RhAPPcast

Amanda Mixon, PA-C and fellow rheumatology providers Heather Finlayson, PA-C, and Amanda Sell, PA-C, discuss managing glucocorticoid toxicity in polymyalgia rheumatica (PMR), focusing on balancing disease control with long-term patient safety. They explore the challenges of prednisone tapering, recurrent flares, and cumulative steroid exposure, including concerns associated with prolonged use at lower doses. The conversation highlights patient characteristics and comorbidities that may increase toxicity risk, including older age, diabetes, hypertension, osteoporosis, glaucoma, and psychiatric conditions. They review practical monitoring strategies for blood pressure, blood glucose, bone health, infection risk, and changes in weight, sleep, mood, and skin. The discussion also examines treat-to-target approaches and when difficulty tapering, repeated relapses, or steroid-related complications should prompt consideration of steroid-sparing therapy. Throughout the episode, they emphasize patient education, shared decision-making, and coordination across healthcare providers to establish treatment expectations and address patients’ concerns about reducing steroids.

Designed for nurse practitioners, physician assistants, and other healthcare professionals caring for patients with PMR, this podcast offers practical insights into glucocorticoid safety, individualized treatment decisions, and reducing steroid burden while maintaining symptom control and quality of life. For more expert-led education, visit the Content Rheum and download the RhAPP Ace app to stay up to date with the latest clinical insights in rheumatologic care.

In this FAQ video module, Jennifer Mylod, a rheumatology nurse practitioner in Phoenix, Arizona, compares the mechanisms of action of guselkumab and icotrokinra within the interleukin-23 (IL-23)/T-helper 17 (Th17) signaling pathway. This overview highlights the differences between an injectable monoclonal antibody that targets the IL-23 cytokine and an oral peptide that selectively binds the IL-23 receptor.

This episode explores guselkumab’s binding to the IL-23 p19 subunit and its interaction with CD64 on IL-23-producing immune cells, alongside icotrokinra’s receptor-targeted approach to blocking IL-23 signaling. Jennifer also discusses downstream inflammatory cytokines, including IL-17A, IL-17F, and IL-22, and their connection to the inflammatory processes involved in psoriasis and psoriatic arthritis. The discussion helps clarify how these different molecular targets intersect within the same inflammatory pathway.

Designed for rheumatology advanced practice providers, nurse practitioners, physician assistants, and other clinicians caring for patients with psoriasis and psoriatic arthritis, this module offers an overview of IL-23 signaling, targeted therapies, and the distinction between cytokine inhibition and receptor blockade. For more rheumatology education and clinical resources, visit RhAPP’s website, the RhAPP Content Rheum, or the RhAPP ACE app.

In this FAQ video, Heather Finlayson, PA-C, discusses how treatment duration should be approached after achieving remission or low disease activity in systemic lupus erythematosus (SLE). As treatment options continue to expand and more patients achieve sustained disease control, questions about when and how to taper therapy have become increasingly important.

This educational discussion reviews current guideline recommendations for long-term lupus management, including the ongoing role of hydroxychloroquine, strategies for minimizing corticosteroid exposure, and considerations for tapering immunosuppressive therapies after sustained remission. Heather also explores the challenges of determining when treatment reduction may be appropriate, as biologic therapies become more widely used in lupus care.

Watch now to learn more about maintaining remission, reducing treatment burden, and the evolving approach to long-term disease management in SLE. For more expert-led education, visit the Content Rheum and download the RhAPP Ace app to stay up to date with the latest clinical insights in rheumatologic care.

In this episode of RhAPPcast, host Amanda Mixon, PA-C, is joined by Jeannette Hart, PA-C, to discuss lupus disease activity assessment and the distinction between active disease and irreversible organ damage. The conversation explores how the SLEDAI-2K can help clinicians organize comprehensive assessments, monitor disease activity across multiple organ systems, and guide treatment decisions for patients with systemic lupus erythematosus (SLE).

This episode highlights practical strategies for incorporating disease activity scoring into busy clinic visits, monitoring for lupus nephritis, and recognizing changes that may warrant treatment escalation. Amanda and Jeannette also discuss the limitations of disease activity scores, the importance of clinical judgment when evaluating partial improvements, and balancing inflammation control with reducing long-term glucocorticoid exposure. Through clinical examples, they emphasize individualized patient education, shared decision-making, and collaboration between rheumatology, nephrology, and other specialists to support coordinated lupus care.

Designed for rheumatology advanced practice providers, nurse practitioners, physician assistants, and other clinicians managing lupus, this discussion offers practical insights into disease monitoring, organ damage prevention, and patient communication. For more rheumatology education and clinical resources, visit RhAPP’s website, the RhAPP Content Rheum, or the RhAPP ACE 2.0 app.

In this educational Medication Review, Jennifer Mylod, DNP, provides an overview of the biologic and targeted therapies currently available for the treatment of systemic lupus erythematosus (SLE) and lupus nephritis (LN). This video reviews the different mechanisms of action used to target key immune pathways involved in lupus and highlights how these therapies help manage disease activity and improve patient outcomes.

Learn how currently available treatments work by targeting B cells, B-cell activating factor (BAFF/BLyS), type I interferon signaling, and other immune pathways that contribute to inflammation and autoantibody production. Jennifer discusses important therapies used in the management of SLE and lupus nephritis, including belimumab, anifrolumab, rituximab, obinutuzumab, and voclosporin, and explains how their mechanisms differ.

The discussion also explores the evolving treatment landscape for lupus, emphasizing the growing number of therapeutic options available to help reduce disease activity, preserve organ function, and support long-term disease control. Understanding these mechanisms can help clinicians make informed treatment decisions and optimize care for patients with SLE and lupus nephritis.

Watch this video to gain a better understanding of the biologic and targeted therapies used in lupus care and the science behind their clinical use. For more expert-led education, visit the Content Rheum and download the RhAPP Ace app to stay up to date with the latest clinical insights in rheumatologic care.

In this FAQ video, Amanda Mixon, PA-C, discusses why early intervention is critical in the management of systemic lupus erythematosus (SLE). Early diagnosis and treatment are essential for controlling inflammation, preventing irreversible organ damage, and improving long-term patient outcomes.

This educational discussion reviews the impact of uncontrolled lupus on major organ systems, including the kidneys, heart, lungs, and brain, and highlights how timely treatment can help reduce disease activity, limit flares, and prevent cumulative damage over time. Amanda also explores the importance of early detection and treatment of lupus nephritis, as well as the potential complications associated with uncontrolled disease, including cardiovascular disease, stroke, osteoporosis, infection, and reduced quality of life.

Watch now to learn how early intervention and proactive disease management can help preserve organ function and support better long-term outcomes for patients living with lupus. For more expert-led education, visit the Content Rheum and download the RhAPP Ace app to stay up to date with the latest clinical insights in rheumatologic care.

In this RhAPP Journal Club, Danielle Gatti-Palumbo, a clinical pharmacist in rheumatology, reviews the efficacy and safety of deucravacitinib, an oral selective tyrosine kinase 2 (TYK2) inhibitor, in patients with active psoriatic arthritis (PsA). The presentation focuses on 52-week findings from the phase 3 POETYK PsA-1 trial in patients who had not previously received biologic therapy. Danielle explains TYK2 signaling, patient eligibility, baseline disease characteristics, and the randomized, double-blind, placebo-controlled study design, including the transition from placebo to active treatment after week 16. She examines the primary ACR20 endpoint and additional outcomes, including ACR50 and ACR70 responses, psoriasis improvement measured by PASI 75, minimal disease activity, physical function, fatigue, and quality of life. The discussion also explores enthesitis, dactylitis, and post hoc analyses of radiographic progression, highlighting the importance of distinguishing statistically significant findings from numerical improvements and exploratory results. Additional topics include axial symptoms, treatment response through week 52, and safety findings discussed in the presentation, including acne-like reactions, infections, herpes zoster, laboratory abnormalities, and cardiovascular and thromboembolic safety considerations. Danielle evaluates the study’s strengths and limitations, including the biologic-naive population, absence of an active comparator, interpretation of structural damage findings, and the need for longer-term data. Throughout the journal club, she considers how these results may inform discussions about oral treatment options for patients with active and erosive psoriatic arthritis. Viewers will gain practical insights into interpreting clinical trial endpoints, evaluating efficacy across disease domains, and critically assessing the evidence for TYK2 inhibition in rheumatology practice. Visit the RhAPP Content Rheum or RhAPP ACE app for more rheumatology education, medication reviews, and journal clubs.

In this FAQ video module, Tiffany Terrell, NP, reviews the role of early intervention and steroid reduction in minimizing long-term organ damage in systemic lupus erythematosus (SLE) and lupus nephritis. This overview highlights the importance of timely treatment, routine kidney monitoring, and controlling inflammation while limiting prolonged corticosteroid exposure.

This episode explores American College of Rheumatology (ACR) recommendations for lupus management, including monitoring for kidney involvement and tapering glucocorticoids as disease activity comes under control. Tiffany also discusses the risks associated with long-term, high-dose steroid use, including infections, osteoporosis, glaucoma, and avascular necrosis. The discussion emphasizes the balance between maintaining disease control and reducing treatment-related complications to support long-term outcomes for patients with lupus.

Designed for rheumatology advanced practice providers, nurse practitioners, physician assistants, and other clinicians managing lupus and lupus nephritis, this module highlights the importance of proactive monitoring, early treatment, and individualized steroid reduction. For more rheumatology education and clinical resources, visit RhAPP’s website, the RhAPP Content Rheum, or the RhAPP ACE app.

In this RhAPP journal club video module, Danielle Gatti-Palumbo, PharmD reviews the efficacy and safety of nanoencapsulated sirolimus plus pegadricase (NASP) in patients with uncontrolled gout, based on findings from the randomized, placebo-controlled Phase 3 DISSOLVE I and II trials. She explains how nanoencapsulated sirolimus is designed to reduce anti-drug antibody formation and support sustained serum urate lowering with pegadricase, addressing a key challenge in uricase-based gout treatment.

This episode examines the study design, every-four-week dosing regimen, serum urate response, tophus resolution, tender joint counts, and health-related quality of life. Danielle discusses improved serum urate control compared with placebo, along with key safety considerations, including gout flares, stomatitis, infusion-related reactions, and anaphylaxis. She also evaluates the study’s strengths and limitations, including the 24-week analysis period and the absence of a direct comparison with pegloticase plus methotrexate.

Designed for rheumatology advanced practice providers, nurse practitioners, physician assistants, pharmacists, and clinicians caring for patients with uncontrolled or tophaceous gout, this journal club provides a practical overview of an investigational urate-lowering therapy, its potential benefits, and important considerations when interpreting the clinical trial results. For more rheumatology education and clinical resources, visit RhAPP’s website, the RhAPP content rheum, or the RhAPP ACE app.

In this RhAPP FAQ video module, Jennifer Mylod, nurse practitioner at Arizona Arthritis and Rheumatology Associates in Phoenix, Arizona, explains the Total Improvement Score, or TIS, and how it is used to assess treatment response in idiopathic inflammatory myopathies, including myositis and related autoimmune muscle diseases. This episode reviews how the ACR/EULAR Total Improvement Score serves as a composite outcome measure in inflammatory myopathy clinical trials and clinical practice by evaluating multiple disease domains, including muscle strength, physician global assessment, patient global assessment, physical function, muscle enzyme levels, and extramuscular disease activity affecting areas such as the lungs, skin, and joints. Jennifer discusses how TIS scores are interpreted, with more than 20 points indicating minimal improvement, more than 40 points indicating moderate improvement, and more than 60 points indicating major improvement.

Designed for rheumatology advanced practice providers, nurse practitioners, physician assistants, and clinicians caring for patients with inflammatory muscle disease, this FAQ highlights why TIS is valuable for measuring meaningful global response, tracking disease progression, and looking beyond CK levels or muscle strength alone. For more rheumatology education and clinical resources, visit RhAPP's website, the RhAPP content rheum, or the RhAPP ACE app.