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Peerview.Com/WXC900 Overcoming Challenges in the Diagnosis And CME Overcoming Challenges in the Diagnosis and Management of Axial Spondyloarthritis: New Insights and Implications for Clinical Practice Chair Abhijeet Danve, MD, FACP, FACR Yale School of Medicine New Haven, Connecticut What’s Inside 3 A Closer Look at Strategies to Improve the Timely Recognition of Axial Spondyloarthritis 15 Expert Insight on the Treatment of Axial Spondyloarthritis Participate in interactive questions, download activity slides, and obtain your instant CME credit online. This CME activity is jointly provided by Medical Learning Institute, Inc. and PVI, PeerView Institute for Medical Education. PeerView.com/WXC900 Activity Information Media: Enduring Material Content/Peer Reviewer Disclosures Accredited Activity Release Date: August 28, 2020 The following Content/Peer Reviewer has nothing to disclose: Accredited Activity Expiration Date: August 27, 2021 Time to Complete Activity: 60 minutes Matthew A. Goodman, MD Activity Description Disclosure of Unlabeled Use In this activity, an expert in rheumatology discusses practical strategies for This educational activity may contain discussions of published and/or identifying and managing axial spondyloarthritis (axSpA) in clinical practice. investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled Target Audience indications. The opinions expressed in the educational activity are those of This activity has been designed to meet the educational needs of internists and the faculty and do not necessarily represent the views of the planners. Please other clinicians involved in the identification and care of patients with axSpA. refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Educational Objectives Upon completion of this activity, participants should be better able to: Disclaimer • Identify axSpA in patients with inflammatory back pain via assessment of Participants have an implied responsibility to use the newly acquired medical history, musculoskeletal symptoms and findings, and extra-articular information to enhance patient outcomes and their own professional manifestations and comorbidities development. The information presented in this activity is not meant to serve • Apply classification criteria and diagnostic tests into clinical practice to as a guideline for patient management. Any procedures, medications, or other support early detection of axSpA courses of diagnosis or treatment discussed or suggested in this activity should • Assess efficacy and safety data related to novel biologic options for axSpA, not be used by clinicians without evaluation of their patient's conditions and recognizing the potential clinical impact on the management of patients possible contraindications and/or dangers in use, review of any applicable who do not respond well to traditional pharmacologic therapies manufacturer's product information, and comparison with recommendations • Employ treatment plans for individual patients with axSpA in accordance of other authorities. with current evidence, expert recommendations, and patient needs and preferences Method of Participation • Recognize the importance of collaborating with rheumatologists to provide There are no fees for participating in or receiving credit for this accredited optimal treatment and longitudinal support for patients with axSpA activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing Providership, Credit, and Support board. This CME activity is jointly provided by Medical Learning Institute, Inc. and PVI, PeerView Institute for Medical Education. A statement of credit will be issued only upon receipt of a completed activity evaluation form and will be emailed to you upon completion. You will receive This activity is supported by an educational grant from Novartis your certificate from [email protected]. If you have questions Pharmaceuticals Corporation. regarding the receipt of your emailed certificate, please contact via email at [email protected]. Physician Continuing Medical Education This activity has been planned and implemented in accordance with About This CME Activity the accreditation requirements and policies of the Accreditation PVI, PeerView Institute for Medical Education, and Medical Learning Institute, Council for Continuing Medical Education (ACCME) through the joint Inc. are responsible for the selection of this activity’s topics, the preparation providership of Medical Learning Institute, Inc. and PVI, PeerView Institute for of editorial content, and the distribution of this activity. Our activities may Medical Education. The Medical Learning Institute, Inc. is accredited by the contain references to unapproved products or uses of these products in ACCME to provide continuing medical education for physicians. certain jurisdictions. The preparation of PeerView activities is supported by educational grants subject to written agreements that clearly stipulate and The Medical Learning Institute, Inc. designates this enduring material for a enforce the editorial independence of PVI and Medical Learning Institute, Inc. maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The materials presented here are used with the permission of the authors and/or other sources. These materials do not necessarily reflect the views of Faculty Disclosures PeerView or any of its partners, providers, and/or supporters. Chair Abhijeet Danve, MD, FACP, FACR Assistant Professor of Medicine Director Spondyloarthritis Clinic Yale School of Medicine New Haven, Connecticut Abhijeet Danve, MD, FACP, FACR, has a financial interest/relationship or affiliation in the form of: Consultant and/or Advisor for Janssen Pharmaceuticals, Inc. Grant/Research Support from Novartis Pharmaceuticals Corporation. Stock Shareholder in Novartis Pharmaceuticals Corporation. Planning Committee Disclosures The planners from Medical Learning Institute, Inc., the accredited provider, and PeerView Institute for Medical Education, the joint provider, do not have any financial relationships with an ACCME-defined commercial interest related to the content of this accredited activity during the past 12 months unless listed below. Go online to complete the post-test and evaluation for CME credit PeerView.com/WXC900 2 Overcoming Challenges in the Diagnosis and Management of Axial Spondyloarthritis: New Insights and Implications for Clinical Practice A Closer Look at Strategies to Sacroiliitis Grade 0 (Normal)a Improve the Timely Recognition of Axial Spondyloarthritis Dr. Danve: Hello, this is Dr. Abhijeet Danve, Assistant Professor and Rheumatologist from the Yale School of Medicine in New Haven, Connecticut. Welcome to this educational activity focused on managing axial spondyloarthritis in the internal medicine setting. We’ll begin with a quote. “Learn to see. Learn to hear. Learn to a Image courtesy of Dr. Abhijeet Danve. feel. Learn to smell. And know that by practice alone can you become expert." The practice of rheumatology is all about pattern An x-ray of the pelvis was performed that did not show sacroiliitis. recognition” Patient Casea (Cont’d) Patient Case Back pain is worse with prolonged rest and improves with exercise and activity Patient referred Wakes up because of back pain; NSAIDs provide significant relief 44-year-old to a rheumatologist woman who had high suspicion with chronic of spondyloarthritisb low back Needs to visit her podiatrist for recurrent plantar fasciitis pain (CLBP) for 6-8 years Normal ROM at L spine, mild tenderness at insertion of plantar fascia on calcaneus; otherwise, normal joint examination a Image courtesy of Dr. Abhijeet Danve. Labs show normal ESR and CRP, but positive for HLA-B27 b MRI of pelvis confirmed sacroiliitis; subchondral marrow inflammation shown by increased MRI signal on fat suppressed T2 weighted image (STIR; as shown by white arrows) and joint cavity (as shown by yellow arrows). An MRI of the pelvis without contrast was performed. As you can Dr. Danve: We’ll begin with a case. A 44-year-old, otherwise see, it showed inflammatory changes on both sides of the bilateral healthy woman presents with chronic low back pain that has been SIJs. Here you can see the bone marrow edema in the subchondral ongoing for 6 to 8 years. The back pain is worse with prolonged aspect of the right, as well as the left, SIJ on the T2-weighted STIR rest, and it improves with exercises, as well as activities. Sometimes image. the back pain wakes the patient up in the middle of the night. She reports that NSAIDs provide significant relief from the back pain. The patient also needs to visit her podiatrist often for recurrent plantar fasciitis. On examination, she has normal range of movement at lumbar spine, and she has mild tenderness at the insertion of plantar fascia on the left side. The rest of the joint So what can we call patients who do not have examination, as well as systemic examination, is normal. Blood definitive sacroiliitis but have other features tests show normal sed rate and normal CRP, but she’s positive suggestive of spondyloarthritis? HLA-B27 gene. So what can we call patients who don’t have definitive sacroiliitis but have other features suggestive of spondyloarthritis? Go online to complete the post-test and evaluation
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