThe latest episode of the GHAPP & RhAPP Biosimilar Podcast Series, hosted by Amanda Mixon, PA-C, dives into a critical conversation on the interplay between managed care and biosimilars. Featuring guest expert Audrey Gibson, PA-C, this episode explores how biosimilars are integrated into managed care, the implications for cost savings and access, and the strategies necessary to drive biosimilar adoption in clinical practice.Managed care plays a pivotal role in the healthcare ecosystem, aiming to improve quality while controlling costs. As biosimilars continue to gain traction, their inclusion in formularies, utilization management strategies, and patient education initiatives become...
2023-10-0324 minRhAPPcastInterchangeability & Switching of BiosimilarsIn the latest episode of the GHAPP & RhAPP Biosimilar Podcast Series, host Gabriella McCarty, NP-C, is joined by Janette Villalon, NP, to discuss the critical topic of interchangeability and switching of biosimilars. As the use of biosimilars continues to expand in gastroenterology and rheumatology, understanding what interchangeability means for providers, pharmacists, and patients is essential.Janette breaks down the rigorous FDA approval process required for a biosimilar to be designated as interchangeable. Unlike generics, biosimilars are highly complex medications derived from living cells, making them similar—but not identical—to their reference products. Interchangeable biosimilars must undergo addi...
2023-09-1531 min