The International Society of Extremity MRI in Rheumatology (ISEMIR): A CME Conference

Friday, March 27, 2009
7:00 AM – 5:00 PM

Hilton Miami Downtown
1601 Biscayne Boulevard
Miami, FL 33132
Phone: 305-374-0000


Click here to view the agenda for this CME program
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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

The overall goal of this meeting is to discuss the role of e-MRI in rheumatoid arthritis (RA). Data exist demonstrating that early diagnosis and aggressive treatment of RA improves patient outcomes. E-MRI may allow for an earlier diagnosis than that of traditional radiography.

Intended Audience

This educational activity is designed for rheumatologists and radiologists who manage patients with RA.

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:

Discuss the evolution of magnetic resonance imaging as a clinical tool to diagnose and monitor disease progression in patients with rheumatoid arthritis (RA) (competence) and assess the most effective application of this imaging tool to maximize the benefits of treatment for RA patients (performance/patient outcomes)

  • Jevtic V, Watt I, Rozman B, Kos-Golja M, Demsar F, Jarh O. Distinctive radiological features of small hand joints in RA and seronegative spondyloarthritis by contrast-enhanced (Gd-DTPA) magnetic resonance imaging. Skeletal Radiol.1995;24:351–355. [Evidence Level C]
  • McGonagle D, Gibbon W, O'Connor P, Green M, Pease C, Emery P. Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy. Arthritis Rheum.1998;41:694–700. [Evidence Level C]
  • Klarlund M, Østergaard M, Jensen KE, Madsen JL, Skjødt H, and the TIRA group. Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis. Ann Rheum Dis. 2000;59:521–528. [Evidence Level B]
  • Sugimoto H, Takeda A, Hyodoh K. Early stage RA: prospective study of the effectiveness of MR imaging for diagnosis. Radiology. 2000;216:569–575. [Evidence Level B]
  • Savnik A, Malmskov H, Thomsen HS, et al. MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T). Eur Radiol. 2001;11:1030–1038. [Evidence Level C]
  • ACR Extremity MRI Task Force. Extremity magnetic imaging in RA: report of the American College of Rheumatology Extremity Magnetic Resonance Imaging. Arthritis Rheum. 2006;54:1034–1047. [Evidence Level C]

Recognize the importance of early diagnosis and aggressive treatment of RA and evaluate the role of magnetic resonance imaging (competence) in evaluating radiographic progression and improving patient outcomes (performance/patient outcomes)

  • Van der Horst-Bruinsma IE, Speyer I, Visser H, Breedveld FC, Hazes JM. Diagnosis and course of early-onset arthritis: results of a special early arthritis clinic compared with routine patient care. Br J Rheumatol. 1998;37:1084–1088. [Evidence Level B]
  • American College of Rheumatology. Available at: http://www.rheumatology.org/publications/classification/index.asp?aud=mem. [Evidence Level C]
  • Schiff MH, Hobbs KF, Gensler T, Keenan GF. A retrospective analysis of low-field strength magnetic resonance imaging and the management of patients with rheumatoid arthritis. Curr Med Res Opin. 2007;23:961–968. [Evidence Level B]
  • American College of Rheumatology Subcommittee on RA Guidelines. Guidelines for the management of RA – 2002 update. Arthritis Rheum. 2002;46:328–346. [Evidence Level C]

Cite the limitations of traditional radiography (competence) and discuss the advantages of magnetic resonance imaging in detecting changes in RA erosions early in the course of disease (performance)

  • Gaylis NB, Needell SD, Rudensky D. Comparison of in-office magnetic resonance imaging versus conventional radiography in detecting changes in erosions after one year of infliximab therapy in patients with rheumatoid arthritis. Mod Rheumatol. 2007;17:273–278. [Evidence Level B]
  • Duer-Jensen A, Vestergaard A, Døhn UM, et al. Detection of rheumatoid arthritis bone erosions by 2 different dedicated extremity MRI units and conventional radiography. Ann Rheum Dis. 2008;67:998-1003. [Evidence Level B]
  • Lindegaard HM, Vallø J, Hørslev-Petersen K, Junker P, Østergaard M. 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 B]

Explain the importance of interdisciplinary cooperation between radiologists and rheumatologists in the utilization of eMRI in clinical practice (competence) in order to secure optimum outcomes for patients (performance/patient outcomes)

  • Peloschek P, Langs G, Valentinitsch A, et al. Quantitative imaging in rheumatoid arthritis: from scoring to measurement. Radiologe. 2006;46(5)411-416. [Evidence Level C]
  • Sommer OJ, Kladosek A, Wieiler V. Rheumatoid arthritis: a practical guide to state-of-the-art imaging, image interpretation, and clinical implications. Radiographics. 2005;25(2):381-398. [Evidence Level C]
  • Haraoui B. Is MRI the best method to detect response to treatment in patients with ankylosing spondylitis? Nat Clin Pract Rheumatol. 2006;2:474-475. [Evidence Level C]

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 7.0 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

Philip Conaghan, MD, PhD, FRACP, FRCP
Professor of Musculoskeletal Medicine
University of Leeds
United Kingdom

John Crues, MD
Medical Director
RADNET, Inc
Visiting Professor
University of California San Diego
Los Angeles, CA

Paul Emery, MA, MD, FRCP
Professor of Rheumatology
Head of Academic Unit of Musculoskeletal Disease
University of Leeds
United Kingdom

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

John Heagney
Director of Operations
International Society of Extremity MRI in Rheumatology (ISEMIR)
West Hartford, CT

Steven Needell, MD
Director, Musculoskeletal Imaging
Boca Radiology Group, PA
Boca Raton, FL

Ewa Olech, MD
Clinical Assistant Professor of Medicine
Oklahoma University Health Sciences Center
Clinical Assistant Member
Oklahoma Medical Research Foundation
Oklahoma City, OK

Mikkel Ostergaard, MD
Department of Rheumatology
Copenhagen University Hospitals at Hvidovre and Herley
Denmark

Charles Peterfy, MD, PhD
Chief Medical Officer
Executive Vice President
SYNARC, Inc
San Francisco, CA

John Tesser, MD
Arizona Arthritis & Rheumatology Associates
Paradise Valley, AZ

Orrin Troum, MD
Clinical Professor of Medicine
Keck School of Medicine
University of Southern California
Santa Monica, CA

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