ACR on Air

What is the "Direct Specialty Clinical Care Model" and is it a viable option for clinical rheumatologists in today's medical ecosphere? Dr. Diana Girnita, founder and CEO of Rheumatologists OnCall, joins us to speak on what motivated her to pioneer this clinical approach, how she empowers her patients by putting the cost of care directly in their hands, her thoughts on the financial viability of this model in the near future and how she manages the daily responsibilities facing every clinician, like: dealing with insurance companies, billing, managing referrals, telemedicine and more!

Join us as we explore what's new and exciting at ACR Convergence, the premier gathering for rheumatology science and innovation. Dr. Gregory Gardner, Chair of the Annual Meeting Planning Committee, shares a preview of this year's meeting, including emerging treatments like cellular therapy, hands-on workshops, and the science that could change clinical practice. We discuss the sessions you won't want to miss and offer tips for making the most of your time at the meeting, both inside and outside the conference room

When is Raynaud's phenomenon truly a disease? Dr. Robert Spiera joins us to discuss the key clinical clues, the value of patient photos and nail fold capillary findings, and how to approach a positive ANA without a defined connective tissue disease. We review treatment options from warming strategies and medication review to calcium channel blockers, PDE-5 inhibitors, prostaglandins, and digital sympathectomy and highlight the finding that demands urgent attention: a painful, persistently blanched digit. Most importantly, we discuss the balance between treating serious vascular disease and avoiding unnecessary medicalization of a common phenomenon.

Interstitial Lung Disease (ILD) is difficult to diagnose and treat. At first, the disease could look like a variety of other disorders, such as fibrosis or autoimmunity. Once a diagnosis is made, a decision on how aggressively to treat it can mean the difference between irreversible lung damage or overly impacting your patient's quality of life. We caught up with Dr. Robert Hallowell, a Pulmonary and Critical Care physician at the Massachusetts General Hospital and Director of the Interstitial Lung Disease Program at the Pulmonary Ambulatory Clinic. Dr. Hallowell tells us how he evaluates ILD

September is Rheumatic Disease Awareness Month (RDAM), and today we're sharing the story of Deborah Talbot, an occupational therapist from the Children's Hospital of Philadelphia and her daughter, Molly, who was diagnosed with Juvenile Idiopathic Arthritis (JIA) at the age of 12 years old. When an ankle injury turned out to be far more, Molly endured months of pain, swelling, repeated evaluations and the uncertainty of not understanding why she wasn't getting better. This is the story of how a family came together to fight through pain, discover a disease, find remission that would remain for years and start advocacy for those without the resources they were blessed with, emerging triumphant in the face of overwhelming adversity

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.

The new clinical guidelines for juvenile and adult axial spondyloarthritis (axSpA), developed collaboratively by the American College of Rheumatology (ACR), the Spondylitis Association of America (SAA), and the Spondyloarthritis Research and Treatment Network (SPARTAN), mark an important evolution in the management of this complex disease. In this episode, Drs. Liron Caplan and Matthew Stoll discuss what's changed, why it matters, and how these recommendations can guide everyday clinical practice—from the first-ever juvenile axSpA guideline and the unified approach to radiographic and non-radiographic disease, to practical decisions around MRI use, first-line therapies, biologic selection, treatment failure, and physical activity.

2026 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Axial Spondyloarthritis in Adults and Children/Adolescents

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.

What if some patients who never quite fit their diagnosis actually have an underlying genetic disorder? In this episode, we explore Haploinsufficiency of A20 (HA20), a condition first described less than a decade ago that is already reshaping our understanding of autoinflammation, autoimmunity, and immune dysregulation. How many patients in our clinics have a genetic diagnosis we've never thought to consider? Join us as we discuss this emerging disease and its clinical implications with Dr. Daniella M. Schwartz.

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.

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.

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.

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.

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.

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.

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.

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 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 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 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.