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, and root canals, which may serve as early indicators of HPP. On the musculoskeletal side, patients commonly present with chronic foot pain, shin pain, enthesitis, and frequent stress fractures—often going unnoticed due to persistent discomfort. Many individuals are misdiagnosed with conditions like fibromyalgia or osteoporosis at a young age, and notably, treatment with bisphosphonates may worsen bone health in patients with HPP. This video provides valuable clinical insights for rheumatology providers and advanced practice providers to help improve early recognition, avoid misdiagnosis, and optimize management of hypophosphatasia. For more rheumatology-focused education, visit the RhAPP Content Rheum and RhAPP ACE app.

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 inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, are improving patient convenience, adherence, and quality of life while offering comparable efficacy to traditional IV infusions.

This expert discussion dives into key clinical considerations such as induction versus maintenance strategies, patient selection, safety, and real-world implementation of SubQ therapies. The episode also emphasizes the importance of multidisciplinary collaboration between rheumatology and GI providers, especially when managing patients with overlapping conditions like psoriatic arthritis and axial spondyloarthritis. Listeners will gain practical insights on optimizing treatment decisions, enhancing patient education, and leveraging a shared “toolbox” of therapies to better manage complex, multi-system disease.

For more expert-driven education and cross-specialty insights, subscribe to RhAPPcast and visit RhAPP.org, the Content Rheum & the RhAPP ACE app.

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-term outcomes impact clinical decision-making, including strategies for sustained remission, glucocorticoid tapering, relapse prevention, and real-world patient management. This episode is designed for rheumatology advanced practice providers and clinicians seeking to better interpret clinical trial data and apply it in practice, with a focus on balancing treatment benefits, safety considerations, and patient-specific risk factors. Explore key takeaways on JAK inhibitors, long-term disease control, and evolving therapeutic approaches in vasculitis care.

For more rheumatology education, podcasts, and expert-led content, explore the Content Rheum and the RhAPP ACE app.

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 morning stiffness that improves with activity should prompt further evaluation. Amanda highlights how MRI enables early detection of inflammatory changes like sacroiliitis that may not appear on X-rays, making it an essential tool for accurate diagnosis. Early identification of axial involvement supports a domain-based treatment approach, helping clinicians select the most appropriate therapy and improve patient outcomes. For more rheumatology education and APP-focused resources, visit the RhAPP Content Rheum and RhAPP ACE app.

#PsoriaticArthritis #AxialPsA #MRIImaging #Rheumatology #APPeducation #Sacroiliitis #InflammatoryBackPain

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 discussion also highlights the role of leptin, a hormone produced by fat cells that regulates appetite and immune signaling. In obesity, elevated leptin levels can disrupt normal metabolic signals and promote immune dysregulation, which may worsen inflammatory and autoimmune conditions such as rheumatoid arthritis, psoriatic arthritis, and psoriasis.

For more rheumatology education and APP-focused learning, visit the RhAPP Content Rheum or the RhAPP ACE app.

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. This technology helps clinicians uncover hidden disease activity, risk-stratify patients with psoriasis who may develop psoriatic arthritis, and monitor response to biologic therapies. By detecting inflammation earlier, Power Doppler ultrasound supports more proactive treatment decisions and improved long-term outcomes for patients with inflammatory arthritis.

For more rheumatology education and APP-focused clinical insights, visit the RhAPP website or explore the RhAPP ACE app.

#Rheumatology #PsoriaticArthritis #Spondyloarthritis #Enthesitis #Ultrasound #APPeducation

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 can be a key clue in patients presenting with vague musculoskeletal symptoms, unexplained fractures, dental abnormalities, or chronic fatigue—symptoms frequently encountered in rheumatology clinics. Heather explains how clinicians should approach the diagnostic workup, including trending ALP levels over time, reviewing dental and family history, evaluating radiographic findings, and considering ALPL gene testing when hypophosphatasia is suspected.

The episode also provides practical guidance for rheumatology clinicians and advanced practice providers on integrating low ALP awareness into routine clinical assessments, avoiding missed diagnoses, and recognizing that adult hypophosphatasia may be more common than previously thought. Listeners will learn how identifying genetic causes of low ALP can improve patient outcomes, guide appropriate management, and even help uncover undiagnosed cases within families. This discussion offers valuable insights for rheumatology providers involved in bone health, osteoporosis evaluation, and the investigation of unexplained musculoskeletal complaints. For more rheumatology education visit the Content Rheum or the RhAPP ACE app.

#Rheumatology #Hypophosphatasia #LowALP #BoneHealth #Osteoporosis #GeneticDisorders #RheumatologyAPP #MedicalEducation #MusculoskeletalHealth

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, durability, and the rationale for IL-23 pathway targeting are also reviewed to support evidence-based treatment decisions in TNF-experienced patients.