Ask the Expert: Addressing questions on the management of patients with rheumatoid arthritis

Managing patients with rheumatoid arthritis (RA) can be a challenge for primary care physicians (PCPs). Establishing a diagnosis and managing referrals to a rheumatologist is important; however, many PCPs may not be familiar with the processes and strategies for making a diagnosis. Additionally, PCPs must also manage RA patients who have such complicating issues as infections, fever, cardiovascular disease, and pregnancy. In this question-and-answer–based activity, rheumatology experts provide answers to some of the challenging questions faced by PCPs who treat patients with RA.

Release date: September 13, 2011
Expiration date: September 13, 2012
Estimated time to complete activity: 45 minutes

Co-sponsored by Curatio CME Institute and Jefferson Medical College of Thomas Jefferson University

Acknowledgements
Support for this activity has been provided through educational grants from Abbott Laboratories, Janssen Services, LLC, and Pfizer Inc.

Hardware/Software Requirements

Javascript-enabled browser
Active Internet connection

Target Audience
This activity has been designed to meet the educational needs of PCPs who are involved in the care of patients who have or are suspected to have RA.

Learning Objectives
Upon completion of this activity, participants should be able to:

Identify patients who have probable early RA and should be referred to a rheumatologist
Order appropriate laboratory tests when RA is suspected
Incorporate simple screening techniques for RA into daily practice
Order proper vaccinations for patients starting disease-modifying antirheumatic drug (DMARD) therapy
Appropriately manage infections in patients taking DMARD therapy
Assess and aggressively reduce cardiovascular disease risk in RA patients

Activity Faculty

Michael E. Weinblatt, MD
John R. and Eileen K. Riedman Professor of Medicine
Harvard Medical School
Co-Director, Clinical Rheumatology
Division of Rheumatology, Immunology, and Allergy
Brigham and Women’s Hospital
Boston, Massachusetts

Clifton O. Bingham III, MD
Associate Professor of Medicine
Divisions of Rheumatology and Allergy and Clinical Rheumatology
Director, Johns Hopkins Arthritis Center
Director, Rheumatology Clinics
Johns Hopkins University
Baltimore, Maryland

Karen H. Costenbader, MD, MPH
Associate Physician
Division of Rheumatology, Immunology and Allergy
Brigham and Women’s Hospital
Assistant Professor of Medicine
Harvard Medical School
Boston, Massachusetts

Faculty Steering Committee
Michael E. Weinblatt, MD–Co-Chair

Lauren G. Collins, MD–Co-Chair
Assistant Professor of Family and Community Medicine
Jefferson Medical College of Thomas Jefferson University
Philadelphia, Pennsylvania

Clifton O. Bingham III, MD

Joyce P. Carlone, MN, RN, FNP-BC, CCRC
Nurse Practitioner
Division of Rheumatology
Emory University
Atlanta, Georgia

Mary Suzanne Schrandt, JD (Patient/Patient Educator)
Senior Analyst
Kansas Health Institute
Topeka, Kansas

Jeanne G. Cole, EdD, FACME
Director, Office of CME
Jefferson Medical College of Thomas Jefferson University
Philadelphia, Pennsylvania

Karen H. Costenbader, MD, MPH

Paul P. Doghramji, MD, FAAFP
Medical Director for Health Services at Ursinus College
Family Physician, Collegeville Family Practice
Collegeville, Pennsylvania

Daniel Duch, PhD
Medical Director
Curatio CME Institute
Exton, Pennsylvania

David S. Kountz, MD, MBA, FACP
Senior Vice President
Medical and Academic Affairs
Jersey Shore University Medical Center
Professor of Medicine
Robert Wood Johnson Medical School
New Brunswick, New Jersey

Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME). Jefferson Medical College of Thomas Jefferson University is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
Jefferson Medical College of Thomas Jefferson University designates this enduring material for a maximum of .75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Participation
There are no fees for participating in this CME activity. To receive credit during the period September 13, 2011 to September 13, 2012, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, and (3) complete the presurvey, posttest, and the activity evaluation form online. To obtain a certificate, participants must receive a score of 70% or better on the posttest. The posttest can be accessed at the end of the activity.

Medium
The Internet was selected as the instructional format to accommodate the learning preferences of a significant portion of the target audience.

Retrieving Your Certificate
Participation records for CME will be uploaded to the Jefferson Electronic Transcripts and Certificates (JeffETC) site (http://jeffline.jefferson.edu/jeffcme/JeffETC/ ) on a bi-weekly basis. CME certificates are only available at this online site and will not be mailed.

Jefferson Electronic Transcripts and Certificates (JeffETC) is a service of the Office of CME that allows participants to conveniently retrieve their CME credit transcripts as needed. To use this service, be sure to include the last four digits of your SSN (or any 4 digits that you will remember). This will enable to you retrieve your certificate online. Simply go to the above link and enter your last name as well as the last four digits of your social security number (or the four digit number previously identified). Here you will find a listing of all Jefferson-sponsored CME activities that you have participated in, and you will be able to print a transcript or individual certificate. Please allow the appropriate time for posting of your credits.

To contact Jefferson Medical College of Thomas Jefferson University, the accredited provider for this activity, please e-mail jeffersoncme@jefferson.edu or call us at 888 JEFF CME.

Disclosure
Jefferson Medical College of Thomas Jefferson University endorses the Standards of the ACCME and the Guidelines for Commercial Support. Every effort has been made to encourage faculty to disclose any commercial relationships or personal benefit with commercial companies whose products may be discussed in this educational tool. Disclosure of a relationship is not intended to suggest or condone bias in any presentations, but is made to provide participants with information that might be of potential importance to their evaluation of this CME activity.

Faculty/Faculty Steering Committee

Clifton O. Bingham III, MD, has disclosed the following financial interests and/or affiliations:

Grant/Research Support	BMS, Genentech, Roche, UCB
Consultant	Celgene, Centocor Ortho Biotech, Flexion, Genentech, Merck, Roche, UCB

Joyce P. Carlone, MN, RN, FNP-BC, CCRC, has disclosed the following financial interests and/or affiliations:

Consultant, Product/Speakers Bureau, Other

UCB

Mary Suzanne Schrandt, JD, has declared no financial interests and/or affiliations.

Lauren G. Collins, MD, has declared no financial interests and/or affiliations.

Karen H. Costenbader, MD, MPH, has declared no financial interests and/or affiliations.

Paul P. Doghramji, MD, FAAFP, has declared no financial interests and/or affiliations.

David S. Kountz, MD, MBA, FACP, has disclosed the following financial interests and/or affiliations:

Consultant	Chelsea Pharmaceuticals
Visiting Speaker	Takeda Pharmaceuticals

Michael E. Weinblatt, MD, has disclosed the following financial interests and/or affiliations:

Grant/Research Support	Abbott
Consultant	Abbott, Centocor Ortho Biotech, Pfizer/Wyeth

Jefferson Medical College of Thomas Jefferson University
Jeanne G. Cole, EdD, FACME, Director, Office of CME, has disclosed no relevant financial relationships.

Curatio CME Institute
Shari Dermer, PhD Director, Scientific Services, has disclosed no relevant financial relationships.
Daniel Duch, PhD, Medical Director, has disclosed no relevant financial relationships.
Jonathan S. Simmons, ELS, Senior Managing Editor, has disclosed no relevant financial relationships.

Disclaimer
The information presented in this activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician regarding diagnosis and treatment of a specific patient's medical condition.

Unapproved Product Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Thomas Jefferson University, Curatio CME Institute, Abbott Laboratories, Janssen Services LLC, and Pfizer Inc. do not recommend the use of any agent outside the labeled indications.

The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Curatio CME Institute, Thomas Jefferson University, Abbott Laboratories, Janssen Services LLC, or Pfizer Inc. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

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