Supplement
Issue:
Improving Clinical and Managed Care Outcomes in Rheumatoid Arthritis: New Guidelines, Therapies, and Challenges [CPE]
Volume:
20
Number:
7 Suppl
Release date: May 21, 2014 |  Expiration date: May 21, 2016
Estimated time to complete activity: 2.5 hours
Type of Activity: Knowledge | Activity fee: Free of charge
Medium: Print with Internet-based posttest, evaluation, and request for credit.

This activity is supported by educational grants from Antares Pharma, Inc.

Intended Audience
Managed care professionals, pharmacists, and specialty pharmacists.

Statement of Educational Need
Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis, affecting approximately 1% of the worldwide population. RA is characterized by polyarticular synovial inflammation of the small joints of the hands and feet and production of autoimmune antigens that initially result in joint swelling, stiffness, and tenderness. In the absence of effective treatment, RA eventually results in destruction of both the cartilaginous and bony elements of the joint, with resultant disability. RA also results in ongoing systemic inflammation that is associated with comorbidities, particularly increased cardiovascular disease, which contributes to morbidity and mortality. In addition to the pain, disability, and work limitation resulting from joint damage, the burden of RA includes psychosocial deficits, fatigue, cognitive impairment, and reduction in health-related quality of life.

Over the past 20 years, the management of RA has been transformed from mere alleviation of symptoms with analgesics and corticosteroids to disease control with the introduction of effective biologic disease-modifying antirheumatic drugs (DMARDs) and new treatment paradigms such as early, treat-to-target management. In particular, the early use of traditional DMARDs (eg, methotrexate) in combination with biologic DMARDs directed against tumor necrosis factor and other mediators of inflammation, have helped to reduce disease progression to joint damage and to make disease remission a reasonable goal of RA management. Treatment recommendations that define therapeutic options based on patient characteristics and duration of disease have been promulgated recently by the American College of Rheumatology. Similarly, a recent report by the Agency for Healthcare Quality and Research summarized evidence on the comparative safety and efficacy of the drugs used to treat RA. Rheumatologists must be aware of emerging research such as this, which can affect both the choice and the timing of agents to be used in a particular patient with RA.

Educational Objectives
Upon completion of the educational activity, the participant should be able to:
  • Assess the epidemiology, burden, and pathophysiology of disease related to RA and the importance of early intervention to delay disease progression
  • Distinguish and compare standard, new, and emerging agents for the treatment of RA, including biologic therapies, and on new uses, administration rates, or formulations of previously approved agents
  • Delineate the optimal role of the managed care provider and use of disease therapy management programs in optimizing patient care
Disclosure Policy
According to the disclosure policies of Pharmacy Times Office of Continuing Professional Education and The American Journal of Managed Care, all persons who are in a position to control content are required to disclose any relevant financial relationships with commercial interests. If a conflict is identified, it is the responsibility of the Pharmacy Times Office of Continuing Professional Education to initiate a mechanism to resolve the conflict(s). The existence of these relationships is not viewed as implying bias or decreasing the value of the activity. All educational materials are reviewed for fair balance, scientific objectivity of studies reported, and levels of evidence.

Accreditation and Credit Designation
Pharmacy Times Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 2.5 contact hours (.25 CEUs) under the ACPE universal activity number 0290-0000-14-047- H01-P. The activity is available for CE credit through May 21, 2016.

Obtaining Credit:
Participants must read each article in this supplement and proceed to www.ajmc.com/ce or www. PharmacyTimes.org to complete the online posttest, achieving a passing score of 70% or higher, complete an online evaluation, and then request their statement of credit.

Faculty

Allan Gibofsky, MD, JD, FACP, FCLM
Professor of Medicine and Public Health
Weill Medical College of Cornell University
New York, New York
Attending Rheumatologist
Hospital for Special Surgery
New York, New York

Gary M. Owens, MD
President
Gary Owens Associates
Ocean View, Delaware

Contributing Editorial Support

Joseph Melton, PhD
Medical Writer
Melton Medical Communication
Kendall Park, New Jersey

Elizabeth Paczolt, MD, FACNM
Medical Consultant
Churchville, Pennsylvania

Faculty Disclosures 
These faculty have disclosed the following relevant commercial financial relationships or affiliations in the past 12 months.

Allan Gibofsky, MD, JD, FACP, FCLM
Consultant or paid advisory board: AbbVie, Amgen, Antares Pharma, Inc, Celgene, Iroko, and Pfizer
Speaker’s bureau: AbbVie, Amgen, Antares Pharma, Inc, Celgene, Pfizer, and UCB
Stock/shareholder: AbbVie, Amgen, Bristol-Myers Squibb, GlaxoSmithKline, Johnson & Johnson, Pfizer, and Regeneron

Gary M. Owens, MD
Consultant: AbbVie, Crescendo Bioscience, and Johnson & Johnson

Joseph Melton, PhD
Stock/shareholder: Johnson & Johnson

Elizabeth Paczolt, MD, FACNM,  has no relevant financial relationships with commercial interests to disclose.

The American Journal of Managed Care
Publishing Staff—Jeff D. Prescott, PharmD, RPh; Ida Delmendo; and Tara Petersen have disclosed no relevant financial relationships with commercial interests.
Pharmacy Times Office of Continuing Professional Education 
Physicians’ Education Resource®, LLC

Planning staff—David Heckard; Mary Jo Dixon, RPh;  Donna Fausak; and  Nathalie Harden have no relevant financial relationships with commercial interests to disclose.

Off-label Disclosure and Disclaimer
The contents of this CME/CE supplement may include information regarding the use of products that may be inconsistent with or outside the approved labeling for these products in the United States. Physicians and pharmacists should note that the use of these products  outside current approved labeling is considered experimental and are advised to consult prescribing information
for these products.

For additional information about approved uses, including approved indications, contraindications, and warnings, participants are advised to consult prescribing information for all products discussed. The information provided in this CME/CE activity is for continuing medical and pharmacy education purposes only and is not meant to substitute for the independent medical or pharmacy judgment of a physician or pharmacist relative to diagnostic, treatment, or management options for a specific patient’s medical condition. 

The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of The American Journal of Managed Care, Physicians’ Education Resource® , LLC, the Pharmacy Times Office of Continuing Professional Education, or any of the companies that provided commercial support for this CME/CE activity.

Signed disclosures are on file at the office of The American Journal of Managed Care, Plainsboro, New Jersey.

Opinions expressed by authors, contributors, and advertisers are their own and not necessarily those of Clinical Care Targeted Communications, LLC, d/b/a Managed Care & Healthcare Communications, LLC, the editorial staff, or any member of the editorial advisory board. Clinical Care Targeted Communications, LLC, d/b/a Managed Care & Healthcare Communications, LLC, is not responsible for accuracy of dosages given in articles printed herein. The appearance of advertisements in this publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality, or safety. Clinical Care Targeted Communications, LLC, d/b/a Managed Care & Healthcare Communications, LLC, disclaims responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements.

Publisher’s Note: The opinions expressed in this supplement are those of the authors, presenters, and/or panelists and are not attributable to the sponsor or the publisher, editor, or editorial board of The American Journal of Managed Care. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this supplement are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

System Requirements
PC-based participants
Windows 7, Vista, XP, 2003 Server, or 2000

Macintosh®-based participants
Required: Mac OS X 10.4.11 (Tiger) or newer

© 2013 Managed Care & Healthcare Communications, LLC
ARTICLES
Allan Gibofsky, MD, JD, FACP, FCLM
Allan Gibofsky, MD, JD, FACP, FCLM
Gary M. Owens, MD
AUTHOR INDEX
CE/CME QUIZ