ACR on Air

Rheumatoid arthritis may begin years before the first swollen joint appears, with autoantibodies circulating long before a clinical diagnosis is made. In this episode, we explore what happens during this critical preclinical phase and whether RA can be prevented before it starts. Dr. Kevin Dean, director of the Autoimmune Disease Prevention Center at the University of Colorado Anschutz, joins us to discuss what a positive CCP antibody really means, where RA may originate, lessons from the STOP-RA trial, whether we should screen people at risk, and how clinicians should counsel patients who test positive for CCP antibodies.

In this episode, Dr. Randy Q. Cron discusses hyperinflammation and Macrophage Activation Syndrome (MAS), one of the most serious complications of Still's disease. Because MAS can mimic infection, sepsis, malignancy, or a disease flare, early recognition is critical—and treatment often must begin before every diagnostic criterion is met. We explore the clinical patterns and laboratory findings that matter most, how to interpret ferritin, and how to make timely decisions when multiple diagnoses may exist at once.

Could chronic inflammatory calcium pyrophosphate deposition disease (CPPD) be hiding in plain sight? In this episode, we explore why CPPD may be far more common than previously recognized, how it can masquerade as conditions such as refractory inflammatory arthritis, polymyalgia rheumatica, and erosive osteoarthritis, and why it is so often overlooked in clinical practice. We discuss the growing role of musculoskeletal ultrasound in diagnosis and disease management, the structural damage associated with chronic CPPD, and where the field may be headed as researchers pursue more effective treatment strategies.

In the future, can autoimmune disease become curable? A groundbreaking study from Germany suggests there may be a pathway in some cases. Patients with severe, treatment-refractory lupus who received CD19 CAR-T cell therapy have remained in drug-free remission for up to five years without ongoing immunosuppression. In this episode, we discuss how these findings are shifting the conversation from disease control to the possibility of cure, and what they could mean for lupus, inflammatory myopathies, systemic sclerosis, vasculitis, rheumatoid arthritis, and autoimmune diseases more broadly. We also explore CAR-T therapy, immune resets, regulatory T cells, relapse risk, and the future of rheumatology with Dr. Georg Schett.

Today, we discuss a new guidance statement from the American College of Rheumatology aimed at bringing much-needed structure to the evaluation and management of patients with VEXAS. This episode breaks down key recommendations, including who should be tested, the best approaches to diagnostic evaluation, how to interpret bone marrow findings, and emerging strategies for treatment—offering clarity in a diagnosis that, until recently, was marked by uncertainty.

Pericardial Disease is couched between two medical disciplines: Cardiology and Rheumatology, and those with these conditions visit medical professionals viewing their treatment through one lens or the other. This episode addresses the shifting reality that pericarditis and myocarditis are no longer separate silos but rather takes the broader view of inflammatory heart disease. We'll examine how rheumatologists should be thinking about pericardial disease, when we should get involved, how diagnosis and imaging fit in, plus the evolution of treatment.

In this episode, we discuss the growing workforce challenges in rheumatology with nurse practitioner Chris Estes. Chris shares how he entered the field, the training he received early in his career, and how he developed expertise in musculoskeletal ultrasound. The conversation explores how advanced practice providers (APPs) can help address rheumatology workforce shortages by expanding access to care—seeing new patients, managing follow-ups, and working both collaboratively and independently within a practice. Chris also discusses training pathways for new APPs, common misconceptions practices may have, and how investing in APP development may be an important strategy for the future of rheumatology care.

In this episode, we explore Antiphospholipid Syndrome (APS) with Dr. Yu (Ray) Zuo, beginning with a clear, clinically grounded explanation before diving into the personal and scientific journey that drew him to this notoriously complex disease. Along the way, Dr. Zuo shares a case that forever changed how he understands APS, then takes us inside his latest Arthritis & Rheumatology study, where machine learning reveals hidden patterns that may reshape how we think about patients and risk. The conversation moves from bedside to bench and back again, tackling what AI can—and can't—do for rheumatology, where APS research is headed next, and what early investigators need to know to build impactful careers.

In this episode, our expert guest challenges a common assumption by explaining why the T-score—despite being central to osteoporosis diagnosis—is surprisingly easy to misinterpret. He walks us through how to read a DEXA scan like a detective, highlighting subtle clues that can dramatically improve diagnostic accuracy for your patients. Once osteoporosis is identified, the conversation turns to clinical decision-making: how to choose between anabolic agents, denosumab, and bisphosphonates, and why that choice depends on thoughtful risk stratification and patient-specific comorbidities. We also dive into the often-overlooked importance of sequencing osteoporosis medications correctly, including a compelling discussion on why starting with an anabolic agent may offer greater long-term benefits than reserving it as a last-line option.

Once the prescription is written, pharmacists like Katherine McCarthy step in—often becoming the steady guide patients rely on throughout their health journey. Specializing in the care of people with rheumatic diseases, Katherine tackles insurance barriers, supports patients through biosimilar transitions, and helps demystify complex medication regimens. Her work underscores just how pivotal pharmacists are in driving better outcomes in rheumatology.

In this episode, we explore what happens when clinicians look beyond the prescription pad and begin listening more deeply to what their patients have lost. This isn't a conversation about rejecting medications but about expanding the tools we use to foster healing. We discuss the concept of disenfranchised grief—the often-unspoken losses that accompany chronic illness—the intricate links between depression and inflammation, and the transformative power of helping patients heal in ways that no pill alone can achieve. This episode was sponsored by Pfizer

In this episode, we explore RheumCode, a groundbreaking new initiative from the American College of Rheumatology (ACR) designed to build a common digital language for rheumatology. RheumCode aims to ensure that data means the same thing wherever it lives—whether in an EHR, a clinic, or a registry—enabling systems to seamlessly communicate and make better use of the medical information already being documented. We discussed how RheumCode began, the collaboration behind its development, and its potential to transform the way clinicians practice; researchers study disease, and patients experience their care. This episode was sponsored by Pfizer

In this week's episode, we dive into the ins and outs of the rheumatology musculoskeletal ultrasound certification process—what it takes to log 150 scans, meet CME requirements, and ultimately sit for the exam. We're joined by Dr. Liudmila Kastsianok, who shares her insights on how ultrasound is reshaping clinical practice, from enhancing diagnostic accuracy to opening new avenues in research. We also explore how incorporating ultrasound into routine care can deepen the physician-patient relationship and improve communication. Finally, Dr. Kastsianok offers her perspective on where the field is headed and why ultrasound is becoming an essential skill for the next generation of rheumatologists.