In this video, Kyle George, PA-C, a rheumatology physician assistant with St. Luke’s Rheumatology in Idaho, reviews the key clinical takeaways from the 2015 ACR and EULAR treatment guidelines for polymyalgia rheumatica (PMR). PMR is a common inflammatory condition in older adults, marked by bilateral shoulder or hip girdle pain and stiffness. Kyle discusses the diagnostic criteria, the hallmark rapid response to low-dose glucocorticoids, and the importance of screening for concurrent giant cell arteritis (GCA). He breaks down recommended prednisone tapering strategies, the definition and management of disease flares, and the conditional use of methotrexate for patients with frequent relapses or steroid intolerance. The video also explores the emerging role of biologics, including the 2023 FDA approval of sarilumab, an IL-6 receptor inhibitor, for moderate to severe PMR. As treatment options evolve, understanding both the foundation of existing guidelines and new advances is critical to optimizing care. For more PMR-focused education, visit RhAPP.org.

In this video, clinical pharmacist and RhAPP faculty member Danielle Gatti Palumbo breaks down the mechanism of action of methotrexate, explaining how this folate antimetabolite works to inhibit DNA synthesis, reduce inflammation, and regulate immune response.

Methotrexate is a folate antimetabolite that plays a crucial role in inhibiting DNA synthesis, repair, and cellular replication, making it a widely used treatment for autoimmune diseases and certain cancers. Its primary mechanism involves binding to and inhibiting dihydrofolate reductase (DHFR), which prevents the formation of reduced folate, a key component in DNA and RNA synthesis. This inhibition is why folic acid supplementation is recommended for patients taking methotrexate. Additionally, methotrexate blocks thymidylate synthase (TS), further disrupting purine and pyrimidine synthesis, leading to decreased cell proliferation.

Beyond its effects on cellular replication, methotrexate exerts powerful anti-inflammatory properties by interfering with dendritic cell and T-cell communication, reducing pro-inflammatory cytokines, and increasing adenosine levels at sites of inflammation. These actions help suppress immune system overactivity, making methotrexate a cornerstone therapy in conditions like rheumatoid arthritis, psoriasis, and other autoimmune diseases. Furthermore, methotrexate promotes cell apoptosis, contributing to its efficacy in disease management.

For more insights into methotrexate, its uses, and best practices for patient care, visit the RhAPP website or explore additional educational content on the RhAPP ACE App.

In this journal club session, Danielle Gatti-Palumbo, PharmD, a clinical pharmacist at Northwell Health Division of Rheumatology, explores the safety and efficacy of deucravacitinib, a first-in-class, oral selective TYK2 inhibitor approved for the treatment of moderate-to-severe plaque psoriasis. Published in the Journal of Drugs in Dermatology (Feb 2025) by Dr. Milan Shaw and colleagues, the expert consensus review highlights six key recommendations based on a comprehensive literature review and panel discussion. Danielle breaks down how deucravacitinib offers a highly targeted mechanism that avoids many of the risks seen with traditional JAK inhibitors, including no observed increase in MACE (major adverse cardiovascular events), serious infections, or lab abnormalities. With no black box warnings and minimal monitoring requirements, deucravacitinib presents a promising treatment alternative for patients with psoriasis, particularly those at risk for or intolerant of broader immunosuppressive therapies. Tune in to learn how this therapy compares to other oral agents like apremilast and how expert consensus supports its use in clinical practice. For more rheumatology-focused content, visit RhAPP.org and explore the Content Rheum section.

In this episode of RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers (RhAPP), host Amanda Mixon, PA-C, dives into the evolving role of TYK2 inhibition in the treatment of psoriatic arthritis (PsA). Joined by special guest and PsA expert Eileen Lydon, NP, the episode unpacks the science behind the TYK2/STAT signaling pathway, how it differs from traditional JAK inhibition, and what this means for patient care. Together, Amanda and Eileen explore key cytokines like IL-12, IL-23, and type I interferons, and how selective TYK2 inhibitors such as deucravacitinib offer targeted modulation with a potentially improved safety profile.

Listeners will gain valuable insight into recent clinical trial data, including promising Phase 2 and Phase 3 results in PsA, as well as long-term safety outcomes from psoriasis studies with over five years of data. Eileen shares her practical clinical perspective on where TYK2 inhibitors may fit within the current PsA treatment landscape—especially for patients seeking oral options, those with comorbidities, or those who struggle with adherence to injectable or monitored therapies. The episode also highlights the findings from a recent expert consensus panel published in the Journal of Drugs in Dermatology, supporting the favorable safety profile of deucravacitinib without the need for extensive lab monitoring.

Whether you're a rheumatology provider, fellow, or someone exploring new therapeutic strategies, this episode delivers actionable insights into precision medicine and the future of TYK2-targeted care.

Explore more expert content at RhAPP.org or download the RhAPP ACE app.

Hydroxychloroquine is a cornerstone therapy in rheumatology, offering significant benefits for mild rheumatoid arthritis (RA) and lupus. In this video, Jessica Farrell, PharmD, clinical pharmacist in rheumatology at Albany Medical Center and faculty at Albany College of Pharmacy and Health Sciences, explores the dosing, safety, and clinical applications of hydroxychloroquine.

Jessica Farrell explains the weight-based dosing strategy (5 mg/kg/day) to minimize the risk of retinal toxicity, discusses its crucial role in lupus management, and highlights its use during pregnancy, particularly in patients with anti-SSA and anti-SSB antibodies to help prevent neonatal heart block. She also shares clinical pearls on managing tolerability issues, including desensitization protocols for patients who experience mild hypersensitivity reactions.

For more expert insights on rheumatology treatments and the latest clinical updates, visit RhAPP.org and explore the RhAPP ACE 2.0 App for digital education.

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In this FAQ Video Module, Christy Vath, PA-C, a seasoned rheumatology expert from Seattle Rheumatology Associates, explores how the selectivity of TYK2 and JAK enzyme inhibition impacts safety profiles. She provides a clear comparison between traditional pan-JAK inhibitors and selective TYK2 inhibitors like deucravacitinib, highlighting their differing mechanisms of action and clinical implications.

Christy breaks down how TYK2’s selective inhibition of the pseudokinase domain—versus the broader catalytic inhibition seen with JAK1, JAK2, and JAK3—can reduce risks associated with immunosuppression, such as major adverse cardiovascular events (MACE), malignancy, and thrombosis. She reviews safety findings from pivotal clinical trials in plaque psoriasis and psoriatic arthritis, where deucravacitinib demonstrated a favorable safety profile and limited systemic immunosuppressive effects.

Watch now to understand why TYK2 selectivity matters—and how it may shape the future of treatment in immune-mediated diseases like psoriasis and PsA.

Visit https://rhapp.org or download the RhAPP app for more expert insights and updates on TYK2 inhibition.

Join Monica Richey, NP, with 20+ years of experience in Rheumatology, as she breaks down the latest 2024 ACR guidelines for monitoring lupus nephritis. Learn the best practices for urine testing, protein-creatinine ratios, and medication adjustments to ensure optimal patient care.

She emphasizes the importance of regular urine tests, protein-creatinine ratio checks, and full blood panels to track disease progression and adjust treatment as needed. Monitoring should be done at every visit, especially after starting new medications, with particular attention to trends in protein levels to guide treatment decisions. Additionally, Monica highlights the critical role of medication adherence, noting that treatment failure is sometimes due to missed doses rather than ineffective therapy. By consistently tracking lab results and confirming patient compliance, healthcare providers can optimize lupus nephritis management.

For more expert insights, visit the RhAPP website or explore additional educational content on the RhAPP ACE App.

This video is a must-watch for rheumatologists, nephrologists, nurse practitioners, and lupus patients looking to stay updated on evidence-based monitoring strategies.

Join Audrey Gibson, PA-C, a seasoned rheumatology provider at the Arthritis Center of North Georgia with 18 years of clinical experience, as she explores the question: Can patients recapture their response to IL-17 inhibitor therapy after an interruption or discontinuation?

In this discussion, Audrey reviews key findings from a pivotal clinical trial by Landewé et al., which examined the recapture and retreatment rates of Ixekizumab in axial spondyloarthritis (axSpA) after therapy withdrawal. The randomized, placebo-controlled study followed 155 patients with axSpA who achieved remission and were either continued on Ixekizumab or switched to placebo.

Key results from the study revealed that 96% of patients who withdrew to placebo were able to recapture low disease activity upon retreatment, while 71% regained inactive disease status. These findings offer critical insights for rheumatology providers counseling patients who experience therapy interruptions due to illness, infection, surgery, or personal choice.

This discussion provides a valuable clinical perspective on IL-17 inhibitor retreatment strategies and helps answer common patient concerns about treatment withdrawal and re-initiation.

For more expert insights on IL-17 inhibition and axial spondyloarthritis management, visit RhAPP.org or explore additional educational content on the RhAPP ACE App.