ACR on Air

The 2026 ACR Guidelines for Juvenile Idiopathic Arthritis (JIA) are here, and lead author Dr. Karen Onel joins us to unpack the key updates shaping pediatric rheumatology care. From a biologics-first approach in systemic JIA to more individualized treatment pathways for non-systemic disease, the new recommendations emphasize earlier intervention, faster treatment tailoring, and risk-based decision-making. Dr. Onel also discusses the guidelines' broader focus on mental health, physical activity, rehabilitation, and the challenges of growing up with a chronic illness. More than an update to treatment algorithms, these guidelines reflect a fundamental shift in philosophy—one that puts the whole child, not just the diagnosis, at the center of care.

Fifty years ago, pediatric rheumatic disease was often marked by disability, limited treatment options, and low expectations for long-term outcomes. In 1976, a small group of clinicians and scientists helped launch a new understanding of immune-mediated disease in children and laid the foundation for modern pediatric rheumatology. In this episode, we explore how the field evolved from managing chronic disability to expecting remission, transforming both treatment and quality of life for children. We also examine the scientific breakthroughs, models of care, and remaining challenges that continue to shape the future of pediatric rheumatology.

Private rheumatology practice is contracting under multi-directional pressure: shrinking margins, escalating prior authorizations, tightening Pharmacy Benefit Managers (PBM) and payer restrictions on drug access, and instability across core revenue streams. At the same time, demand is rising, wait times are surging, and workforce shortages are intensifying—driving clinician burnout and retention challenges. This episode is about The American College of Rheumatology's response, in expanding its leadership role in advocacy, health policy reform, and workforce development to help private practices move from survival to sustainable growth.

For years, myositis treatment has relied on broad immune suppression with drugs like steroids, methotrexate, and rituximab—but what if we could target the disease more precisely? Inflammatory myopathies are not a single condition, but a group of biologically distinct syndromes with different clinical features and immune pathways. As our understanding evolves, so does the potential for more personalized, targeted therapies. In this episode, we're joined by Dr. Julie J. Paik to discuss how this shift could reshape the future of myositis treatment.

In this episode, we explore the paradox of gout—one of the most biologically understood and treatable diseases in medicine, yet still among the most poorly controlled chronic conditions in practice. With effective therapies readily available, why do patients continue to cycle through painful flares, start and stop medications, and return to clinics and hospitals in a pattern that feels like a recurring failure? We unpack the complex interplay between biology, patient behavior, medication adherence, and health system barriers, asking whether the problem lies in the disease itself or in how care is delivered. As new treatments emerge, we also question whether innovation alone can solve the problem—or whether lasting change requires fixing the systems struggling to fully use the tools already at hand.

In this episode, we sit down with Dr. William Harvey, the newly appointed President of the American College of Rheumatology and a dedicated volunteer of nearly 20 years. Dr. Harvey shares what it's like stepping into the presidency, the key priorities shaping the year ahead, and how the ACR is approaching strategy, advocacy, partnerships, and leadership during this pivotal moment for the field.

In this episode, we explore malignant atrophic papulosis—also known as Degos disease—an extraordinarily rare microvascular disorder so uncommon that most clinicians will never see a single case. For decades, medical literature labeled it "uniformly fatal." Our guest, Dr. Lee Shapiro, encountered this reality when he began treating a rapidly deteriorating 16-year-old boy with no clear treatment path. Driven by urgency, he reached out to experts across the country, slowly piecing together clues that ultimately led to the first successful treatment of systemic Degos disease. Today, Dr. Shapiro is a leading advocate for patients, connecting a global community, promoting early recognition, and working tirelessly to expand access to life-saving therapies. Learn more at The Degos Disease Foundation

This episode explores the evolving intersection of rheumatology and cognitive science, beginning with what initially drew researchers to investigate cognitive symptoms in patients with rheumatoid arthritis (RA). We discuss the prevalence and nature of patient-reported cognitive concerns, how these subjective complaints compare with objective neurocognitive testing, and what current studies reveal underlying inflammatory and neurobiological mechanisms. The conversation examines the cognitive effects of commonly used RA therapies, as well as modifiable contributors—including physical activity, sleep apnea, diet, and stress—that clinicians should assess in routine practice. We also consider when formal neuropsychological evaluation is warranted, how to counsel patients seeking to prevent cognitive decline, and the most pressing unanswered questions that remain in the field.

In this episode, we shine a light on Calcium Pyrophosphate Deposition Disease (CPPD)—a condition that has been hiding in plain sight for decades. Despite being common, painful, and prevalent in clinics everywhere, CPPD has long been misdiagnosed, undertreated, and under-researched. Our guest has been working to change that by uncovering the genetic and molecular underpinnings of the disease and exploring new ways to improve patient outcomes. We discuss what's new and what's next for CPPD, why it may be the most common inflammatory arthritis after age 60, how it overlaps with rheumatoid arthritis and osteoarthritis, and what emerging studies of biologics are revealing about its biology and untapped therapeutic potential. This episode was sponsored by Pfizer

Welcome to ACR Convergence 2025 in Chicago! Here, Dr. Hausmann delivers a quick update on what our podcasts will cover while the meeting is in session. Don't forget to tune in to ACR on Air and ACR Journals on Air each morning, starting this Saturday, to catch up on the latest in Rheumatology

In this episode, we preview ACR Convergence 2025 in Chicago this October with Dr. Greg Gardner, Chair of the Annual Meeting Planning Committee (AMPC). We'll explore key topics like emerging therapies, AI in rheumatology, and highlights such as the Practice Innovation Summit, Ultrasound Course, and Fellows In Training (FiT) Program. Dr. Gardner also discusses highlights such as, CAR T-cell therapies, new non-renal lupus guidelines, a Live Journals Club focused on Big Data and why this year's meeting is earlier on the calendar. Tune in for a sneak peek at what's to come!

It's been over two decades since the American College of Rheumatology (ACR) last released comprehensive treatment guidelines for systemic lupus erythematosus (SLE), and much has changed. In this episode, we're joined by Dr. Lisa Sammaritano to discuss the forthcoming 2025 ACR Guidelines for the Treatment of SLE. These updated recommendations reflect a significant evolution in our approach to lupus care, from the growing range of therapeutic options to a stronger emphasis on patient engagement and minimizing steroid toxicity. We'll dive into how the guidelines tailor treatment across diverse organ systems and patient populations, and what clinicians need to know to effectively incorporate these updates into their practice.

In this episode, we're joined by myositis expert Dr. Brian Feldman to explore Juvenile Dermatomyositis (JDM). We cover its clinical presentation, key diagnostic clues, and the workup including labs and imaging. We examine the MDA5 variant, known triggers, and non-pharmacologic management strategies. Dr. Feldman also addresses the high-stakes scenario of JDM-associated rapidly progressive interstitial lung disease, offering insights into pathophysiology, imaging, and aggressive early treatment. The episode concludes with a look at the field's questions that remain.