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 highlights practical considerations for advanced practice providers, including weight-based dosing, infusion strategies, and the importance of premedication and hydration to reduce adverse effects. Key safety risks such as thrombosis, renal complications, and infusion reactions are reviewed, along with strategies to minimize these risks. The episode also addresses common challenges with insurance approval and patient access, offering real-world tips to navigate these barriers.

With additional insights on subcutaneous options, brand differences, and monitoring considerations like IgA levels, this episode provides a concise, practical guide to safely and effectively incorporate IVIG into rheumatology care.

#IVIG #Rheumatology #AutoimmuneDisease #APPs #ClinicalEducation #Immunology

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 patient-reported outcomes. Psoriatic arthritis is a complex, multi-domain inflammatory condition that significantly impacts quality of life, making effective and durable treatment strategies essential for long-term disease control.

The analysis highlights rapid and sustained improvements with guselkumab, with joint symptom relief seen as early as week 2 and broader disease activity improvements by week 8, maintained through 2 years. Across multiple severity cohorts, patients treated with guselkumab were significantly more likely to achieve and maintain low disease activity compared to placebo, with consistent efficacy across both every-4-week and every-8-week dosing regimens. These findings reinforce the importance of early biologic intervention and support guselkumab as a strong first-line treatment option for patients with severe PsA.

Visit the RhAPP Content Rheum and the RhAPP ACE app for more rheumatology education.

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 inflammation activates key immune pathways, including the IL-23 and IL-17 axis, which are central to psoriatic arthritis pathogenesis and progression.

Patients with both obesity and psoriatic arthritis often experience poorer outcomes, including higher disease activity scores (DAPSA), increased joint pain, and reduced likelihood of achieving low disease activity or remission. Obesity also contributes to reduced effectiveness of conventional DMARDs and biologic therapies, making disease management more challenging. In addition to systemic inflammation, increased adiposity places mechanical stress on joints, further worsening pain and functional limitations.

This video highlights the complex relationship between metabolic dysfunction and immune response, emphasizing that obesity is not just a comorbidity but a key driver of more severe psoriatic arthritis and diminished therapeutic response. Understanding this connection is essential for improving patient outcomes and optimizing treatment strategies in rheumatology.

For more educational content, visit the RhAPP content rheum or explore the RhAPP ACE app.

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.