Clinical Issues in Rheumatoid Arthritis Discussions and Debates on the Evolving Roles of Targeted Synthetic DMARDs

Rieke Alten, MD; Joel Kremer, MD, FACP; Josef Smolen, MD

This activity is jointly provided by Global Education Group and Integritas Communications.


Based on a live symposium supported by an educational grant from Gilead Sciences, Inc.

Target Audience

This activity has been designed to meet the educational needs of health care professionals involved in the diagnosis, treatment, or management of patients with rheumatoid arthritis.

Educational Objectives

After completing this activity, the participant should be better able to:

  • Discuss the latest insights into RA immunopathology with a focus on JAK enzyme activation
  • Evaluate patients with RA longitudinally based on an understanding of treat-to-target recommendations and appropriate disease activity measures
  • Describe the mechanistic profiles and clinical trial data for current and emerging targeted synthetic DMARDs
  • Integrate targeted synthetic DMARDs into treatment regimens for patients with RA based on current clinical practice guidelines and evidence for efficacy and safety


Rieke Alten, MD (Course Chair)
Professor of Medicine
Department Head
Internal Medicine, Rheumatology, Clinical Immunology, and Osteology
Schlosspark-Klinik University Medicine Berlin
Berlin, Germany

Joel Kremer, MD, FACP
Pfaff Family Professor of Medicine
Albany Medical College
Director of Research
The Center for Rheumatology
Albany, New York, USA

Josef Smolen, MD
Professor of Medicine
Chair, Division of Rheumatology
Department of Medicine III
Medical University of Vienna
Vienna, Austria


Pathophysiology: A Focus on JAK Enzymes
Josef Smolen, MD

Long-term Assessment of Patients With RA: Understanding Treatment Targets as a Foundation for Therapeutic Tailoring
Joel Kremer, MD

Targeted Synthetic DMARDs in the Treatment of RA
Rieke Alten, MD

Case Study Panel Discussion: Putting the Evidence to Practice
Moderated by: Rieke Alten, MD

Program Overview

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that can cause bone and cartilage damage and lead to disability.1 RA affects about 24.5 million people, with 5 and 50 per 100,000 people newly developing the condition each year.1,2 RA has resulted in increased mortality in recent years, creating a need for an understanding of treat-to-target recommendations and appropriate disease activity measures.3 Adopting treat-to-target strategies in RA patients has shown great promise in improving RA outcomes.4 Treatments for RA continue to emerge along with advances in the understanding of its pathologic mechanisms and the development of drugs that target them.5 Many cytokines involved in controlling cell growth and the immune response in RA function by binding to and activating cytokine receptors, which in turn rely on the Janus kinase (JAK) family of enzymes for signal transduction. Disease-modifying antirheumatic drugs (DMARDs) inhibit the activity of these JAK enzymes and block cytokine signaling.Identifying the mechanistic profiles and clinical trial data for current and emerging targeted synthetic DMARDs can assist health care providers in optimizing RA patient outcomes.7 In this Clinical Issues™ program, an expert faculty panel will discuss and debate the latest insights into RA immunopathology with a focus on JAK enzyme activation, increase participants’ understanding of treat-to-target recommendations and appropriate disease activity measures, and describe the mechanistic profiles and clinical trial data for current and emerging targeted synthetic DMARDs. Attendees will leave this engaging program with new information and a fresh perspective on the evolving best practices for managing patients with RA. 


  1. Smolen JS, et al. Lancet. 2016;388(10055):2023-2038.
  2. GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388 (10053): 1545-1602.
  3. GBD 2013 Mortality and Causes of Death, Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;385 (9963): 117-171.
  4. Bykerk VP, et al. Tocilizumab in patients with active rheumatoid arthritis and inadequate responses to DMARDs and/or TNF inhibitors: a large, open-label study close to clinical practice. Ann Rheum Di. 2012;71(12): 1950-1954.
  5. Kahlenberg JM, Fox DA. Advances in the medical treatment of rheumatoid arthritis. Hand Clin. 2011;27(1):11-20.
  6. Kontzias A, et al. Jakinibs: a new class of kinase inhibitors in cancer and autoimmune disease. Curr Opin Pharmacol. 2012;12(4):464-470.
  7. Ramiro S, et al. Safety of synthetic and biological DMARDs: a systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis. 2017;76(6):1101-1136.

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

Global Education Group designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or

Fee Information

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Rieke Alten, MD: Grants/Research Support: Gilead Sciences, Inc., and Pfizer Inc. Honoraria/Consultation fees: Eli Lilly & Company, and Pfizer Inc. Speakers Bureau: Eli Lilly & Company, and Pfizer Inc.

Joel Kremer, MD, FACP: Grants/Research Support: AbbVie Inc., Genentech, Inc., Eli Lilly & Company, and Novartis Pharmaceuticals Corporation. Stock Shareholder: Corrona

Josef Smolen, MD: Grants/Research Support: AbbVie Inc., AstraZeneca, Janssen Pharmaceuticals, Inc., Eli Lilly & Company, F. Hoffmann-La Roche Ltd, Merck Sharp Dohme Corp., and Pfizer Inc. Honoraria/Consultation fees:  AbbVie Inc., Amgen Inc., AstraZeneca, Astro-Pharma GmbH, Bristol-Myers Squibb, Celgene Corporation, Celltrion Inc., Chugai Pharmaceutical Co., Ltd., Eli Lilly & Company, Gilead Sciences, Inc., GlaxoSmithKline, F. Hoffmann-La Roche Ltd, ILTOO Pharma, Janssen Pharmaceuticals, Inc., Medimmune, LLC, Merck Sharp Dohme Corp., Pfizer Inc., Sandoz International GmbH, Samsung Pharmaceutical Co., Ltd., Sanofi, and UCB S.A.

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

Lindsay Borvansky: Nothing to disclose
Andrea Funk:  Nothing to disclose
Liddy Knight:  Nothing to disclose
Jim Kappler, PhD:  Nothing to disclose

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score 70% on the posttest and complete the program evaluation

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credit amount 1.00

credit type CME/CE

release 10/10/2018

expiration 10/10/2019

type Webcast