Participating Faculty: Improving Clinical and Managed Care Outcomes in Rheumatoid Arthritis: New Guidelines, Therapies, and Challenges [CPE]

Published Online: May 31, 2014
This supplement to The American Journal of Managed Care is intended to provide an understanding of the pathophysiology, symptoms, and management of rheumatoid arthritis (RA). Included is the most recent classification criteria used in diagnosis and in clinical guideline recommendations. This supplement also provides an overview of the current therapeutic options in RA, with a focus on the role of disease-modifying antirheumatic drugs. The economic impact and managed care implications associated with managing RA and its common comorbities is also discussed.
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 or www. to complete the online posttest, achieving a passing score of 70% or higher, complete an online evaluation, and then request their statement of credit.


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


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

PDF is available on the last page.