Expert Rheumatology Exchange:
A series of online byte-size CME programs

This activity is cosponsored by The Foundation for Better Health Care and the Saint Louis University School of Medicine and is supported by an educational grant from Centocor, Inc.

You and your colleagues are invited to view a series of online byte-size CME programs, designed to provide physicians with the most recent evidence-based data covering the different management strategies for rheumatic diseases. In light of the wide range of new therapies on the rise, and the everchanging rheumatology landscape, this activity intends to help physicians implement an individualized and optimized therapy that maximizes patient outcomes.

Intended Audience

This educational activity is designed for rheumatologists.

Needs Assessment

Through needs assessment surveys, literature searches, advisory board suggestions, and previous meeting evaluations, the FBHC and Saint Louis University have determined a need to address the current state of knowledge regarding the management of rheumatic diseases; specifically, areas related to early and aggressive treatment, switching therapy, emerging therapies, and the long-term safety issues associated with biologic therapies are highlighted.

Method of Clinician Participation

View the contents of the CME bytes carefully and complete the respective online posttest. A minimum score of 80% must be obtained for credit to be awarded by the Saint Louis University School of Medicine. There is no fee for this activity. Credit for the series posttests is available until October 15, 2009.

Content Validation

The Saint Louis University School of Medicine follows the Accreditation Council for Continuing Medical Education’s policy on Validation of Content for CME activities, which requires that:

  • All recommendations involving clinical medicine must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients.
  • All scientific research referred to, and reported or used in CME in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.

The Foundation for Better Health Care (FBHC) validates the content of its CME activities through a peer review process and by utilizing evidence-based medicine sources throughout the planning and implementation of its activities. Adopting the levels of evidence used by the American Academy of Family Physicians1 and the principles of evidence-based medicine outlined by Straus et al,2 the FBHC rates the level of evidence of the literature used to determine needs and learning objectives, as well as all data cited and presented.

All recommendations involving clinical medicine are based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. Further, all scientific research referred to, reported, or used in support or justification of a patient care recommendation conforms to the generally accepted standards of experimental design, data collection, and analysis.

Levels of Evidence1

  • Level A (randomized controlled trial [RCT]/meta-analysis)
  • Level B (other evidence): A well-designed, nonrandomized clinical trial. A nonquantitative systematic review with appropriate search strategies and well-substantiated conclusions. Includes lower-quality RCTs, clinical cohort studies, and case-controlled studies with nonbiased selection of study participants and consistent findings. High-quality, historical, uncontrolled studies, or well-designed epidemiologic studies with compelling findings are also included
  • Level C (consensus/expert opinion)
  1. Siwek J, Gourlay ML, Slawson DC, Shaughnessy AF. How to write an evidence-based clinical review article. Am Fam Physician. 2002;65:251-258.
  2. Straus SE, Richardson WS, Glasziou P, Haynes RB. Evidence-Based Medicine. 3rd ed. Edinburgh, Scotland: Churchill Livingstone; 2005.

Learning Objectives

Upon completion of this activity, participants should be able to:

Recognize the importance of early and aggressive treatment for rheumatoid arthritis and other rheumatic diseases in order to improve overall patient outcomes

  • Dubosc AE, Avouac J, Gossec L, Dougados M, Schaeverbeke T. Comparison of radiological progression of patients with rheumatoid arthritis treated or not with TNF alpha inhibitors according to disease duration. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract THU0137. [Evidence Level A]
  • Klarenbeek NB, Güler-Yüksel M, Van der Kooij SM, et al. Clinical outcomes of four different treatment strategies in patients with recent-onset rheumatoid arthritis: 5-years results of the best-study. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract THU0162. [Evidence Level B]
  • Yazici Y, Reed DM, Klem C, Rosenblatt LC, Wu G, Kremer J. Biologic naïve early rheumatoid arthritis (RA) patients treated with abatacept achieve greater disease remission compared to RA patients with long standing disease, with nearly half of early RA patients in DAS28 remission at 3 years. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract OP-0248. [Evidence Level B]

Evaluate data supporting new therapies for rheumatic diseases and recognize patients in your practice for whom these newer therapies may be appropriate

  • Jones G, Gu JR, Lowenstein M, et al. Tocilizumab monotherapy is superior to methotrexate monotherapy in reducing disease activity in patients with rheumatoid arthritis: the ambition study. Presented at: EULAR; June 11–14, 2008; Paris, France. OP-0131. [Evidence Level A]
  • Emery P, Keystone E, Tony H, et al. Tocilizumab (TCZ) significantly improves disease outcomes in patients with rheumatoid arthritis whose anti-TNF therapy failed: the radiate study. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract OP-0251. [Evidence Level A]
  • Smolen J, Kay J, Doyle MK, et al. Golimumab, a new human anti-TNF-alpha monoclonal antibody, subcutaneously administered every 4 weeks in patients with active rheumatoid arthritis who were previously treated with anti-TNF-alpha agent(s): results of the randomized, double-blind, placebo. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract OP-0010. [Evidence Level A]
  • Emery P, Fleischmann RM, Moreland LW, et al. Golimumab (GLM), a new human anti-TNF-alpha monoclonal antibody, administered subcutaneously (sc) every 4 weeks in methotrexate-naïve patients with active rheumatoid arthritis (RA): a randomized, double-blind, placebo-controlled, go-before study. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract THU0138. [Evidence Level A]
  • Keystone E, Genovese MC, Klareskog L, et al. Golimumab, a new human anti-TNF-alpha monoclonal antibody, administered subcutaneously every 4 weeks in patients with active rheumatoid arthritis despite methotrexate: week 24 results of the randomized, double-blind, placebo-controlled, go-forward study. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract THU0156. [Evidence Level A]
  • Van Vollenhoven RF, Felson D, Weinblatt ME, et al. ACR-hybrid analysis confirms benefit of certolizumab pegol with methotrexate in patients with rheumatoid arthritis: data from the rapid 1 and 2 trials. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract FRI-146. [Evidence Level A]

Distinguish patients who are nonresponders or may not be achieving adequate response with their current therapy and devise new treatment strategies in order to achieve optimal therapeutic response

  • Cohen S, Keystone E, Genovese MC, et al. Continued inhibition of structural damage in rheumatoid arthritis patients treated with rituximab at 2 years: reflex study. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract THU0167. [Evidence Level A]
  • Schiff M, Zhou X, Kelly S, Le Bars M, Genovese M. Efficacy of abatacept in RA patients with an inadequate response to anti-TNF therapy regardless of reason for failure, or type or number of prior anti-TNF therapy used. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract FRI0160. [Evidence Level A]
  • Finckh A, Ciurea A, Brulhart L, et al. Which subgroup of rheumatoid arthritis patients benefit most from switching to rituximab versus alternative anti-TNF agents after previous failure to anti-TNF agent? Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract OP-0249. [Evidence Level A]
  • Emery P, Keystone E, Tony H, et al. Tocilizumab (TCZ) significantly improves disease outcomes in patients with rheumatoid arthritis whose anti-TNF therapy failed: the radiate study. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract OP-0251. [Evidence Level A]

Discuss the various issues regarding the long-term safety of biologic therapies for rheumatic diseases in order to select the right patients and attain a lasting treatment response

  • Burmester GR, Mease PJ, Dijkmans BAC, et al. Comprehensive safety profile and reductions in standardized mortality ratios from adalimumab (Humira®) global clinical trials in six autoimmune diseases. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract THU0090. [Evidence Level A]
  • Dixon WG, Symmons DP, Lunt M, Watson KD, Hyrich KL, for the British Society for Rheumatology Biologics Register Control Centre Consortium; from the British Society for Rheumatology Biologics Register. Serious infection following anti-tumor necrosis factor alpha therapy in patients with rheumatoid arthritis: lessons from interpreting data from observational studies. Arthritis Rheum. 2007;56:2896–2904. [Evidence level B]
  • Klareskog L, Moreland LW, Cohen SB, et al. Safety and efficacy of over 10 years of continuous etanercept therapy in patients with rheumatoid arthritis in North America and Europe. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract THU0124. [Evidence Level B]
  • Seror R, Richez C, Sordet C, et al. Pattern of demyelination occurring during anti-TNF alpha therapy: a French national survey. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract FRI0138. [Evidence Level B]
  • Dreyer L, Mellemkjær L, Hetland M. Cancer in Danish patients with rheumatic diseases treated with anti-tumour necrosis factor therapy – a descriptive study from the Danbio registry. Presented at: EULAR; June 11–14, 2008; Paris, France. Abstract AB0285. [Evidence Level B]

Appreciate the role of informed patients in the management of rheumatic diseases to better optimize treatment and increase patient satisfaction

  • Sleath B, Chewning B, Devellis RF, et al. Communication about depression during rheumatoid arthritis patient visits. Arthritis Rheum. 2008;59:186-191. [Evidence Level B]
  • Ishikawa H, Hashimoto H, Yano E, et al. Patients' preferences for decision making and the feeling of being understood in the medical encounter among patients with rheumatoid arthritis. Arthritis Rheum. 2006;55(6):878-883. [Evidence Level B]

Accreditation


The Saint Louis University School of Medicine has been successful in the Accreditation Council for Continuing Medical Education (ACCME) reaccreditation process and has been awarded the status of Accreditation through November 2009. The Saint Louis University CME department has demonstrated compliance with the ACCME's Essential Areas, Elements and Policies. Exemplary Compliance was awarded in Essential Area 2 for consistently using needs assessment data from multiple sources to plan CME activities, including expert faculty recommendations, patient care observation, literature reviews, committee requests, new techniques/equipment/medical issues, and peer/colleague discussions.

Credit Designation

The Saint Louis University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Identifying and Resolving Conflicts of Interest


The Saint Louis University School of Medicine will review this activity’s disclosures and resolve all identified conflicts of interest, if applicable.

Disclosure Policy Statement

It is the policy of the Saint Louis University School of Medicine to ensure balance, independence, objectivity, and scientific rigor in its continuing medical education program. Faculty and planning committee members participating in these activities are required to disclose to the audiences prior to the activity the following:

  1. The existence of any significant financial or other relationship with the manufacturer of any commercial product or provider of any commercial service discussed.
  2. Their intention to discuss a product that is not labeled for the use under discussion.
  3. Their intention to discuss preliminary research data.

The Saint Louis University School of Medicine will review this activity’s disclosures and resolve all identified conflicts of interest, if applicable.

FBHC Staff Disclosures

The FBHC, in keeping with the ACCME’s Essential Areas and their Elements and Standards for Commercial Support, has asked each FBHC staff member who has developed and/or reviewed content for this activity to disclose to learners all financial relationships, including those of their spouse or partner, with the manufacturer(s) of any pharmaceutical product(s), device(s), or providers of commercial services in any financial amount within the past 12 months. The FBHC staff members have disclosed the following:

Tammi Mooshegian has nothing to disclose.
CME, Program Director
The Saint Louis University School of Medicine

Eresso Aga, PhD, has nothing to disclose.
Scientific Director

Susan Duff has nothing to disclose.
Managing Editor

Natacha Menar has nothing to disclose.
Senior Editor

Sejal Patel has nothing to disclose.
Account Manager

Judy Seraphine has nothing to disclose.
Industry Consultant

Supported by and educational grant from

Cosponsored by

Disclaimer

The views expressed are those of the authors. It should not be assumed that this activity expresses the views of Genentech, Inc or any manufacturer of pharmaceuticals. This FBHC CME activity has been independently planned by the FBHC.

All rights reserved, including translation into other languages. No part of these CME activities may be reproduced or transmitted in any form or by any means-electronic or mechanical, including photocopying, recording, or storage in information storage and retrieval systems-without permission in writing from The Foundation for Better Health Care, 33 East 33rd Street, 8th Floor, New York, NY 10016.

System Requirements
FBHC online CME requires version 5 browsers or higher from Microsoft or Netscape as well as version 4 or higher of Adobe Acrobat Reader®. These Webcasts also require Flash Player.


Contact Us
For questions regarding the content of this activity, contact info@FBHC.org. For technical assistance, contact webmaster@FBHC.org.

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Online byte-size CME series

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© 2008 The Foundation for Better Health Care