Rheumnow Podcast Cases & Guidelines
Dec 10, 2025
Join Audrey Gibson, a physician assistant in rheumatology, Benjamin A. Smith, also a physician assistant, and Emma Babbage, a rheumatology nurse from Tasmania, as they tackle complex cases in psoriatic arthritis and rheumatoid arthritis. They discuss treatment decisions, including the challenges of methotrexate and switching to JAK inhibitors. The conversation dives into practical clinic strategies, patient preferences, and the importance of adherence. They also share insights on steroid management and holistic care, providing valuable tips for healthcare professionals.
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Use Domain-Based Treatment Selection
- Use a domain-based approach (GRAPPA) to choose psoriatic arthritis therapy tailored to skin, joints, or dactylitis.
- Discuss patient preferences (pill vs injection) and comorbidities before changing mechanism of action.
Stop Methotrexate If Toxicity Emerges
- If methotrexate causes toxicity or fails, consider switching to a biologic or JAK rather than persisting with harmful DMARDs.
- Monitor labs closely and choose therapy that controls both skin and joint disease.
Skin Versus Joint Efficacy Diverges
- Dermatology has a clear hierarchy for skin response that rheumatology lacks for joint domains.
- IL-23 and IL-17 agents often top dermatology outcomes while TNF and JAKs differ for joints.