Current reviews in rheumatology 2011: Bulletin of the NYU Hospital for Joint Diseases.
Subject: Systemic lupus erythematosus
Pub Date: 07/01/2011
Publication: Name: Bulletin of the NYU Hospital for Joint Diseases Publisher: J. Michael Ryan Publishing Co. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 J. Michael Ryan Publishing Co. ISSN: 1936-9719
Issue: Date: July, 2011 Source Volume: 69 Source Issue: 3
Accession Number: 289120447
Full Text: Target Audience

The target audience for this CME activity is rheumatologists, fellows in rheumatology training, general practitioners interested in rheumatology, as well as ob-gyn specialists, endocrinologists, orthopedic surgeons, physical medicine specialists and radiologists.

Statement of Need

New data has become available related to long-term safety of biologic agents in the treatment of RA. New biologic agents that have become available in 2010 and early 2011 also show possibly unique safety profile, which practitioners need to be aware of in order to effectively create RA treatment plans.

In addition, new RA diagnostic and remission criteria have been proposed over the last year. Practitioners need to be educated about all these new advances in diagnosing and treating patients, which may allow them to identify patients who would benefit from disease-modifying drugs and biologic agents earlier in the disease process.

In 2009 Medicare PQRI (Physician Quality Reporting Initiative) has added new measures for physicians to report. These measures regarding osteoporosis and osteoarthritis are listed below:

Osteoporosis

Communication with the Physician Managing On-going Care Post-Fracture. Percentage of patients aged 50 years and older treated for a hip, spine, or distal radial fracture with documentation of communication with the physician managing the patient's on-going care that a fracture occurred and that the patient was or should be tested or treated for osteoporosis.

Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older. Percentage of female patients aged 65 years and older who have a central dual-energy X-ray ab sorptiometry (DXA) measurement ordered or performed at least once since age 60 or pharmacologic therapy prescribed within 12 months.

Management Following Fracture. Percentage of patients aged 50 years and older with fracture of the hip, spine, or distal radius who had a central dual-energy X-ray absorptiometry (DXA) measurement ordered or performed or pharmacologic therapy prescribed.

Pharmacologic Therapy. Percentage of patients aged 50 years and older with a diagnosis of osteoporosis who were prescribed pharmacologic therapy within 12 months.

Osteoarthritis (OA)

Function and Pain Assessment. Percentage of patient visits for patients aged 21 years and older with a diagnosis of OA with assessment for function and pain.

Assessment for Use of Anti-Inflammatory or Analgesic Over-the-Counter (OTC) Medications. Percentage of patient visits for patients aged 21 years and older with a diagnosis of OA with an assessment for use of anti-inflammatory or analgesic OTC medications.

Implementation of these measures in clinical practice aims to improve patient care and also documentation of this care. In 2009, Medicare PQRI (Physician Quality Reporting Initiative) has added new measures for physicians to report. These measures regarding RA recommend: measuring function, pain and a disease activity measure, in addition to determining the prognosis of a patient based on these measures. These are recommended to be included in routine care. New diagnostic criteria for Ankylosing spondylitis (AS) have been released by the European League against Rheumatism, and additionally they released new tools to monitor AS disease activity. Few physicians know in detail the new diagnostic criteria, which greatly changes patient classification. Clinicians need to be aware of the criteria and how it will effect their classification of patients and thus treatments of AS. New treatments being developed for systemic lupus erythematosus (SLE) have also been published with different safety profiles. Additionally, new data is now available on older drugs, including long-term safety information. Data about new treatment options for systemic vasculitis have been published and safer options may be available at this time to treat ANCA associated vasculitis.

Educational Objectives

* describe new data on long-term safety and efficacy of current biologic agents as well as new biologics available for treatment of RA

* create strategies to apply the new RA diagnostic and remission criteria in practice

* apply the PQRI measures and FRAX guidelines to streamline treatment of osteoporosis while incorporating new available agents

* assess the role of imaging in the management of osteoarthritis and development of disease-modifying drugs for osteoarthritis

* apply the PQRI measures to streamline treatment of rheumatoid arthritis while incorporating new available agents

* describe and apply the new diagnostic criteria for Ankylosing spondylitis (AS) and utilize new tools to monitor disease activity when making treatment decisions

* incorporate new published data on treatments for systemic lupus erythematosus (SLE) into treatment decision trees

* review new efficacy and safety data of rituximab in the treatment of vasculitis

Accreditation Statement

The NYU Post-Graduate Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement

The NYU Post-Graduate Medical School designates this enduring material for a maximum of 6.5 AMA PRA Category 1 Credits[TM]. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Participation

To receive up to 6.5 CME credits, read this supplement, which should take 6.5 hours of your time, complete the evaluation and post-test and submit to the NYU Post-Graduate Medical School (instructions enclosed). A minimum passing grade of 70% is required.

This activity is valid for credit from October 1, 2011 through December 31, 2011.

Faculty Credentials

Maxime Dougados, MD

Professor of Rheumatology

Rene Descartes University

Paris, France

Stephen Honig, MD

Associate Professor of Medicine

NYU School of Medicine

New York, NY

Philip J. Kahn, MD

Assistant Professor of Pediatrics

NYU School of Medicine

New York, NY

Philip J. Mease, MD

Clinical Professor of Medicine

University of Washington School of Medicine

Seattle, WA

Joan T. Merrrill, MD

Adjunct Assistant Professor of Medicine

NYU School of Medicine

New York, NY

Michael H. Pillinger, MD

Associate Professor of Medicine

and Pharmacology

NYU School of Medicine

New York, NY

Theodore Pincus, MD

Clinical Professor of Medicine

NYU School of Medicine

New York, NY

Eric Ruderman, MD

Associate Professor of Medicine

Northwestern University, Feinberg School of Medicine

Chicago, IL

Jonathan Samuels, MD

Assistant Professor of Medicine

NYU School of Medicine

New York, NY

Ismail Simsek, MD

Associate Professor

Division of Rheumatology

Gulhane School of Medicine

Ankara, Turkey

Gary Solomon, MD

Clinical Associate Professor of Medicine

NYU School of Medicine

New York, NY

Yusuf Yazici, MD

Assistant Professor of Medicine

NYU School of Medicine

New York, NY

Disclosure Statement

The NYU Post-Graduate Medical School adheres to ACCME Essential Areas and policies, including the Standards for Commercial Support, regarding industry support of continuing medical education. In order to resolve any identified conflicts of interest, disclosure information is provided during the planning process to ensure resolution of any identified conflicts. Disclosure of faculty and commercial relationships as well as the discussion of unlabeled or unapproved use of any drug, device or procedure by the faculty is listed below.

Maxime Dougados, MD--reports no relevant financial relationships.

Stephen Honig, MD--reports no relevant financial relationships. Dr. Honig's article includes discussion of the unlabeled or unapproved use of a drug, device or procedure; i.e, sclerostin antibody and cathepsin K inhibitors (drugs in development for osteoporosis)

Philip J. Kahn, MD--reports no relevant financial relationships. Dr. Kami's article includes discussion of the unlabeled or unapproved use of a drug, device or procedure; i.e., many drugs used in the treatment of juvenile rheumatoid arthritis are not FDA-approved.

Philip J. Mease, MD--serves as a consultant to and is the recipient of research funding from Abbott Laboratories, Amgen USA, Biogen Idec, Bristol-Myers Squibb, Janssen Ortho Biotech, Genentech, Inc., Lilly USA, Novartis Pharmaceuticals Corp., Pfizer, Inc., UCB, Inc. and Celgene Corporation. He serves on the speakers' bureau of Abbott Laboratories, Amgen USA, Biogen Idec, Bristol-Myers Squibb, Janssen Ortho Biotech, Genentech, Inc., Lilly USA, Pfizer, Inc. and UCB, Inc. Dr. Mease's article includes discussion of the unlabeled or unapproved use of a drug, device or procedure.

Joan T. Merrill, MD--serves as a consultant to Amgen USA, Bristol-Myers Squibb, Cephalon, Inc., EMD Serono, Genentech, Inc., Medarex, Medlmmune, Pfizer, Inc., UCB, Inc., Human Genome Sciences, GlaxoSmithKline, Lilly USA, Neovacs, TEVA Pharmaceuticals, Questcor, Inc., Abbott Laboratories, Ono Pharmaceuticals and Astellas Pharma. Dr. Merrill's article includes discussion of the unlabeled or unapproved use of a drug, device or procedure; i.e., clinical trial designs of investigational treatments for lupus including rituximab, abatacept, epratuzumab and anti-interferons.

Michael H. Pillinger, MD--reports no relevant financial relationships. Dr. Pillinger's article includes discussion of the unlabeled or unapproved use of a drug, device or procedure; i.e., anakinra, rilonacept, canakinumab, RDEA594 and tranilast.

Theodore Pincus, MD--reports no relevant financial relationships.

Eric Ruderman, MD--receives consuting fees from Amgen, Abbott, CVS/Caremark, Pfizer, Roche Laboratories/ Genentech, Inc., and UCB, and has contracted research with Pfizer and Roche/Genentech, Inc. Dr. Ruderman's article includes discussion of the unlabeled or unapproved use of a drug, device or procedure; i.e., use of tocilizumab in Adult Still's and SLE.

Jonathan Samuels, MD--reports no relevant financial relationships.

Ismail Simsek, MD--reports no relevant financial relationships.

Gary Solomon, MD--reports no relevant financial relationships.

Yusuf Yazici, MD--serves as a consultant to Bristol-Myers Squibb; Genentech, Inc., Roche Laboratories, Centocor Ortho Biotech.

Norman Sussman, MD--Associate Dean for Postgraduate Programs and Planner--reports no relevant financial relationships.

The independent reviewer of this activity reports no relevant financial relationships.

Supported by educational grants from: Amgen USA; Bristol-Myers Squibb; Genentech, Inc. and Biogen Idec; Pfizer, Inc.

Sponsored by the NYU Post-Graduate Medical School

Release Date: October 1, 2011

Expiration Date: December 31, 2011

Post-Test Questions

1. Which of the following is not supported by data for use in axial disease in spondyloarthritis?

a. Corticosteroids

b. Etanercept

c. NSAIDs

d. Adalimumab

2. Which of the following works in osteoporosis by inhibiting RANKL?

a. Nitric oxide

b. Sclerostin

c. Denosumab

d. Alendronate

3. Core set criteria for improvement in JIA includes all of the below except

a. Number of active joints

b. Physician global assessment

c. Pain

d. ESR

4. Abatacept currently has which of the indications listed below?

a. Rheumatoid arthritis first line use

b. Psoriatic arthritis

c. Ankylosing spondylitis

d. JIA

5. Pegloticase is a

a. Recombinant uricase

b. IL1-B inhibitor

c. Xanthine oxidase inhibitor

d. Inhibits URAT1

6. Which of the following is correct regarding golimumab?

a. It can used once a month or every two weeks

b. Has indications for adult RA and psoriatic arthritis

c. Can be used as IV or IM

d. Even though both 50 mg and 100 mg doses have been studied, 50 mg dose is approved

7. Which of the following was not seen with tocilizumab use?

a. Gastrointestinal perforations

b. LFT elevations

c. Increased malignancy risk

d. Total cholesterol increase

8. Which of the following is not part of RAPID3?

a. Patient global assessment of disease activity

b. Function

c. Pain

d. Swollen joint count

9. MSKUS global scoring systems include which of the below?

a. Naredo 12 joint system

b. Backhaus 7 joint evaluation

c. 78 joint evaluation

d. All of the above

10. Minimal disease activity criteria for psoriatic arthritis included all of the below except

a. Tender joint count

b. HAQ

c. PASI

d. Physician global assessment of disease activity
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