In Part 3 of the Across the Rheum podcast series, Dr. Sergio Schwartzman concludes the three-part discussion on the IL-23 paradigm in psoriatic arthritis (PsA) with a deep dive into clinical utility, treatment positioning, and real-world decision-making. Building on prior episodes that covered immunologic mechanisms and comparative trial data, this final installment focuses on how IL-23 inhibitors are being integrated into modern PsA treatment algorithms.

Joined by Jessica Farrell, PharmD, and Dr. Monica Schwarzman, the discussion explores where IL-23 inhibitors fit relative to methotrexate, TNF inhibitors, and IL-17 inhibitors, with thoughtful analysis of treatment persistence, safety profiles, radiographic progression, and comorbidity considerations, including inflammatory bowel disease. The episode also addresses evolving practice patterns, payer access considerations, and why many clinicians are moving toward earlier use of targeted biologic therapy in appropriate patients.

Additional insights include the role of radiographic progression prevention, interpretation of modified Sharp scores, and future directions in PsA care—such as axial psoriatic arthritis, combination biologic therapy, difficult-to-treat disease, and emerging oral and long-acting agents.

Subscribe to Across the Rheum for ongoing expert-led discussions on evolving therapies in rheumatology.

Hypophosphatasia (HPP) is a rare genetic bone disorder that is often overlooked in adults, leading to years of misdiagnosis and ineffective treatment. In this episode of RhAPPcast, host Amanda Mixon, PA-C is joined by nurse practitioner Jeremy Morgan to explore how HPP presents in adulthood and why it is frequently missed in rheumatology practice.

The discussion reviews common musculoskeletal features such as chronic bone pain, enthesitis, stress fractures, and functional limitations, along with conditions HPP is often mistaken for, including osteoporosis, fibromyalgia, and seronegative rheumatoid arthritis. Special attention is given to persistently low alkaline phosphatase (ALP) levels and why they should prompt further evaluation rather than being dismissed.

This episode provides practical guidance on recognizing red flags, using additional laboratory testing such as fasting phosphorus and vitamin B6, and supporting patients through a long and often frustrating diagnostic journey. Learn more rheumatology education on the RhAPP Content Rheum or through the RhAPP ACE app.

Delayed diagnosis in psoriatic arthritis (PsA), spondyloarthritis (SpA), and inflammatory bowel disease (IBD) can lead to irreversible damage and prolonged patient suffering. In this FAQ episode, host Audrey Gibson, PA-C reviews validated screening tools that help clinicians identify these conditions earlier and determine when referral to rheumatology or gastroenterology is warranted.

The discussion highlights practical screening strategies for frontline providers, including the Psoriasis Epidemiology Screening Tool (PEST) for identifying PsA risk in patients with psoriasis, as well as referral criteria for spondyloarthritis based on inflammatory back pain features and ASAS recommendations. Key red flags such as early-onset chronic back pain, morning stiffness, extra-articular symptoms, and family history are reviewed.

For gastrointestinal symptoms, the episode explores how tools like CalProQuest and alarm features such as chronic diarrhea, rectal bleeding, anemia, and weight loss can help distinguish IBD from functional GI disorders. This FAQ offers practical guidance to shorten diagnostic delays, support timely referrals, and improve long-term outcomes. Learn more on the RhAPP Content Rheum or in the RhAPP ACE App.

In this FAQ video, Audrey Gibson, PA-C, reviews validated screening tools used to identify psoriatic arthritis, spondyloarthritis, and inflammatory bowel disease and when to refer patients to rheumatology or gastroenterology. The discussion covers practical tools such as PEST for PsA, ASAS referral criteria for SpA, and red flag–based screening for IBD, including CalProQuest. Designed for primary care, dermatology, and specialty providers, this overview highlights how early screening can reduce diagnostic delays and improve patient outcomes.

In Part 2 of the Across the Rheum podcast series, host Dr. Sergio Schwartzman continues the three-part discussion on the IL-23 paradigm in psoriatic arthritis (PsA). This episode takes a focused, clinical look at the currently available IL-23 inhibitors, reviewing their mechanisms of action, structural differences, dosing strategies, and FDA-approved indications across psoriasis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis.

Joined again by Jessica Farrell, PharmD, and Dr. Monica Schwarzman, the conversation examines p19 vs p40 IL-23 inhibition, compares key clinical trial efficacy data in both psoriasis and psoriatic arthritis, and discusses how these data may inform real-world treatment decisions. The episode also explores class switching, limitations of cross-trial comparisons, and the evolving role of head-to-head studies in rheumatology.

This episode is designed for rheumatology clinicians and APPs seeking practical insight into how IL-23 inhibitors are differentiated and positioned in modern PsA management.

Stay tuned for Part 3, where the series concludes with clinical positioning and real-world application of IL-23–directed therapies.

In this Journal Club episode, Holly Reid, APN, CPNP, MS reviews the 2023 Osteoporosis International article, Hypophosphatasia Diagnosis: Current State of the Art and Proposed Diagnostic Criteria for Children and Adults, which offers long-needed clarity around diagnosing hypophosphatasia (HPP). HPP is a rare inherited metabolic bone disease that is frequently misdiagnosed or significantly delayed in both pediatric and adult patients, often leading to inappropriate treatment and poor outcomes. This discussion breaks down why early recognition matters and how rheumatology providers can play a critical role in identifying patients—even when they are not the primary treating clinician.

The episode provides a practical overview of HPP pathophysiology, including the role of tissue-nonspecific alkaline phosphatase (TNSALP), the accumulation of key substrates such as inorganic pyrophosphate and pyridoxal-5-phosphate, and how these defects lead to impaired bone and tooth mineralization. We review the wide spectrum of clinical manifestations across children and adults, from rickets, growth failure, and premature tooth loss in pediatrics to osteomalacia, fractures, chondrocalcinosis, and chronic musculoskeletal pain in adults.

For more education on HPP visit the RhAPP Content Rheum or download the RhAPP ACE app.

Brandon Ko, APRN, DNP, a pediatric rheumatology nurse practitioner at the University of New Mexico and Pediatric Chair for RhAPP, reviews the potential role of guselkumab in juvenile psoriatic arthritis. This medication review explores the current FDA submission for pediatric use, the clinical rationale behind extrapolating adult psoriatic arthritis data, and supporting safety and efficacy findings from pediatric plaque psoriasis studies. The discussion highlights where guselkumab may fit among existing treatment options for juvenile psoriatic arthritis, including TNF inhibitors, IL-17 inhibitors, JAK inhibitors, and other biologics, while addressing key considerations such as disease severity, treatment sequencing, and uveitis risk. Designed for rheumatology APPs and clinicians, this overview provides timely insight into emerging pediatric treatment options and what FDA approval could mean for patient care.

Welcome to the premiere of Across the Rheum, the official podcast of Rheum Connect, where cutting-edge science meets real-world clinical insight in rheumatology. Hosted by renowned rheumatologist Dr. Sergio Schwartzman, this new educational podcast launches with a three-part series exploring The Interleukin-23 (IL-23) Paradigm in Psoriatic Arthritis.

In Episode 1, the series sets the foundation with an in-depth discussion of IL-23 immunology and its role in the pathophysiology of psoriatic disease. Joined by expert guests Jessica Farrell, PharmD, and Dr. Monica Schwarzman, listeners gain a structured understanding of the IL-23/Th17 pathway, cytokine signaling, and how these mechanisms translate into targeted therapeutic strategies for psoriatic arthritis and related immune-mediated diseases.

Designed for rheumatologists, advanced practice providers, pharmacists, and clinicians involved in inflammatory arthritis care, this episode examines why IL-23 has emerged as a critical therapeutic target, the scientific rationale behind selective inhibition, and how evolving immunologic insights are shaping modern treatment decisions. The discussion also highlights key distinctions between IL-23– and IL-17–driven disease, implications for axial involvement, and the future of precision therapy in psoriatic arthritis.

This episode is cross-hosted on Arthros and the RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers, with sincere thanks to RhAPP for their continued partnership. Educational support for this activity is provided by Johnson & Johnson.

Subscribe to Across the Rheum to continue the series in Episode 2, where the conversation shifts to a detailed review of currently available IL-23 inhibitors, clinical trial data, and practical positioning in today’s rheumatology treatment landscape.