In this FAQ, Brandon Ko, APRN, a pediatric rheumatology nurse practitioner and RhAPP Pediatric Chair, provides a practical overview of hypophosphatasia (HPP) across the lifespan and explains why this rare inherited metabolic bone disorder is often missed in clinical practice. The discussion reviews pediatric and adult presentations of HPP, including subtle skeletal symptoms, premature tooth loss with intact roots, stress fractures, osteomalacia, and early-onset pseudogout, and highlights persistently low alkaline phosphatase as a key diagnostic red flag. Designed for APPs and clinicians, this concise video outlines when to suspect HPP, how to begin the evaluation, and why early recognition is critical in both pediatric and adult rheumatology settings.

In this journal club review, clinical pharmacist Danielle Gatti Palumbo, breaks down a March 2025 study examining how guselkumab’s unique Fc-domain interactions with CD64-positive, IL-23–producing myeloid cells enhance its potency in neutralizing IL-23 signaling. The discussion explores the immunologic role of IL-23 in inflammatory diseases such as psoriasis, psoriatic arthritis, and inflammatory bowel disease, compares Fc-domain differences between IL-23 inhibitors, and highlights key in vitro findings using flow cytometry, live-cell imaging, and co-culture assays. This concise overview helps APPs and clinicians better understand emerging mechanisms that may influence therapeutic efficacy and treatment selection in IL-23–driven inflammatory conditions.

In this focused educational video, Heather Mambretti, PA-C, a rheumatology APP with over 12 years of experience and a faculty and board member for RhAPP, explains how hypophosphatasia (HPP) is diagnosed and highlights the key laboratory markers clinicians should not overlook. The discussion reviews the hallmark finding of persistently low serum alkaline phosphatase (ALP), additional supportive labs, characteristic clinical features in adult patients, and the role of imaging and genetic testing in confirming an HPP diagnosis. Designed for APPs and clinicians, this overview emphasizes practical strategies for identifying adult-onset hypophosphatasia, differentiating it from other musculoskeletal conditions, and improving diagnostic confidence in real-world rheumatology practice.