Rheumatology and Infusion Therapy: Practice and Treatment Choices in the New Era
A CME/CE DVD

Release date: December 1, 2007
Expiration date: December 1, 2008
Estimated time to complete: 2 hours

**This activity is cosponsored by the FBHC and Saint Louis University School of Medicine, and is supported by an educational grant from Centocor, Inc.**

Overview

This activity is designed to provide the most current and up-to-date data presented firsthand by national thought-leaders in the field of rheumatology. The issues presented will reflect the most important clinical findings, outcomes, and future directions in the management and treatment of rheumatoid arthritis (RA).

Intended Audience

This educational activity is intended for rheumatologists, nurse practitioners, or certified nurse specialists with an interest in the management and treatment of RA.

Needs Assessment

Through needs assessment surveys, literature searches, advisory board suggestions, and previous meeting evaluations, the FBHC has determined a need to address the current state of knowledge regarding the management of RA, specifically areas related to switching therapies, emerging therapies, and infusion therapy.

Content Validation

Saint Louis University School of Medicine follows the ACCME 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, 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.

This continuing nursing education activity was approved by the Rhode Island State Nurses Association, an accredited approver of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

The 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:

Discuss the role of infusion therapy in rheumatoid arthritis (RA) and the logistics of operating infusion centers with the aim of incorporating it into a rheumatologist's practice to improve patient adherence and outcomes

  • Craze M, Young M. Integrating biologic therapies into a dermatology practice: practical and economic considerations. J Am Acad Dermatol. 2003 49:S139-142. [Evidence Level C]
  • Eijk Y, Boonen A, Schulpen G, et al. safety and Patient satisfaction of infliximab administration in an extramural setting supervised by a rheumatology specialist nurse. Ann Rheum Dis. 2006;65:276. [Evidence Level C]
  • Pierce CA, Baker JJ. A nursing process model: quantifying infusion therapy resource consumption. J Infus Nurs. 2004;27:232-244. [Evidence Level C]

Recognize the evidence for using different imaging techniques in the management of RA including ultrasound, X-ray, and MRI; then discuss practical issues in providing these services in order to benefit patients who require access to them

  • Scheel AK, Hermann KGA, Ohrndorf S, et al. Prospective 7-year follow up imaging study comparing radiography, ultrasonography and magnetic resonance imaging in rheumatoid arthritis finger joints. Ann Rheum Dis. 2006;65:595-600. [Evidence Level C]
  • ACR Extremity MRI Task Force. Extremity magnetic resonance imaging in rheumatoid athritis. Arthritis Rheum. 2006;54:1034-1047. [Evidence Level C]
  • Lindegaard HM, Valle J, Hørslev-Peterson K, et al. Low-cost, low field dedicated extremity magnetic resonance imaging in early rheumatoid arthritis: a 1 year follow-up study. Ann Rheum Dis. 2006;65:1208-1212. [Evidence Level C]

Review the evidence and rational behind new therapies and treatment strategies in RA in order to improve the outcome for those who have inadequate treatment responses and/or who suffer adverse effects from current or older therapies

  • Makininen H, Kautiainen H, Hannonen P, et al. Sustained remission and reduced radiographic progression with combination disease modifying antirheumatic drugs in early rheumatoid arthritis. J Rheumatol. 2007;34:316-321. [Evidence Level A]
  • Gartlehner G, Hanson RA, Jonas BL, Thieda P, Lohr KN. The comparative efficacy and safety of biologics for the treatment of rheuamtoid arthritis: a systematic review and meta-analysis. J Rheumatol. 2006;33:2398-2408. [Evidence Level A]
  • Hyrich KL, Lunt M, Watson KD, Symmons DPM, Silman AJ, for the British Society for Rheumatology Biologics Register. Outcomes after switching from one anti-tumor necrosis factor a agent to a second anti-tumor necrosis factor a agent in patients with rheumatoid arthritis. Results from a large UK national cohort. Arthritis Rheum. 2007;45:13-20. [Evidence Level B]
  • Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies. Systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA. 2006;295:2275-2285. [Evidence Level A]

Describe various emerging pharmacological treatments for RA including new gene therapies, in order to maximize treatment options available to patients with RA

  • Maini RN, Taylor PC, Szechinski J, et al. Double-blind randomized controlled clinical trial of the interleukin-6 receptor antagonist, tocilizumab, in European patients with rheumatoid arthritis who had an incomplete response to methotrexate. Arthritis Rheum. 2006;54:2817-2829. [Evidence Level A]
  • Kay J, Matteson EL, Dasgupta B, et al. Subcutaneous injection of CNTO148 compared with placebo in patients with active rheumatoid arthritis despite treatment with methotrexate: a randomized, double-blind, dose-ranging trial. Presented at: 70th American College of Rheumatology Meeting; November 11-15, 2006; Washington, DC. Presentation 1921. [Evidence Level A]
  • Genovese MC, Kaine JL, Kohen MD, et al. Safety and clinical activity of ocrelizumab (a humanized antibody targeting CD20+ B cells) in combination with methotrexate (MTX) in moderate-severe rheumatoid arthritis (RA) patients (pts) (PH I/II ACTION Study). Presented at: 70th American College of Rheumatology Meeting; November 11-15, 2006; Washington, DC. Presentation 6. [Evidence Level A]

Accreditation

Saint Louis University School of Medicine has been successful in the Accreditation Council for Continuing Medical Education's (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, Element 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

Saint Louis University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 CreditsTM.

Rhode Island State Nurses Association designates this educational activity for a maximum of 4 contact hours.

Physicians and nurses should only claim credit commensurate with the extent of their participation in the activity.

FBHC Disclosure Statement

The FBHC is an independent professional organization that does not endorse specific products of any pharmaceutical concern. This FBHC CME activity has been independently planned by the FBHC.

Faculty

Marc D. Cohen, MD
Professor of Medicine
Chief of Rheumatology
National Jewish Medical and Research Center
Denver, CO

Norman Gaylis, MD, FACP, FACR
Voluntary Clinical Associate Professor
University of Miami School of Medicine
President and Managing Partner
Arthritis and Rheumatic Disease Specialties
Aventura, FL

CME Independent Reviewer

Trinh T. Tran, MD
Arthritis and Rheumatic Disease Specialties
Aventura, FL

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© 2008 The Foundation for Better Health Care