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.