Expert Rheumatology Exchange: Interactive ClassRheums: A series of interactive CME dinner discussions

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Supporter

This activity is supported by an educational grant from

Program Overview

This CME activity will provide physicians with the most up-to-date, evidence-based data in the area of rheumatic diseases. Given the wide array of emerging therapies on the rise, and the ever-changing rheumatology landscape, this activity intends to help physicians implement optimal management strategies that maximize patient outcomes.

Intended Audience

This educational activity is designed for rheumatologists.

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 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 diagnosis and the role of aggressive treatment for rheumatoid arthritis and other rheumatic diseases in order to improve overall patient outcomes

  • Nishimura K, Sugiyama D, Kogata Y, et al. Meta-analysis: Diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med. 2007;146:797. [Evidence Level A]
  • Finckh A, Liang MH. Anti-cyclic citrullinated peptide antibodies in the diagnosis of rheumatoid arthritis: bayes clears the haze. Ann Intern Med. 2007;146:816. [Evidence Level B]

Cite the data around emerging therapies for rheumatic diseases and recognize patients in your practice for whom these newer therapies may be appropriate

  • Gomez-Reino JJ, Fairfax MJ, Pavelka K, et al. Targeted inhibition of IL-6 signaling with tocilizumab improves quality of life and function in patients with rheumatoid arthritis with inadequate response to a range of DMARDS. American College of Rheumatology Meeting; November 6-11, 2007; Boston, Mass. Presentation L6. [Evidence Level A]
  • van der Heijde D, Cohen SB, Sharp JT, et al. OP0120 The RANKL inhibitor denosumab reduces progression of the total sharp score and bone erosions in patients with rheumatoid arthritis: X-ray results at 12 months. Presented at: EULAR 2007 Meeting; June 13-16, 2007; Barcelona, Spain. Abstract OP0120. [Evidence Level A]
  • Cohen SB, Valen PA, Ritchlin C, et al. Inhibiting RANKL with denosumab reduces progression of bone erosions in patients with rheumatoid arthritis: 6- month MRI results from a randomized, placebo-controlled study. Presented at: EULAR 2007 Meeting; June 13-16, 2007; Barcelona, Spain. Abstract OP0226. [Evidence Level A]

Identify patients in your practice who may not be achieving adequate response with their current therapy and implement new management and treatment strategies in order to attain optimal therapeutic response

  • Keystone E, Emery P, Peterfy CG, et al. Inhibition of radiographic progression with rituximab is not dependent on clinical efficacy: results from a study in rheumatoid arthritis patients with an inadequate response to one or more TNF inhibitors (REFLEX). Ann Rheum Dis. 2007;66:431. [Evidence Level A]
  • Genovese MC, Becker J-C, Schiff M, et al. Abatacept for rheumatoid arthritis refractory to tumor necrosis factor ? inhibition. N Engl J Med. 2005;353:1114-1123. [Evidence Level A]
  • Kremer JT, Genant HK, Moreland LW, et al. Effects of abatacept in patients with methotrexate-resistance active rheumatoid arthritis. A randomized trial. Ann Intern Med. 2006;144:865-876. [Evidence Level A]

Appreciate various perspectives regarding the management of rheumatic diseases in order to improve patient improve treatment response, comorbid conditions and overall quality of life

  • Heller JE, Shadick NA. Outcomes in rheumatoid arthritis: incorporating the patient perspective. Current Opin Rheumatol. 2007;19(2):101-105. [Evidence Level B]
  • Bingham CO III, Miner MM. Treatment, management, and monitoring of established rheumatoid arthritis. J Fam Pract. 2007;56 (10 suppl ):S1-7. [Evidence Level C]
  • Wislowska M, Jaszczyk B, et al. Diastolic heart function in RA patients. Rheumatol Int. 2007. [Epub ahead of print]. [Evidence Level B]
  • Smith BW, Zautra AJ. The effects of anxiety and depression on weekly pain in women with arthritis. Pain. 2008. [Epub ahead of print] [Evidence Level B]

Discuss the role of clinician-patient communication in the management of rheumatic diseases to better optimize treatment and increase patient satisfaction

  • Sleath B, Chewning B, et al. Communication about depression during rheumatoid arthritis patient visits. Arthritis Rheum. 2008;59(2):186-191. [Evidence Level B]
  • Ishikawa H, 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]

Needs Assessment

Through needs assessment surveys, literature searches, advisory board suggestions, and previous meeting evaluations, The Foundation for Better Health Care 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 diagnosis, first-line therapy, emerging therapies, and benefit and risk issues associated with biologic therapies are highlighted. In addition, the burden of the disease and its physical, psychological, and social impact will be discussed.

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 Credits TM. 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 CME 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.

Meeting Registration

To register for this meeting, please click below:

1. CME Information

2. Learning Objectives

3. Faculty

4. Schedule

5. Meeting Registration

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© 2008 The Foundation for Better Health Care