Updated RA Treatment Guidelines: Additions, Changes, and Implications for Your Practice

Online Course | Specialties: Rheumatology
Released: 3/29/2021
Expires: 3/28/2022
Max Credits: 0.75
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Jeffrey Curtis, MD, MS, MPH
Professor of Medicine, Division of Clinical Immunology and Rheumatology
Marguerite Jones Harbert – Gene Ball Endowed Professor of Medicine
Co-Director, UAB Pharmacoepidemiology and Pharmacoeconomics Research Unit
University of Alabama at Birmingham
Birmingham, AL

Stanley B. Cohen, MD
Clinical Associate Professor, Department of Internal Medicine
University of Texas Southwestern Medical School
Director, Rheumatology Division
Texas Health Resources Presbyterian Hospital
Co-Medical Director
Metroplex Clinical Research Center
Dallas, TX

Activity Planners
Lisa Hack
Manager, Education Strategy and Content
Baltimore, MD

Rebecca L. Julian, MS, ELS
Senior Manager, Editorial
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager
Baltimore, MD

Amy Sison
Director of CME
Baltimore, MD

Kathryn Schaefer, MSN, RN, CPHRM
Associate Director, Education Quality and Compliance
East Lansing, MI

Learning Objectives
Upon completion, participants should be able to:

  • Describe recent updates to RA treatment guidelines, specifically regarding individualizing management strategies for patients with RA who are not achieving adequate disease control
  • Incorporate patients’ treatment preferences and priorities, adherence considerations, and cost concerns into evidence-based care options for individuals with RA

Target Audience
This activity is intended for rheumatology physicians, physician assistants, nurse practitioners, nurses, fellows, and residents.

Statement of Need
The most recent update to the ACR’s Guideline for the Treatment of Rheumatoid Arthritis occurred in 2015. Since that time, the understanding of RA science has improved, the Food and Drug Administration approved new therapies, and significantly more data on existing and emerging therapies have been collected and published. To reflect these advances in the field, EULAR updated their 2016 guidelines in late 2019, and the ACR is working to follow suit in early 2021.

Early versions of guideline updates were released for discussion in the rheumatology community. Not surprisingly, they included significant changes, especially regarding the expanded use of Janus kinase (JAK) inhibitors in the treatment of patients with RA. The first JAK inhibitor, approved just before the ACR’s 2015 update, received only “conditional” recommendations (specifically under its generic name of tofacitinib, not as a therapeutic class) in the 2015 ACR guidelines due to the lack of long-term safety and efficacy data at the time. Conversely, the new EULAR recommendations and the anticipated ACR update expand and strengthen the recommended use of JAK inhibitors, providing clinicians and patients with a greater variety of therapeutic options.

Providership Statement
Provided by Med-IQ.

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Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Med-IQ designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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This nursing activity has been approved for up to 0.75 contact hour.

Other healthcare professionals who successfully complete the activity will receive a Statement of Participation indicating the maximum credits available.

Medium/Method of Participation
This is a 0.75-credit CME activity. To receive credit, read the introductory CME material, complete all of the modules, and complete the evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.

Initial Release Date: March 29, 2021
Expiration Date: March 28, 2022
Estimated Time to Complete This Activity: 45 minutes

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Med-IQ requires any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as those in any amount occurring within the past 12 months, including those of a spouse/life partner, that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and resolve COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Off-label/unapproved drug uses or products are mentioned within this activity.

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.

Jeffrey Curtis, MD, MS, MPH
Consulting fees/advisory boards: AbbVie Inc., Amgen, Bristol Myers-Squibb, Corrona, Janssen Pharmaceuticals, Inc., Myriad Genetics, Novartis Pharmaceuticals Corporation, Pfizer, Inc., Sanofi-aventis U.S. Inc.
Contracted research: Amgen, Bristol Myers-Squibb, Corrona, Janssen Pharmaceuticals, Inc., Myriad Genetics, Pfizer, Inc., Sanofi-aventis U.S. Inc.

Stanley B. Cohen, MD
Consulting fees/advisory boards: AbbVie Inc., Amgen, F. Hoffmann-La Roche Ltd., Genentech, Gilead Sciences, Inc., Pfizer, Inc.
Contracted research: AbbVie Inc., Amgen, F. Hoffmann-La Roche Ltd., Genentech, Gilead Sciences, Inc., Pfizer, Inc.

The peer reviewers and activity planners have no financial relationships to disclose.

Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, it is the policy of Med-IQ to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.

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The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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Acknowledgment of Commercial Support
This activity is supported by an educational grant from Gilead Sciences, Inc

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Here are the key takeaways from this activity. Deeper insights and evidence, plus an opportunity to receive credit, are available at the "Continue" button below.

  • Both the ACR and EULAR have recently updated or are currently updating their guidelines for the treatment of RA
  • According to the proposed ACR guidelines, in DMARD-naïve patients with moderate to high disease activity, MTX is strongly recommended over hydroxychloroquine or sulfasalazine, conditionally recommended over leflunomide, and strongly recommended over bDMARD or tsDMARD monotherapy
  • EULAR continues to recommend MTX as part of the first treatment strategy for DMARD-naïve RA patients, confirming its place as the anchor drug for subsequent treatment
  • The use of glucocorticoids represents a major difference between the proposed ACR recommendations and the EULAR recommendations
  • For patients taking a bDMARD or tsDMARD who are not at target, the proposed ACR guidelines conditionally recommend a switch to a bDMARD or tsDMARD of a different class over a switch to a bDMARD or tsDMARD belonging to the same class
  • Based on the proposed ACR guidelines, for patients taking maximally tolerated doses of MTX who are not at target, the addition of a bDMARD or tsDMARD is conditionally recommended over triple therapy
  • In addition to guidelines, clinicians should consider patient preferences and concerns when making treatment decisions

View reference list.

Click "Continue" to proceed through this activity and/or receive credit. To receive credit and a certificate, you must complete all of the chapters in this activity.

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Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors.

The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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