Rheumnow Podcast Focus on Guidelines
5 snips
Jan 28, 2026 
Emma Babbage, a rheumatology nurse practitioner from Tasmania, Benjamin A. Smith, a rheumatology physician assistant, and Audrey Gibson, a PA-C in rheumatology, discuss tough clinical cases. They cover methotrexate use in psoriatic arthritis, choosing biologics using GRAPPA domains, RA escalation choices including TNF vs JAK, TB screening before biologics, steroid-sparing strategies and managing polypharmacy.
AI Snips
Chapters
Transcript
Episode notes
Choose Therapy By Dominant Psoriatic Domain
- Use a domain-based approach (GRAPPA) to choose therapy for psoriatic disease focusing on the patient's predominant manifestations.
- Include patient preferences (pill vs injection), comorbidities, and shared decision-making when selecting next therapy.
Act Fast In Aggressive RA
- In aggressive, erosive rheumatoid arthritis act quickly and consider biologic or JAK therapy rather than prolonged conventional DMARD trials.
- Maximize methotrexate (subcutaneous or split oral) while preparing to escalate therapy for joint preservation.
Maximize Methotrexate Absorption First
- If oral methotrexate seems inadequate, use subcutaneous dosing or split oral doses to increase absorption before declaring failure.
- Consider short-term steroids and reassess in one month before moving to costly therapies.