In this episode of RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers, host Amanda Mixon and Bonnie Smeryage, NP, explore the real-world impact of X-linked hypophosphatemia (XLH) through a powerful patient perspective. Featuring Shannon Sharp, a patient ambassador with Kyowa Kirin, this discussion dives into the genetic basis, diagnostic challenges, and lifelong burden of XLH—a rare, chronic metabolic bone disorder characterized by renal phosphate wasting. Learn how XLH symptoms such as bone pain, muscle weakness, fractures, and joint stiffness can mimic common rheumatologic conditions, often leading to misdiagnosis. This episode highlights the critical role of family history, genetic testing, and fasting serum phosphorus in identifying XLH, while also emphasizing the importance of compassionate, patient-centered care when discussing sensitive topics like family planning. Gain valuable clinical insights into disease progression, surgical considerations, and quality-of-life challenges, along with practical strategies to improve diagnosis and management. Whether you're a rheumatology provider, advanced practice provider (APP), or healthcare professional, this episode offers essential education on recognizing and supporting patients with XLH.

Explore the safety profile of tirzepatide in this clinician-focused medication review led by Bharati Bhardwaja, PharmD, a rheumatology clinical pharmacist at Kaiser Permanente Colorado. This video provides a comprehensive overview of common adverse effects associated with tirzepatide, including gastrointestinal symptoms such as nausea, diarrhea, constipation, abdominal pain, and decreased appetite, as well as other reactions like injection site reactions, fatigue, and hair loss.

The discussion also highlights important drug interaction considerations, including the need to adjust doses of insulin or sulfonylureas to reduce hypoglycemia risk, and the impact of delayed gastric emptying on the absorption of medications with narrow therapeutic windows, such as warfarin. Special attention is given to potential considerations with mycophenolate mofetil and oral hormonal contraceptives, along with guidance on monitoring and alternative strategies. Additionally, this review covers key safety considerations for pregnancy and lactation, emphasizing the importance of risk-benefit discussions and appropriate discontinuation when necessary.

Designed for healthcare professionals managing patients with metabolic and rheumatologic conditions, this video delivers practical insights to support safe prescribing, minimize adverse effects, and optimize patient outcomes with tirzepatide therapy. Explore more expert-led education and medication reviews on the Content Rheum and stay up to date with the latest clinical insights in rheumatologic care.

Learn the recommended starting dose and titration strategy for tirzepatide in this medication review featuring Jennifer Mylod, DNP, from Arizona Arthritis & Rheumatology Associates in Phoenix, Arizona. This video provides a practical, clinician-focused overview of how to initiate tirzepatide at 2.5 mg once weekly to improve gastrointestinal tolerability and patient adherence, followed by a structured dose escalation approach. Viewers will gain insight into the standard titration schedule—advancing in 2.5 mg increments every 4 weeks up to a maximum of 15 mg—as well as how to individualize treatment based on patient response and side effect profile.

The discussion highlights common adverse effects such as nausea, vomiting, diarrhea, and constipation, along with strategies to manage these symptoms, including slower titration, dose adjustments, and patient counseling on diet, hydration, and meal size. This review also explores key clinical outcomes associated with tirzepatide, including glycemic control, weight reduction, and appetite regulation, while emphasizing that not all patients require maximum dosing to achieve meaningful benefits. Special considerations for older adults, patients with gastrointestinal sensitivity, renal impairment, or those on concomitant insulin or sulfonylureas are also addressed to help clinicians minimize risk and optimize safety.

Whether you're managing patients with type 2 diabetes or obesity, this video delivers actionable guidance on how to personalize tirzepatide therapy, improve tolerability, and support long-term treatment success. Explore more expert-led education and medication reviews on Content Rheum and stay up to date with the latest clinical insights in metabolic and rheumatologic care.

Stay up to date with the latest advancements in psoriatic arthritis treatment in this journal club review featuring Jessica Farrell, PharmD, from Albany Medical Center. This video explores a Phase 3 SOLSTICE clinical trial evaluating the efficacy and safety of guselkumab in patients with active psoriatic arthritis who had an inadequate response to a prior TNF inhibitor.

The discussion highlights key clinical outcomes, including ACR20, ACR50, and ACR70 response rates, minimal disease activity, and psoriasis improvement, demonstrating that guselkumab significantly outperformed placebo across multiple endpoints. Importantly, the review examines dosing strategies, comparing every-4-week versus every-8-week regimens, and explains why increased dosing frequency did not lead to superior outcomes—offering valuable insights into pharmacokinetics and receptor saturation in IL-23 inhibition.

Designed for healthcare professionals managing complex psoriatic arthritis cases, this video provides practical, evidence-based guidance on biologic sequencing after TNF failure, real-world applicability of clinical trial data, and how to optimize treatment strategies for improved patient outcomes. For more expert-led education, visit the Content Rheum and stay up to date with the latest clinical insights in rheumatologic care.

In this educational FAQ video, Wendy Simmons, PA-C from Carolina Arthritis Associates, shares expert insights on hypophosphatasia (HPP)—a rare genetic metabolic bone disorder that is frequently underrecognized in rheumatology practice. With over 25 years of experience in rheumatology and specialization in osteoporosis, she highlights how HPP is characterized by low alkaline phosphatase levels and impaired bone mineralization, leading to chronic pain, fractures, and reduced quality of life. This comprehensive discussion explores why patients with HPP are often misdiagnosed with more common conditions such as fibromyalgia, osteoarthritis, neuropathies, or even psoriatic arthritis, and emphasizes the importance of recognizing overlapping, cross-specialty symptoms.

Wendy outlines key clinical pearls to help advanced practice providers and healthcare professionals improve early diagnosis, including the importance of obtaining a detailed childhood history, dental history (early tooth loss with intact roots), and careful interpretation of alkaline phosphatase lab values across adult and pediatric ranges. She also discusses hallmark fracture patterns such as metatarsal stress fractures and atypical femur fractures, as well as the significant diagnostic delay—often averaging over a decade—that many patients experience. This video serves as a practical guide for clinicians to better identify HPP, avoid common diagnostic pitfalls, and ultimately improve patient outcomes through earlier recognition and appropriate management.

Perfect for rheumatology APPs, physician assistants, nurse practitioners, and clinicians interested in rare bone diseases, osteoporosis, and metabolic disorders, this video reinforces the importance of a thorough clinical history, targeted lab evaluation, and heightened awareness of hypophosphatasia in everyday practice. For more expert-driven APP education, visit the RhAPP Content Rheum or access resources through the RhAPP ACE app.

Explore the mechanism of action of tirzepatide in this comprehensive medication review led by Bharati Bhardwaja, PharmD, from Kaiser Permanente Colorado. This video breaks down how tirzepatide, a first-in-class dual incretin receptor agonist, targets both glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors to improve metabolic outcomes. Learn how this once-weekly injectable therapy is FDA-approved for improving glycemic control in patients with Type 2 Diabetes and for chronic weight management in adults with obesity or overweight with comorbidities, including its role in treating obstructive sleep apnea.

This educational module provides a detailed, clinically relevant overview of tirzepatide’s effects across multiple organ systems. Discover how GLP-1 receptor activation reduces appetite, slows gastric emptying, enhances insulin secretion, and decreases glucagon release, while GIP receptor agonism further supports insulin regulation, improves tolerability, and enhances fat metabolism. The combined incretin effect results in improved insulin sensitivity, reduced inflammation in adipose tissue, decreased hepatic glucose production, and meaningful weight loss outcomes. Ideal for healthcare professionals and advanced practice providers, this video offers valuable insights into the pharmacology, therapeutic benefits, and real-world applications of tirzepatide in metabolic disease management.

For more expert-driven APP education, visit the RhAPP Content Rheum or access resources through the RhAPP ACE app.

Danielle Gatti-Palumbo, PharmD reviews the phase 3 APEX trial evaluating Guselkumab in patients with active psoriatic arthritis (PsA), highlighting its role in reducing inflammation, improving clinical outcomes, and preventing structural joint damage. The discussion emphasizes the importance of early biologic intervention in a disease that can quickly lead to irreversible damage and disability.

Results show that guselkumab significantly improved ACR response rates and inhibited radiographic progression by week 24 compared to placebo, with benefits seen across multiple disease domains including joints, skin, nails, and physical function. With a favorable safety profile and durable efficacy, this IL-23 inhibitor represents a valuable treatment option for clinicians managing PsA and aiming to prevent long-term disease progression.

In this episode of RhAPPcast, host Amanda Mixon PA-C, is joined by Wendy Simmons, PA-C, they explore the diagnostic challenges of hypophosphatasia (HPP), a rare genetic metabolic bone disease that is frequently overlooked or misdiagnosed. Mixon and Simmons discuss key clinical red flags, including persistently low alkaline phosphatase, fracture patterns, dental history, and musculoskeletal pain that can mimic more common conditions such as osteoporosis or fibromyalgia. The conversation highlights the underlying biology of HPP, common diagnostic pitfalls, and the real-world burden of delayed diagnosis across the lifespan. This episode is designed to sharpen clinical reasoning, improve awareness of hypophosphatasia in rheumatology practice, and support earlier, more accurate diagnosis to improve patient outcomes.