Immunotherapy in Rheumatic Diseases-Science and Clinical Practice: A CME Conference

Thursday, February 26, 2009 – Saturday, February 28, 2009

The Lodge at Sonoma Renaissance Resort & Spa
1325 Broadway at Leveroni & Napa Roads
Sonoma, CA 95476
Phone: 707-935-6600

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CME INFORMATION

This activity is sponsored by The Foundation for Better Health Care

This activity is supported by educational grants from



Overview

This CME conference will allow dissemination of successful clinical practices in rheumatology across two continents and enhance the care of patients in both Europe and the United States. This activity will be measured through commitment to change and Look-Back studies.

Intended Audience

This educational activity is designed for rheumatologists who manage patients with RA and other rheumatic diseases.

Content Validation

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

The learning objectives for this activity have been designed to address clinician competency, performance, and patient outcomes. Upon completion of this activity, participants should be able to:

Utilize effective, efficient immunomodulatory therapies for rheumatoid arthritis (RA) along with monitoring the safety of their RA patients (performance) in order to improve overall outcomes (patient outcomes)

  • Scott, DL, Symmons, DPM, Coulton, DL, Popert, AJ. Long-term outcome of treating rheumatoid arthritis: Results after 20 years. Lancet 1987;1:1108. [Evidence Level B]
  • Pisetsky, DS, St Clair, EW. Progress in the Treatment of Rheumatoid Arthritis. JAMA 2001; 286:2787. [Evidence Level C]
  • American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum. 2002;46:328-346. [Evidence Level C]

Recognize the importance of educating patients on the toxicities of immunomodulatory therapies, including infection, malignancy and organ specific damage (competence) so that patients are able to maintain control of their health (patient outcomes)

  • Hammond-Thelin LA. Cutaneous reactions related to systemic immunomodulators and targeted therapeutics. Dermatol Clin.2008;26(1):121-159. [Evidence Level C]
  • Doran F, Crowson CS, Pond GR, et al. Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum. 2002;46:2287–2293. [Evidence Level B]
  • Moreland L, Cohen SB, Baumgartner SW, et al. Long-term safety and efficacy of etanercept in patients with rheumatoid arthritis. J Rheum. 2001;28:1238–1244. [Evidence Level B]

Effectively diagnose crystalline arthropathy and employ therapy for patients with the disease (performance) to enhance healthcare outcomes (patient outcomes)

  • McCarty, DJ. Synovial fluid. In: Arthritis and Allied Conditions, 14th ed, Koopman, WJ, (Ed). Philadelphia, PA: Lippincott Williams and Wilkins; 2001:83. [Evidence Level C]
  • Choi, HK, Atkinson, K, Karlson, EW, et al. Alcohol intake and risk of incident gout in men: a prospective study. Lancet. 2004;363:1277. [Evidence Level B]

Discuss the role of emerging therapies for rheumatoid arthritis (competence) and identify patients in your practice for whom these therapies may be appropriate (competence/performance)

  • 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]

Review the evidence for using specific imaging techniques in the management of rheumatoid arthritis (competence) and recognize practical issues in providing these services to patients in order to maximize the benefits of treatment (competence/performance)

  • van der Heijde, DM, van Leeuwen, MA, van Riel, PL, et al. Biannual radiographic assessments of hands and feet in a three-year prospective followup of patients with early rheumatoid arthritis. Arthritis Rheum. 1992; 35:26. [Evidence Level B]
  • Fuchs, HA, Kaye, JJ, Callahan, LF, et al. Evidence of significant radiographic damage in rheumatoid arthritis within the first 2 years of disease. J Rheumatol. 1989;16:585. [Evidence Level B]
  • Poleksic, L, Zdravkovic, D, Jablanovic, D, et al. Magnetic resonance imaging of bone destruction in rheumatoid arthritis: Comparison with radiography. Skeletal Radiol. 1993;22:577. [Evidence Level B]

Cite the importance of using cost effective strategies in the diagnosis and management of the vasculidities (competence) so that patient outcomes are improved (patient outcomes)

  • Sais, G, Vidaller, A, Jucgla, A, et al. Colchicine in the treatment of cutaneous leukocytoclastic vasculitis. Results of a prospective, randomized controlled trial. Arch Dermatol. 1995;131:1399. [Evidence Level A]
  • Nurnberg, W, Grabbe, J, Czarnetzki, BM. Urticarial vasculitis syndrome effectively treated with dapsone and pentoxifylline. Acta Derm Venereol. 1995;75:54. [Evidence Level B]

Needs Assessment

The FBHC has incorporated into this CME activity the relevant educational needs concerning knowledge, competence, or performance that underlie the professional practice gaps of our participants.

Accreditation

The FBHC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The FBHC takes responsibility for the content, quality, and scientific integrity of this CME activity.

Credit Designation

The FBHC designates this educational activity for a maximum of 13.5 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Identifying and Resolving Conflicts of Interest

The FBHC requires all planning committee members, faculty, teachers, authors, and staff of a CME activity to identify all relevant financial relationships that benefit the individual and his or her spouse or partner in any financial amount within the past 12 months. Such relationships may affect the content of CME regarding the products or services of the commercial interest.

The FBHC has created the FBHC Committee to Identify and Resolve Conflicts of Interest, which reviews Faculty and Staff Disclosure Statements, identifies and resolves conflicts of interest, and determines the level of participation of planning committee members, faculty members, teachers, and authors.

FBHC Faculty and Staff Disclosure Policy Statement

The FBHC will disclose to participants the existence of any relevant financial relationships between faculty members, FBHC staff members, and the staffs of Joint Sponsor and/or Educational Partner (when applicable), who planned, authored, contributed, and/or reviewed the content of this activity, and any commercial interest discussed in this educational activity. Disclosure will occur prior to the presentation(s), either through oral communication to the audience by the moderator or chair, or written communication in the syllabus or handout material.

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

Planning Committee
Stanford M. Shoor, MD – Chair
Gerald D. Levy, MD, MBA
Frederic Liote, MD
Marco Cimmino, MD
David J. Zelman, MD

Rheumatoid Arthritis
Thomas M. Burns, MD
Matthew H. Liang, MD, MPH
Gurkirpal Singh, MD
Michael M Ward, MD, PhD

Rheumatoid Arthritis Imaging
Chee C. Chow, MD
Marco Cimmino, MD
Gerald D. Levy, MD, MBA
Wolfgang A. Schmidt, MD

Crystalline Disease
Frederic Liote, MD
Fernando Perez-Ruiz, MD, PhD
John F. Scavulli, MD
Robert Terkeltaub, MD
David J. Zelman, MD

Vasculitis
Daniel Aletaha, MD, MSc
Thomas Bush, MD
Kenneth J. Warrington, MD
Steven R. Ytterberg, MD

Contact Us

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