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Can You Spot Axial Spondyloarthritis? The PCP’s Role in Timely Recognition and Referral

Lianne Gensler, MD; Paul Nadler, MD

 

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

 

This activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.

Faculty

Lianne Gensler, MD
Associate Professor 
Department of Medicine
Division of Rheumatology
Director, Ankylosing Spondylitis Clinic
University of California, San Francisco
San Francisco, California

Paul Nadler, MD
Clinical Professor of Medicine
Medical Director, Screening and Acute Care Clinic
University of California, San Francisco
San Francisco, California

Target Audience

The educational design of this activity addresses the needs of primary care providers, including family medicine and internal medicine physicians, nurse practitioners, and physician assistants.

Statement of Need/Program Overview

Axial spondyloarthritis (AxSpA) is a chronic, inflammatory arthritis of the sacroiliac joints and spine.1 The disease may also present with peripheral arthritis and/or extra-articular manifestations.1 Progressive joint damage, irreversible loss of spinal mobility, and impaired patient function are accompanied by significant psychosocial and quality-of-life burdens. All too often, the diagnosis of AxSpA is delayed—historically, by an average of 10–14 years from the time of symptom onset—profoundly exacerbating the disease sequelae.2,3 Given their frontline position in the assessment of back pain, primary care providers (PCPs) are essential to accelerating the identification of AxSpA. This multimedia eHealth Source™ program has been designed to help PCPs efficiently screen patients with suspicious clinical presentations, correlate signs and symptoms with various AxSpA subtypes, and utilize available first-line diagnostic modalities. The overall goal is to expedite evidence-based management of AxSpA by enhancing disease awareness among PCPs, improving patient evaluations in primary care, and encouraging rheumatology referrals with an expectation of ongoing collaborative care.4,5

References

  1. Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73-84.
  2. Martindale J, Goodacre L. The journey to diagnosis in AS/axial SpA: the impact of delay. Musculoskeletal Care. 2014;12(4): 221-231.
  3. Ramonda R, Marchesoni A, Carletto A, et al. Patient-reported impact of spondyloarthritis on work disability and working life: the ATLANTIS survey. Arthritis Res Ther. 2016;18:78.
  4. Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheumatol. 2016;68(2): 282-298.
  5. Rudwaleit M, Sieper J. Referral strategies for early diagnosis of axial spondyloarthritis. Nat Rev Rheumatol. 2012;8(5):262-268.

Educational Objectives

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

  • Identify patients with inflammatory back pain (IBP) and correlate clinical findings with axial spondyloarthritis (AxSpA) via historical features, manifestations, and comorbidities
  • Apply first-line diagnostic modalities for the provisional identification of AxSpA
  • Refer patients to rheumatologists for diagnostic confirmation and targeted treatment of AxSpA within a clinically advantageous timeframe
  • Provide longitudinal support for patients with AxSpA

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. 

This CME/CE activity complies with all requirements of the federal Physician Payment Sunshine Act. If a reportable event is associated with this activity, the accredited provider managing the program will provide the appropriate physician data to the Open Payments database.

Physician Credit Designation

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

Nursing Continuing Education

Global Education Group is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This educational activity for 1.0 contact hours is provided by Global Education Group. Nurses 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 cme@globaleducationgroup.com

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score 70% or better on the posttest and complete the program evaluation. Certificates will be distributed online at the conclusion of the activity.

System Requirements

PC
Microsoft Windows 2000 SE or above.
Flash Player Plugin (v7.0.1.9 or greater)
Internet Explorer (v5.5 or greater), or Firefox
Adobe Acrobat Reader*

MAC
MAC OS 10.2.8
Flash Player Plugin (v7.0.1.9 or greater)
Safari
Adobe Acrobat Reader*
Internet Explorer is not supported on the Macintosh.

*Required to view printable (PDF) version of the lesson.

Fee Information & Refund/Cancellation Policy

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: 

Lianne Gensler, MD Consultant/Independent Contractor: Janssen Pharmaceuticals, Inc.; Novartis Pharmaceuticals Corporation

Paul Nadler, MD Nothing to disclose

The following planners and managers 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:

Andrea Funk  Nothing to disclose
Ashley Marostica, RN, MSN  Nothing to disclose
Jeanette Ruby, MD 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 Communications 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.

Disclaimer

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.

Click "Begin Activity" to acknowledge that you have reviewed the preamble information for this activity.

Begin Activity

expiration 10/31/2018

type eHealthSource


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Context properties
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  •  => 
  •  => 
  •  => 
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Context properties
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Context class ActivitiesController
Inheritance CommonActivitiesController » Controller » CController » CBaseController
Defined in file protected/controllers/ActivitiesController.php
Context properties
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  •  => 
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Context properties
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Context properties
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  •  => 
  •  => 
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Context class ActivitiesController
Inheritance CommonActivitiesController » Controller » CController » CBaseController
Defined in file protected/controllers/ActivitiesController.php
Context properties
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Route activities/view
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Action params
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Context ActivitiesController
Context class ActivitiesController
Inheritance CommonActivitiesController » Controller » CController » CBaseController
Defined in file protected/controllers/ActivitiesController.php
Context properties
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  •  => 
  •  => 
  •  => 
  •  => 
Route activities/view
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Render methodrenderPartial
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Context ActivitiesController
Context class ActivitiesController
Inheritance CommonActivitiesController » Controller » CController » CBaseController
Defined in file protected/controllers/ActivitiesController.php
Context properties
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  •  => 
  •  => 
  •  => 
  •  => 
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Driver mysql
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Questions 40791025
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Queries per second avg 4.756
Query Count Total (s) Avg. (s) Min. (s) Max. (s)
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3 0.002568 0.000856 0.000266 0.002016
SELECT * FROM `activities` `t` WHERE `t`.`id`=72 LIMIT 1
5 0.001623 0.000325 0.000285 0.000471
SHOW COLUMNS FROM `activities`
1 0.001574 0.001574 0.001574 0.001574
SHOW COLUMNS FROM `events`
1 0.001426 0.001426 0.001426 0.001426
SHOW COLUMNS FROM `users`
1 0.001228 0.001228 0.001228 0.001228
SHOW COLUMNS FROM `view_log`
1 0.001120 0.001120 0.001120 0.001120
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
2 0.001104 0.000552 0.000266 0.000838
SHOW COLUMNS FROM `resources`
1 0.001071 0.001071 0.001071 0.001071
SHOW COLUMNS FROM `user_activitiesstatus`
1 0.000996 0.000996 0.000996 0.000996
SHOW COLUMNS FROM `questionnaires`
1 0.000984 0.000984 0.000984 0.000984
SHOW COLUMNS FROM `interactions`
1 0.000971 0.000971 0.000971 0.000971
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
2 0.000942 0.000471 0.000463 0.000479
SELECT `t`.`id` AS `t0_c0`, `t`.`group_id` AS `t0_c1`, `t`.`resource_id` AS `t0_c2`, `t`.`title` AS `t0_c3`, `t`.`type` AS `t0_c4`, `t`.`facultyNames` AS `t0_c5`, `t`.`shortDescription` AS `t0_c6`, `t`.`fullDescription` AS `t0_c7`, `t`.`creditAmount` AS `t0_c8`, `t`.`shortAddress` AS `t0_c9`, `t`.`creditType` AS `t0_c10`, `t`.`startDate` AS `t0_c11`, `t`.`finishDate` AS `t0_c12`, `t`.`sponsors` AS `t0_c13`, `t`.`status` AS `t0_c14`, `t`.`createDate` AS `t0_c15`, `t`.`image` AS `t0_c16`, `t`.`image_featured` AS `t0_c17`, `t`.`archived` AS `t0_c18`, `t`.`managers_list` AS `t0_c19`, `t`.`is_send_pp_email` AS `t0_c20`, `t`.`muvi_sync_date` AS `t0_c21`, `t`.`expert_questions` AS `t0_c22`, `interaction`.`id` AS `t1_c0`, `interaction`.`activity_id` AS `t1_c1`, `interaction`.`title` AS `t1_c2`, `interaction`.`link` AS `t1_c3`, `interaction`.`type` AS `t1_c4`, `interaction`.`status` AS `t1_c5`, `interaction`.`createDate` AS `t1_c6` FROM `activities` `t` LEFT OUTER JOIN `interactions` `interaction` ON (`interaction`.`activity_id`=`t`.`id`) WHERE (`t`.`id`=72)
1 0.000629 0.000629 0.000629 0.000629
SELECT * FROM `questionnaires` `t` WHERE t.activity_id=:id AND t.type=:type LIMIT 1
1 0.000511 0.000511 0.000511 0.000511
SELECT `resource`.`id` AS `t1_c0`, `resource`.`shortAddress` AS `t1_c1`, `resource`.`status` AS `t1_c2`, `resource`.`title` AS `t1_c3`, `resource`.`type` AS `t1_c4`, `resource`.`image` AS `t1_c5`, `resource`.`slides` AS `t1_c6`, `resource`.`linkedResources` AS `t1_c7`, `resource`.`reading` AS `t1_c8`, `resource`.`shortDescription` AS `t1_c9`, `resource`.`fullDescription` AS `t1_c10`, `resource`.`link` AS `t1_c11`, `resource`.`createDate` AS `t1_c12`, `resource`.`archived` AS `t1_c13` FROM `resources` `resource` WHERE (`resource`.`id`=:ypl0)
1 0.000459 0.000459 0.000459 0.000459
SELECT `activity_id` AS `c`, COUNT(*) AS `s` FROM `user_activitiesstatus` `t` WHERE (user_id=:user AND isFinished=1) AND (`t`.`activity_id`=72) GROUP BY `activity_id`
1 0.000451 0.000451 0.000451 0.000451
SHOW CREATE TABLE `activities`
1 0.000353 0.000353 0.000353 0.000353
SHOW CREATE TABLE `events`
1 0.000340 0.000340 0.000340 0.000340
SHOW CREATE TABLE `users`
1 0.000327 0.000327 0.000327 0.000327
SHOW CREATE TABLE `view_log`
1 0.000318 0.000318 0.000318 0.000318
SHOW CREATE TABLE `resources`
1 0.000281 0.000281 0.000281 0.000281
SHOW CREATE TABLE `user_activitiesstatus`
1 0.000277 0.000277 0.000277 0.000277
SHOW CREATE TABLE `questionnaires`
1 0.000271 0.000271 0.000271 0.000271
SHOW CREATE TABLE `interactions`
1 0.000270 0.000270 0.000270 0.000270
# Query Time (s)
0
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000838
1
SHOW COLUMNS FROM `activities`
0.001574
2
SHOW CREATE TABLE `activities`
0.000353
3
SHOW COLUMNS FROM `users`
0.001228
4
SHOW CREATE TABLE `users`
0.000327
5
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000479
6
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
0.003622
7
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000463
8
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2491849
0.003030
9
SELECT * FROM `activities` `t` WHERE `t`.`id`=72 LIMIT 1
0.000471
10
SHOW COLUMNS FROM `events`
0.001426
11
SHOW CREATE TABLE `events`
0.000340
12
SELECT `event`.`id` AS `t1_c0`, `event`.`group_id` AS `t1_c1`, `event`.`shortAddress` AS `t1_c2`, `event`.`resource_id` AS `t1_c3`, `event`.`type` AS `t1_c4`, `event`.`addType` AS `t1_c5`, `event`.`title` AS `t1_c6`, `event`.`shortDescription` AS `t1_c7`, `event`.`facultyNames` AS `t1_c8`, `event`.`faculty` AS `t1_c9`, `event`.`calendarDate` AS `t1_c10`, `event`.`creditAmount` AS `t1_c11`, `event`.`creditType` AS `t1_c12`, `event`.`shortWhen` AS `t1_c13`, `event`.`fullWhen` AS `t1_c14`, `event`.`venue` AS `t1_c15`, `event`.`shortWhere` AS `t1_c16`, `event`.`fullWhere` AS `t1_c17`, `event`.`createDate` AS `t1_c18`, `event`.`status` AS `t1_c19`, `event`.`description` AS `t1_c20`, `event`.`image` AS `t1_c21`, `event`.`linkout` AS `t1_c22`, `event`.`registrationEnabled` AS `t1_c23`, `event`.`activity_id` AS `t1_c24`, `event`.`adobe_connect_sco` AS `t1_c25`, `event`.`adobe_connect_datetime` AS `t1_c26`, `event`.`users_limit` AS `t1_c27`, `event`.`adobe_connect_duration` AS `t1_c28`, `event`.`calendar_description` AS `t1_c29` FROM `events` `event` WHERE (`event`.`activity_id`=:ypl0)
0.002016
13
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000266
14
SELECT * FROM `activities` `t` WHERE `t`.`id`=72 LIMIT 1
0.000291
15
SELECT `event`.`id` AS `t1_c0`, `event`.`group_id` AS `t1_c1`, `event`.`shortAddress` AS `t1_c2`, `event`.`resource_id` AS `t1_c3`, `event`.`type` AS `t1_c4`, `event`.`addType` AS `t1_c5`, `event`.`title` AS `t1_c6`, `event`.`shortDescription` AS `t1_c7`, `event`.`facultyNames` AS `t1_c8`, `event`.`faculty` AS `t1_c9`, `event`.`calendarDate` AS `t1_c10`, `event`.`creditAmount` AS `t1_c11`, `event`.`creditType` AS `t1_c12`, `event`.`shortWhen` AS `t1_c13`, `event`.`fullWhen` AS `t1_c14`, `event`.`venue` AS `t1_c15`, `event`.`shortWhere` AS `t1_c16`, `event`.`fullWhere` AS `t1_c17`, `event`.`createDate` AS `t1_c18`, `event`.`status` AS `t1_c19`, `event`.`description` AS `t1_c20`, `event`.`image` AS `t1_c21`, `event`.`linkout` AS `t1_c22`, `event`.`registrationEnabled` AS `t1_c23`, `event`.`activity_id` AS `t1_c24`, `event`.`adobe_connect_sco` AS `t1_c25`, `event`.`adobe_connect_datetime` AS `t1_c26`, `event`.`users_limit` AS `t1_c27`, `event`.`adobe_connect_duration` AS `t1_c28`, `event`.`calendar_description` AS `t1_c29` FROM `events` `event` WHERE (`event`.`activity_id`=:ypl0)
0.000266
16
SELECT * FROM `activities` `t` WHERE `t`.`id`=72 LIMIT 1
0.000288
17
UPDATE activities SET archived=1 WHERE finishDate<now();
0.005948
18
SHOW COLUMNS FROM `view_log`
0.001120
19
SHOW CREATE TABLE `view_log`
0.000318
20
INSERT INTO `view_log` (`source`, `unique_id`, `resource_id`, `type`) VALUES (:yp0, :yp1, :yp2, :yp3)
0.003057
21
SHOW COLUMNS FROM `user_activitiesstatus`
0.000996
22
SHOW CREATE TABLE `user_activitiesstatus`
0.000277
23
SHOW COLUMNS FROM `interactions`
0.000971
24
SHOW CREATE TABLE `interactions`
0.000270
25
SELECT `t`.`id` AS `t0_c0`, `t`.`group_id` AS `t0_c1`, `t`.`resource_id` AS `t0_c2`, `t`.`title` AS `t0_c3`, `t`.`type` AS `t0_c4`, `t`.`facultyNames` AS `t0_c5`, `t`.`shortDescription` AS `t0_c6`, `t`.`fullDescription` AS `t0_c7`, `t`.`creditAmount` AS `t0_c8`, `t`.`shortAddress` AS `t0_c9`, `t`.`creditType` AS `t0_c10`, `t`.`startDate` AS `t0_c11`, `t`.`finishDate` AS `t0_c12`, `t`.`sponsors` AS `t0_c13`, `t`.`status` AS `t0_c14`, `t`.`createDate` AS `t0_c15`, `t`.`image` AS `t0_c16`, `t`.`image_featured` AS `t0_c17`, `t`.`archived` AS `t0_c18`, `t`.`managers_list` AS `t0_c19`, `t`.`is_send_pp_email` AS `t0_c20`, `t`.`muvi_sync_date` AS `t0_c21`, `t`.`expert_questions` AS `t0_c22`, `interaction`.`id` AS `t1_c0`, `interaction`.`activity_id` AS `t1_c1`, `interaction`.`title` AS `t1_c2`, `interaction`.`link` AS `t1_c3`, `interaction`.`type` AS `t1_c4`, `interaction`.`status` AS `t1_c5`, `interaction`.`createDate` AS `t1_c6` FROM `activities` `t` LEFT OUTER JOIN `interactions` `interaction` ON (`interaction`.`activity_id`=`t`.`id`) WHERE (`t`.`id`=72)
0.000629
26
SELECT `activity_id` AS `c`, COUNT(*) AS `s` FROM `user_activitiesstatus` `t` WHERE (user_id=:user AND isFinished=1) AND (`t`.`activity_id`=72) GROUP BY `activity_id`
0.000451
27
SELECT `event`.`id` AS `t1_c0`, `event`.`group_id` AS `t1_c1`, `event`.`shortAddress` AS `t1_c2`, `event`.`resource_id` AS `t1_c3`, `event`.`type` AS `t1_c4`, `event`.`addType` AS `t1_c5`, `event`.`title` AS `t1_c6`, `event`.`shortDescription` AS `t1_c7`, `event`.`facultyNames` AS `t1_c8`, `event`.`faculty` AS `t1_c9`, `event`.`calendarDate` AS `t1_c10`, `event`.`creditAmount` AS `t1_c11`, `event`.`creditType` AS `t1_c12`, `event`.`shortWhen` AS `t1_c13`, `event`.`fullWhen` AS `t1_c14`, `event`.`venue` AS `t1_c15`, `event`.`shortWhere` AS `t1_c16`, `event`.`fullWhere` AS `t1_c17`, `event`.`createDate` AS `t1_c18`, `event`.`status` AS `t1_c19`, `event`.`description` AS `t1_c20`, `event`.`image` AS `t1_c21`, `event`.`linkout` AS `t1_c22`, `event`.`registrationEnabled` AS `t1_c23`, `event`.`activity_id` AS `t1_c24`, `event`.`adobe_connect_sco` AS `t1_c25`, `event`.`adobe_connect_datetime` AS `t1_c26`, `event`.`users_limit` AS `t1_c27`, `event`.`adobe_connect_duration` AS `t1_c28`, `event`.`calendar_description` AS `t1_c29` FROM `events` `event` WHERE (`event`.`activity_id`=:ypl0)
0.000286
28
SELECT * FROM `activities` `t` WHERE `t`.`id`=72 LIMIT 1
0.000288
29
SELECT * FROM `activities` `t` WHERE `t`.`id`=72 LIMIT 1
0.000285
30
SHOW COLUMNS FROM `questionnaires`
0.000984
31
SHOW CREATE TABLE `questionnaires`
0.000271
32
SELECT * FROM `questionnaires` `t` WHERE t.activity_id=:id AND t.type=:type LIMIT 1
0.000511
33
SHOW COLUMNS FROM `resources`
0.001071
34
SHOW CREATE TABLE `resources`
0.000281
35
SELECT `resource`.`id` AS `t1_c0`, `resource`.`shortAddress` AS `t1_c1`, `resource`.`status` AS `t1_c2`, `resource`.`title` AS `t1_c3`, `resource`.`type` AS `t1_c4`, `resource`.`image` AS `t1_c5`, `resource`.`slides` AS `t1_c6`, `resource`.`linkedResources` AS `t1_c7`, `resource`.`reading` AS `t1_c8`, `resource`.`shortDescription` AS `t1_c9`, `resource`.`fullDescription` AS `t1_c10`, `resource`.`link` AS `t1_c11`, `resource`.`createDate` AS `t1_c12`, `resource`.`archived` AS `t1_c13` FROM `resources` `resource` WHERE (`resource`.`id`=:ypl0)
0.000459
Log Messages
Message (details) Level Category Time