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.

Frequent patient assessments and laboratory monitoring play a crucial role in ensuring stability throughout the tapering process. Identifying early signs of disease worsening is essential to making timely adjustments and preventing potential flares. By adopting a personalized approach, healthcare providers can optimize outcomes and improve the long-term management of lupus nephritis.

For more expert insights on lupus nephritis treatment strategies, visit the RhAPP website or explore additional educational content on the RhAPP ACE App.

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 view of PsA’s impact, the Minimal Disease Activity (MDA) index goes beyond joint symptoms, assessing enthesitis, skin involvement, pain, function, and patient-reported outcomes. Achieving MDA is a key goal in treat-to-target strategies, guiding adjustments in therapy to improve long-term patient health.

Clinical trials and real-world evidence highlight guselkumab’s efficacy in PsA treatment. The DISCOVER-2 trial found that 25% of biologic-naïve PsA patients on guselkumab achieved MDA by week 24, increasing to 40% over two years. Additionally, real-world registry data from CorEvitas showed that 80% of patients remained on guselkumab at six months, with one in four achieving low disease activity—reinforcing the effectiveness seen in clinical trials.

Understanding and utilizing these PsA-specific disease activity measures helps rheumatology providers make informed treatment decisions and ensure sustained improvements in patient care.

For more expert insights into rheumatology advancements, visit RhAPP.org or explore the RhAPP ACE App.

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 hid their skin under long sleeves and struggled with daily activities due to joint pain now confidently enjoy time with their families at the beach, free from discomfort and embarrassment.

Ixekizumab’s rapid onset of action not only improves physical symptoms but also restores quality of life, allowing patients to regain mobility and confidence in ways they never thought possible. For more expert insights on psoriasis and psoriatic arthritis treatments, visit the RhAPP website, explore the Content Rheum hub, and access the latest educational materials on the RhAPP ACE App.

Monica 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. Monica highlights the importance of performing full urinalysis at every patient visit, a practice that allows for earlier intervention and better disease management.

The discussion also covers when healthcare providers should consider a kidney biopsy to confirm a lupus nephritis diagnosis and determine disease severity. Understanding lupus nephritis classifications and chronicity is crucial for tailoring treatment strategies and preventing long-term kidney damage. Monica shares her real-world insights on proactive patient care, offering guidance on how frequent monitoring can lead to more effective disease control.

For rheumatology professionals, nephrologists, and caregivers, this video provides a comprehensive overview of the evolving landscape of lupus nephritis diagnosis. By staying informed on the latest screening recommendations, healthcare providers can enhance their approach to patient care and contribute to improved outcomes in lupus management.

For more expert discussions on the latest advancements in rheumatology, visit RhAPP.org or explore the RhAPP ACE App.

In 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 in preventing irreversible kidney damage. The discussion also highlights screening protocols, emphasizing the need for regular urine protein monitoring in lupus patients every six to twelve months to detect early signs of kidney involvement.

One of the most significant shifts in the guidelines is the preference for triple therapy over dual therapy for patients with active lupus nephritis. This new approach integrates glucocorticoids with mycophenolate mofetil (MMF) or cyclophosphamide, combined with an additional immunosuppressive agent such as belimumab or a calcineurin inhibitor. The rationale behind this shift is to reduce long-term steroid exposure while improving renal outcomes. The conversation dives into the evidence supporting these recommendations and how providers can implement them effectively in clinical practice.

Beyond treatment selection, the discussion touches on the importance of shared decision-making and addressing healthcare disparities in lupus care. Patients from diverse socioeconomic backgrounds often face barriers to timely treatment, which can significantly impact their prognosis. By fostering strong patient-provider relationships and ensuring open communication, rheumatology teams can better support patients in managing their disease and adhering to treatment plans.

With advancements in lupus nephritis management, providers now have more tools than ever to improve patient outcomes. The insights shared in this episode aim to equip healthcare professionals with the knowledge and strategies needed to implement the latest guidelines in their practice.

Stay informed on evolving lupus nephritis research, treatment guidelines, and clinical insights by visiting RhAPP.org or accessing the latest educational content on the RhAPP ACE App.

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 urine protein screening every six to twelve months for lupus patients, with more frequent monitoring in those with known kidney disease. Patients who fail to achieve complete renal response should have kidney function and protein levels checked at least every three months, with biopsy considered for persistent proteinuria or unexplained kidney function decline.

By following updated screening recommendations and initiating treatment early, clinicians can help preserve kidney function and improve long-term outcomes.

Stay informed on the latest lupus nephritis research, treatment strategies, and expert discussions by visiting RhAPP.org or accessing educational content on the RhAPP ACE App.

Join 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 in a controlled setting.

RWE, however, reflects real-world treatment patterns and patient outcomes. Unlike RCTs, it includes diverse populations with varied medical histories and prior treatments. A 12-month claims analysis from the IBM MarketScan database found that 72% of PsA patients on Guselkumab maintained treatment persistence, compared to 44% for subcutaneous TNF inhibitors. Additionally, data from the CorEvitas Registry showed that nearly 80% of patients continued Guselkumab for at least six months, with significant symptom improvements.

By considering both RCTs and RWE, clinicians gain a more comprehensive understanding of treatment effectiveness, helping them tailor therapy decisions to each patient’s unique needs.

For more insights into Guselkumab and psoriatic arthritis management, visit RhAPP.org or access educational resources on the RhAPP ACE App.

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 a lower-dose glucocorticoid regimen, starting at 0.5 mg/kg per day (max 40 mg) with tapering to 5 mg daily within six months. For Class III and IV lupus nephritis, triple therapy—including glucocorticoids, MMF, and belimumab or a calcineurin inhibitor—is now preferred. In Class V cases with significant proteinuria, MMF and a calcineurin inhibitor remain key components.

Frequent monitoring, particularly urine protein assessments, is crucial for tracking disease progression and preventing irreversible kidney damage. With these updates, clinicians have clearer guidance on optimizing lupus nephritis care while minimizing long-term complications.

Stay informed on the latest lupus nephritis treatment strategies by visiting RhAPP.org and exploring the RhAPP ACE App.

In 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 suggest using Methotrexate as a steroid-sparing agent in patients at high risk of relapse or those requiring prolonged treatment. However, due to limited clinical trial data and conflicting results regarding Methotrexate’s impact on disease progression, Leflunomide is emerging as a potential alternative for steroid reduction and long-term disease control.

This study followed 186 PMR patients from 2007 to 2023, examining treatment outcomes in those prescribed Methotrexate (10-15 mg weekly) or Leflunomide (20 mg daily). While flare rates remained comparable between both treatment groups, the study found that Leflunomide demonstrated a significantly higher remission rate and faster steroid discontinuation compared to Methotrexate. Patients treated with Leflunomide achieved steroid withdrawal within 4.7 months, while those on Methotrexate required an average of 31.8 months. Additionally, Leflunomide patients exhibited a higher probability of sustained remission up to 40 months post-treatment.

The findings of this study suggest that Leflunomide may be a superior steroid-sparing option in PMR, particularly for patients who struggle with Methotrexate tolerability or require faster tapering of glucocorticoids. Although the study had limitations, including its observational design and the relatively low Methotrexate dosing range of 10-15 mg weekly, it provides important clinical insights for rheumatology providers seeking alternative treatment strategies.

With the growing need for effective, steroid-sparing therapies in PMR management, Leflunomide presents a viable option that warrants further research and consideration in clinical practice.

Visit the RhAPP website or explore additional educational content on the RhAPP ACE App.

In 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 and sacroiliitis. The discussion also differentiates Axial PsA from Axial Spondyloarthritis (AxSpA)—two conditions with overlapping but distinct disease mechanisms.

As a leader in rheumatology education, Amanda Mixon, PA-C, brings her expertise in clinical practice, education, and advocacy to the conversation, while Audrey Gibson, PA-C, shares real-world clinical insights on IL-23 inhibitors and their role in managing PsA.

With the STAR trial set to further evaluate Guselkumab’s effectiveness in AxPsA, this discussion is essential for rheumatology providers looking to refine their treatment strategies and stay ahead of the latest advancements in PsA management.

For more expert insights on PsA and IL-23 targeted therapy, visit RhAPP.org or explore the RhAPP ACE App for the latest educational resources.