In this educational segment, Wendy Simmons, PA-C, from Carolina Arthritis Associates in Wilmington, North Carolina, shares her nearly three decades of experience in rheumatology to address a critical question: What is the clinical significance of structural damage in psoriatic arthritis? Drawing on insights from decades of evolution in psoriatic arthritis care—from the pre-biologic era of the 1990s to today’s advanced targeted therapies—Wendy explains how persistent inflammation at enthesial sites can lead to periosteal reaction, joint space narrowing, and ultimately irreversible joint destruction. She reflects on early cases that demonstrated severe deformities underscoring the need for early detection and aggressive management to prevent disability and preserve quality of life. This discussion highlights why understanding structural progression is essential for optimizing outcomes in patients with inflammatory arthritis. For additional resources and in-depth data, visit the RhAPP website for expert-led rheumatology education tailored to advanced practice providers.

In this medication review, Wendy Simmons, PA-C, from Carolina Arthritis Associates in Wilmington, North Carolina, draws on nearly three decades of rheumatology experience to explore the clinical efficacy of guselkumab in inhibiting the progression of structural damage in psoriatic arthritis. Referencing the APEX Phase 3B Trial presented at the 2025 EULAR Congress, Wendy reviews key data on guselkumab's dual IL-23 mechanism of action—targeting both the p19 subunit and the CD64 receptor on IL-23–producing myeloid cells. She highlights significant findings in joint space narrowing, bone erosion, and radiographic progression, demonstrating the therapy’s ability to slow disease progression compared to placebo. With efficacy shown across both Q4 and Q8 week dosing intervals, this medication represents a meaningful advancement in psoriatic arthritis management. For a deeper dive into the data and additional resources, visit the RhAPP website to access full clinical insights and educational materials for advanced practice providers.

#RheumatologyEducation #APEXTrial #BiologicTherapies #AdvancedPracticeProviders #AutoimmuneDisease #JointHealth

In this episode, Wendy Simmons, PA-C from Carolina Arthritis in Wilmington, North Carolina, shares insights from nearly three decades of rheumatology experience to answer an important clinical question. Drawing on the pivotal APEX trial, recently presented at EULAR Congress 2025, Wendy reviews how guselkumab demonstrated inhibition of radiographic progression in PsA patients. Using modified vdH-S scores to assess joint space narrowing and bone erosion, the study showed that patients treated with guselkumab experienced significantly lower rates of structural joint damage compared to placebo. With ACR20 response achieved at week 24 and radiographic outcomes confirming long-term benefit, this trial reinforces the role of guselkumab as an effective therapy for psoriatic arthritis beyond symptom control. For clinicians seeking the latest data on PsA treatment and disease-modifying strategies, this discussion highlights key findings that support improved patient outcomes. For more information and additional resources, visit the RhAPP website.

In this episode, Kyle George, PA-C at St. Luke’s Rheumatology in Idaho, explains the Inflation Reduction Act of 2022 and its impact on the affordability of biologic therapies for patients with chronic conditions. This landmark law introduces sweeping reforms to lower prescription drug costs for Medicare beneficiaries, including giving Medicare the authority to negotiate prices on high-cost drugs, capping annual out-of-pocket expenses at $2,000 starting in 2025, and requiring manufacturers to pay inflationary rebates if prices rise faster than inflation. Kyle highlights how these provisions will directly affect patients on biologics, offering much-needed financial relief, greater price stability, and improved access to care. He also discusses how the act encourages competition through biosimilars, expands eligibility for low-income subsidies, and limits annual premium increases, all designed to make therapies more affordable and accessible for vulnerable populations. For patients and providers alike, this episode offers a clear, practical look at how the Inflation Reduction Act is reshaping the future of drug pricing and access to biologic medications.

In this episode of RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers, host Amanda Mixon, PA-C, is joined by Bonnie Smeryage, NP, to shed light on X-linked hypophosphatemia (XLH)—a rare hereditary condition that often goes unrecognized or misdiagnosed in rheumatology. XLH can mimic common rheumatologic and musculoskeletal disorders such as rheumatoid arthritis, ankylosing spondylitis, or fibromyalgia, leading to delayed diagnosis and treatment. Amanda and Bonnie discuss the underlying causes of XLH, key clinical red flags in both pediatric and adult patients, and the importance of ordering a fasting serum phosphorus level as part of routine evaluation for unexplained bone or joint pain. They highlight how early detection, family history, and multidisciplinary care are critical for improving patient outcomes, and why rheumatology providers are uniquely positioned to recognize and manage this condition. This conversation emphasizes the value of shared decision-making, coordinated care, and practical diagnostic strategies to ensure patients with XLH receive timely and effective treatment.

In this episode of RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers, host Amanda Mixon, PA-C, is joined by Claudia Rivera Salas, NP, to tackle one of the most challenging areas in rheumatology: managing patients with polymyalgia rheumatica (PMR) who do not respond well to glucocorticoids or struggle with steroid tapering. While steroids remain the cornerstone of PMR treatment, many patients relapse or develop serious steroid-related side effects, making it essential to consider steroid-sparing therapies and newer biologic options. Amanda and Claudia define refractory PMR, highlight key diagnostic considerations, and walk through real-world case discussions that illustrate when to escalate therapy. The conversation explores common pitfalls in management, the role of methotrexate and other DMARDs, and the growing impact of IL-6 inhibitors like sarilumab in helping patients achieve remission faster and with fewer toxicities. With practical guidance on shared decision-making, monitoring strategies, and treatment goals, this episode offers clinicians valuable insights to optimize care for patients with PMR while reducing long-term steroid dependence.

In this final episode of the GCA Fireside Chat series on RhAPPcast, host Amanda Mixon, PA-C, is joined again by Naomi Amudala, CRNP, and Jessica Farrell, PharmD, to explore the critical risk-benefit considerations of upadacitinib in the treatment of giant cell arteritis (GCA). With upadacitinib gaining FDA approval, understanding its safety profile is essential for providers treating an older, high-risk patient population. The discussion breaks down results from the SELECT-GCA trial, covering baseline patient characteristics, major adverse cardiovascular events (MACE), venous thromboembolism (VTE), infection risk—including herpes zoster—and how to stratify patients appropriately for therapy. The experts highlight key differences between GCA and RA populations, compare upadacitinib risks to the well-documented toxicities of long-term corticosteroid use, and provide real-world perspectives on lab monitoring, vaccination, and patient counseling. This episode helps clinicians feel more confident in prescribing steroid-sparing therapy while keeping patient safety at the forefront of decision-making.

In this expert-led video, Heather Mambretti, PA-C, who has over 13 years of experience in rheumatology, reviews the safety profile of sarilumab for patients with polymyalgia rheumatica (PMR) and rheumatoid arthritis (RA). Heather explains how more than 10 years of cumulative safety data—including 7 years from RA clinical trials and 3 years from PMR studies—provides reassurance for patients and clinicians considering sarilumab therapy. She highlights important safety considerations such as screening for infections and tuberculosis prior to initiation, managing treatment interruptions in the event of serious infections, and monitoring for adverse events like neutropenia, leukopenia, rash, fatigue, myalgia, constipation, and injection site reactions. Heather also compares the risks of sarilumab to the long-term risks of high-dose corticosteroids, helping patients understand the benefit-risk balance in real-world practice. Viewers will learn about recommended safety monitoring protocols, including early lab checks (CBC, metabolic panel, lipid profile) and ongoing annual tuberculosis screening. This video provides practical, evidence-based guidance for healthcare providers and patients navigating treatment decisions in PMR and RA.