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.

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.