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Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease characterized by immune system damage to multiple joints. It results in pain, physical disability, reduced quality of life, increased mortality, and significant socioeconomic costs. The estimated prevalence of RA is 0.5% to 1% of the population worldwide; women are 2 to 3 times more likely to be affected than men. RA can begin at any age; however, the onset is typically during the sixties. Up to 60% to 90% of individuals with RA have progressive destruction of joints, and as many as one-third are work-disabled within 2 years of disease onset.
Historically, initial RA treatment focused on corticosteroids and NSAIDs to reduce painful inflammation; eventually, nonresponders were given disease-modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX). Over the last decade, earlier and more aggressive treatment has been recommended to slow disease progression. Newer strategies include combination DMARD regimens and early use of biologic DMARDs that target specific components of the immune system. The American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR), have published treatment guidelines for RA that include the use of biologic agents alone or in combination with nonbiologic DMARDs.
This issue will briefly review RA in adults, then focus on newer treatments including biologic agents (tumor necrosis factor [TNF] inhibitors and non-TNF inhibitors), delayed-release prednisone (Rayos®), and tofacitinib (Xeljanz®).
Publication Date: 03/18/2013
Expiration Date: 03/18/2016
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based
This program was developed by The Rx Consultant and published by Continuing Education Network, Inc.
The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and
is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased,
balanced information to health care practitioners.
Programs developed by The Rx Consultant are written by health care providers with expertise in the topic
area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure
that every program presents information that is current, accurate, relevant to "real world" health care
providers, and written in an easy reading, "plain English" style.
William J. Cardarelli, PharmD, Tracy Farnen, PharmD and Pamela Mausner, MD
Dr. Cardarelli, Dr. Farnen and Dr. Mausner report no financial or personal relationship with any commercial
interest producing, marketing, reselling, or distributing a product or service that appears in this issue.
This accredited program is targeted to pharmacists and nurses.
Goals & Objectives
At the conclusion of this program, participants will be able to:
- Describe the symptoms and natural course of rheumatoid arthritis (RA). Discuss treatment goals.
- Discuss the role in RA therapy of nonbiologic DMARDs, TNF inhibitors, non-TNF biologic DMARDs, NSAIDs, & corticosteroids.
- List at least 8 biologic drugs (TNF inhibitors, non-TNF agents) for RA. Discuss their main adverse effects and safety issues.
- For each of the 2 new approvals (tofacitinib and DR prednisone): discuss the evidence supporting their use in RA. Provide 2-3 patient counseling tips.
The Rx Consultant is a publication of Continuing Education Network, Inc.
Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a
provider of continuing pharmacy education.
Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.
ACPE Universal Activity Number: 0428-0000-13-004-H01-P
Exam & Credit Statement Procedures
Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and
Editorial and Review Board
Chief Editor and CE Administrator
Terry M. Baker, PharmD
Tracy Farnen, PharmD
James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA
Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA
Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA
Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System
Adjunct Clinical Professor
College of Pharmacy
Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Visiting Associate Professor and Lecturer
Samuel Merritt University
Pamela Mausner, MD
Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Senior Editorial Advisor
Gerard Hatheway, PharmD, PhD
Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD
Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners
Meuleman, RN, C, MS
About the Rx Consultant
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