RhAPPcast

Danielle Gatti-Palumbo, PharmD reviews the phase 3 APEX trial evaluating Guselkumab in patients with active psoriatic arthritis (PsA), highlighting its role in reducing inflammation, improving clinical outcomes, and preventing structural joint damage. The discussion emphasizes the importance of early biologic intervention in a disease that can quickly lead to irreversible damage and disability. Re...

In this episode of RhAPPcast, host Amanda Mixon PA-C, is joined by Wendy Simmons, PA-C, they explore the diagnostic challenges of hypophosphatasia (HPP), a rare genetic metabolic bone disease that is frequently overlooked or misdiagnosed. Mixon and Simmons discuss key clinical red flags, including persistently low alkaline phosphatase, fracture patterns, dental history, and musculoskeletal pain th...

In this Journal Club Review, Eileen Lydon, NP, a rheumatology provider at NYU Hospital, discusses the challenges of diagnosing hypophosphatasia (HPP) in adults, based on a 2023 Osteoporosis International publication from the HPP International Working Group. HPP is a rare genetic metabolic bone disease characterized by low alkaline phosphatase levels and highly variable, non-specific symptoms such...

In this educational video, Shannon Ghizzoni, a physician assistant at Columbus Arthritis Center, explores the impact of weight reduction on disease activity and treatment outcomes in Psoriatic Arthritis. This discussion highlights the strong connection between obesity—particularly visceral fat—and increased inflammation in patients with psoriatic arthritis and psoriasis. Learn how excess adipose t...

In this FAQ video, Jeremy Morgan, NP, from Access Solutions Rheumatology in Tulsa, Oklahoma, discusses the neuromuscular and functional burden of hypophosphatasia (HPP), a rare and often underdiagnosed metabolic bone disease. While severe forms may present in infancy, many patients with milder HPP go unrecognized until adolescence or adulthood, experiencing chronic bone pain, joint pain, enthesiti...

In this episode of RhAPPcast, Amanda Mixon, PA-C, and Laura Hoover, PharmD, break down the clinical use of intravenous immunoglobulin (IVIG) in rheumatology. They explore how IVIG works to modulate the immune system, where it is most effective—particularly in dermatomyositis and polymyositis—and its role as a second- or third-line option in refractory autoimmune conditions. The discussion highligh...

In this journal club review module, Danielle Gatti Palumbo, PharmD, explores a post hoc analysis of a phase 3 clinical trial evaluating the efficacy of Guselkumab in biologic-naive patients with severe psoriatic arthritis (PsA). The discussion breaks down how guselkumab performs across multiple PsA disease domains, including joint involvement, skin and nail disease, enthesitis, dactylitis, and pat...

In this FAQ, Libby Allen, a rheumatology nurse practitioner, explains how obesity impacts psoriatic arthritis outcomes and why it plays a critical role in disease severity and treatment response. Obesity is known to increase pro-inflammatory cytokines such as TNF-alpha (TNFA), IL-6, and IL-1B, creating a chronic low-grade inflammatory state that directly worsens psoriatic arthritis. This inflammat...

In this educational FAQ video, Jeremy Morgan, NP, of Access Solutions Rheumatology in Tulsa, Oklahoma, explores the key skeletal and dental manifestations associated with hypophosphatasia (HPP), a rare metabolic bone disease that is often under recognized in clinical practice. This overview highlights important dental findings such as recurrent cavities, early tooth loss, frequent fillings, crowns...

In this episode of RhAPPcast, host Amanda Mixon, PA-C, is joined by Christina Hanson, FNP-C, to explore the growing intersection between rheumatology and gastroenterology, focusing on shared immune pathways and the evolving role of subcutaneous biologic therapies in immune-mediated inflammatory diseases (IMIDs). The conversation highlights how advances in subcutaneous (SubQ) biologics for inflamma...

Stay up to date on the latest advances in giant cell arteritis (GCA) management with this Fireside Chat episode featuring expert insights from Naomi Amudala, NP, and Dr. Peter Merkel. Hosted by Amanda Mixon, PA-C, this discussion breaks down the two-year SELECT-GCA trial data, highlighting the efficacy and safety of upadacitinib as a steroid-sparing therapy in patients with GCA. Learn how long-ter...

In this video, rheumatology physician assistant Amanda Mixon, PA-C, discusses the critical role of MRI in identifying axial involvement in psoriatic arthritis. While clinicians often focus on peripheral joint and skin symptoms, up to 20–40% of patients may have axial disease, which can sometimes be the presenting feature. Key symptoms such as inflammatory back pain, nighttime discomfort, and morni...

Obesity can significantly impact immune system function and contribute to chronic inflammation. In this educational segment, rheumatology nurse practitioner Libby Allen, ARNP, FNP, explains how obesogenic diets alter the gut microbiome and trigger inflammatory pathways that increase cytokines such as TNF-alpha and IL-6, placing the immune system in a persistent low-grade inflammatory state. The di...

Power Doppler ultrasound is transforming how clinicians detect subclinical enthesitis in conditions like psoriatic arthritis (PsA) and spondyloarthritis (SpA). In this educational segment, Audrey Gibson, PA-C explains how Power Doppler imaging can identify active inflammation at tendon and ligament insertion sites by visualizing increased blood flow—often before symptoms appear on physical exam. T...

In this episode of RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers, host Amanda Mixon sits down with rheumatology PA Heather Mambretti to explore the clinical significance of low alkaline phosphatase (ALP) and why this often overlooked lab value may signal important genetic conditions such as hypophosphatasia (HPP). The conversation highlights how persistently low ALP c...

In this FAQ video, Will Saalfeld, NP, reviews the clinical efficacy of switching to guselkumab after an inadequate response to a TNF inhibitor in psoriatic arthritis. The discussion highlights key trial data from DISCOVER-1 and COSMOS, real-world outcomes, and improvements in joint and skin disease, including ACR20 response rates, low disease activity, and remission through one year. Safety, durab...

In this episode of RhAPPcast, host Amanda Mixon, PA-C, leads a 2026 Fireside Chat exploring the intersection of rheumatology and gastroenterology. Joined by Kim Orleck, PA-C (GI APP), and Wendy Simmons, PA-C (Rheumatology APP), the panel discusses the shared inflammatory pathways linking Crohn’s disease, ulcerative colitis, psoriatic arthritis, and ankylosing spondylitis, with a focus on the gut–j...

In this episode of RhAPPcast, Amanda Mixon and Wendy Simmons explore how guselkumab may help protect joints and slow structural damage in psoriatic arthritis, an important goal in long-term disease management. The discussion reviews clinical trial data, radiographic progression, and real-world considerations for using this IL-23 inhibitor in patients with active psoriatic arthritis, especially tho...

In this FAQ video, Iris Zink, MSN, ANP-BC, RN-BC, shares practical strategies for discussing weight management with patients living with psoriatic arthritis. She outlines how obesity drives systemic inflammation, increases disease activity, and raises cardiovascular risk, and explains why addressing BMI should be part of routine rheumatology care. This episode explores patient-centered communicati...

In this updated medication review video module, Brandon Ko, DNP, and Pediatric Chair of RhAPP, reviews the recent FDA approval of guselkumab for juvenile psoriatic arthritis (JPsA) in children ages 6 and older weighing more than 40 kg. He covers dosing, mechanism of action as an IL-23 inhibitor, and how the approval was based on extrapolated data from pediatric plaque psoriasis (PROTOSTAR) and adu...

In this comprehensive medication review, Lisa Asfahani, PA-C, a rheumatology physician assistant with over 14 years of clinical experience, explores the rates of anti-drug antibody development to guselkumab in patients with psoriatic arthritis. Guselkumab, an IL-23 p19 monoclonal antibody inhibitor, is approved for the treatment of plaque psoriasis, psoriatic arthritis, ulcerative colitis, and Cro...

In this educational FAQ, Heather Mambretti, PA-C, a rheumatology physician assistant and RhAPP faculty and board member, explains the critical role of tissue-nonspecific alkaline phosphatase (TNSALP) in hypophosphatasia (HPP). TNSALP is an essential enzyme involved in bone and tooth mineralization, as well as vitamin B6 transport into cells. Mutations in the ALPL gene, which encodes TNSALP, lead t...

In this Medication Review, Lisa Asfahani, PA-C, shares practical laboratory monitoring recommendations for guselkumab across psoriasis, psoriatic arthritis, and inflammatory bowel disease. The discussion reviews FDA-approved indications, dosing basics, and what labs to check before and after initiating therapy, including TB screening and liver function monitoring. Designed for rheumatology, dermat...

In this episode of RhAPPcast, the official podcast of rheumatology advanced practice providers, we explore the complex and often underrecognized relationship between psoriatic arthritis and obesity. Host Amanda Mixon, PA-C, President of RhAPP, is joined by distinguished RhAPP faculty member and rheumatology nurse practitioner Iris Zink for an in-depth, real-world discussion on how obesity function...

In this video, Kimberly Orleck, PA-C, senior director of advanced practice providers at United Digestive and board member of GHAPP, provides a comprehensive review of the efficacy and safety data supporting guselkumab in the treatment of moderate to severely active ulcerative colitis and Crohn’s disease. Drawing from pivotal clinical trials, including QUASAR for ulcerative colitis and GALAXI and G...