Rheumatoid arthritis is a chronic, debilitating systemic inflammatory autoimmune disorder. It involves inflammation of the synovial membranes of certain joints, which leads to the destruction of the articular cartilage and bone. Over time, rheumatoid arthritis may result in progressive joint destruction, deformity, disability, and death. It affects almost 1% of the US population, or 2.5 million people. It can occur at any age, although the peak time of onset is between the ages of 40 and 60 years. Rheumatoid arthritis occurs 3 times more often in women than men. Within 10 years of the onset, 80% with have some disability or deformity. It is imperative that patients diagnosed with rheumatoid arthritis be treated quickly and effectively to slow or halt progression of disease. 

Four categories of biologic agents have been approved for the treatment of rheumatoid arthritis in the US: TNF-alpha inhibitors, T-cell costimulation inhibitors, IL-1 inhibitors, and B-cell targeted therapies. This activity will provide an overview of the mechanism of action of each of the approved biologic agents, and the FAQ sections will address some of the efficacy and safety questions surrounding these therapies.

This activity has been designed to meet the educational needs of rheumatologists and immunologists.

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

• Identify three types of immunomodulatory therapies and their key mechanisms of action in the treatment of patients with RA
• Name two reasons that patients treated with immunomodulatory therapy must be monitors on an ongoing basis

Professor of Medicine;
Center for Innovative Therapy;
Division of Rheumatology;
Allergy and Immunology;
University of California at San Diego, San Diego, California.

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Postgraduate Institute for Medicine and Med Learning Group.  The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The Postgraduate Institute for Medicine designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit ^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity; ahughes@pimed.com

One in five (>21%) adults in the US report having doctor-diagnosed arthritis. Of these, about 2.1 million adults have rheumatoid arthritis (RA). RA is a systemic disease that manifests throughout multiple joints of the body, affecting the synovial membrane (lining of the joints) and sometimes even organs. When the synovium becomes inflamed, cartilage and bone erode, sometimes leading to joint deformity. Common symptoms of RA include pain, swelling, and redness of the joints. The exact cause of RA is unknown, but it is believed to be related to deficient immune response. Arthritis and other rheumatic conditions, including RA, are the leading cause of disability in the US. Arthritis has been associated with limitations in activities of daily living (e.g., walking, climbing stairs_ and major depression (attributable risk 18.1%). Arthritis is also responsible for about 3% of all US hospitalizations each year and 4% of all ambulatory care visits. In addition, arthritis is responsible for about 9400 deaths each year; approximately 22% of these occur in patients with RA. The total costs attributed to arthritis and other rheumatic conditions are $128 billion/year, with $80.8 billion of that direct medical costs. This program will focus on helping rheumatologists and immunologists understand the disease and the new biologic treatments available with the goal of improving diagnosis and treatment of rheumatoid arthritis for improved patient safety and quality of life.

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial insterests related to the content of this CME activity:

Dr. Kavanaugh: Contracted research: Abbott Laboratories; Amgen, Inc.; Bristol-Myers Squibb Co.; Genentech, Inc.; and Biogen Idec.

Jan Hixon, RN, MSN, Postgraduate Institute for Medicine: no real or apparent conflict of interest to report.

Tara Hun-Dorris, Medical Writer Med Learning Group: Consulting Fees: UCB Group, Inc.

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate Institute for Medicine (PIM), Med Learning Group, and Bristol-Myers Squibb do not recommend the use of any agent outside the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, Med Learning Group, or Bristol-Myers Squibb.  Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.