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CME Snapshot™

Evolving Treatment Paradigms For Rheumatoid Arthritis

Translating Comprehensive Patient Evaluations Into Personalized Therapy

Guidelines

2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis.

Singh JA, et al. Arthritis Rheumatol. 2016;68(1):1-26.

Consensus statement on blocking the effects of interleukin-6 and in particular by interleukin-6 receptor inhibition in rheumatoid arthritis and other inflammatory conditions.

Smolen JS, et al. Ann Rheum Dis. 2013;72(4):482-492.

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update.

Smolen JS, et al. Ann Rheum Dis. 2017;76(6):960-977.

Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force.

Smolen JS, et al. Ann Rheum Dis. 2016;75(1):3-15.

Patient and Provider Resources

American College of Rheumatology Disease Overview

The American College of Rheumatology has published a concise overview to help patients and caregivers learn more about rheumatoid arthritis and to provide tips for living well with this rheumatic disease.

American College of Rheumatology Patient Education Videos

The American College of Rheumatology has produced a library of videos about the impact of rheumatic disease, what to do when diagnosed with rheumatic disease, when to see a rheumatologist, and what patients have to say about their experiences of living with rheumatic disease.

Arthritis Foundation

The Arthritis Foundation provides self-care tools and resources covering treatment options, pain management, diet and exercise, and common comorbidities associated with many different arthritic conditions.

EULAR ‘Don’t Delay, Connect Today’ Campaign

This European League Against Rheumatism (EULAR) Campaign aims to raise awareness of the importance of early diagnosis in preventing further damage to those living with rheumatic and musculoskeletal diseases, and to encourage timely access to evidence-based treatment.

European League Against Rheumatism

EULAR is an organization that represents people with arthritis/rheumatism, health professionals, and scientific societies of rheumatology of all the European nations. 

Health Topics: Rheumatoid Arthritis

A resource from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for people who have rheumatoid arthritis, as well as for their family members, friends, and others who want to find out more about this disease. 

Rheumatoid Arthritis Support Network

The Rheumatoid Arthritis Support Network provides up-to-date information for patients with rheumatoid arthritis, including links to patient support groups, blogs written by patients with rheumatoid arthritis, resources to help pay for medications, and smart device apps to help track symptoms over time.

Suggested Readings

American College of Rheumatology 2017 Annual Meeting Abstracts.

November 2017; San Diego, California.

Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice.

Anderson J et al. Arthritis Care Res (Hoboken). 2012;64(5):640-647.

Methotrexate and rheumatoid arthritis: current evidence regarding subcutaneous versus oral routes of administration.

Bianchi G, et al. Adv Ther. 2016;33(3):369-378.

Efficacy and safety of sarilumab monotherapy versus adalimumab monotherapy for the treatment of patients with active rheumatoid arthritis (MONARCH): a randomised, double-blind, parallel-group phase III trial.

Burmester GR, et al. Ann Rheum Dis. 2017;76(5):840-847.

Tocilizumab in early progressive rheumatoid arthritis: FUNCTION, a randomised controlled trial.

Burmester GR, et al. Ann Rheum Dis. 2016;75(6):1081-1091.

Long-term safety of tofacitinib for the treatment of rheumatoid arthritis up to 8.5 years: integrated analysis of data from the global clinical trials.

Cohen SB, et al. Ann Rheum Dis. 2017;76(7):1253-1262.

Baricitinib in patients with inadequate response or intolerance to conventional synthetic DMARDs: results from the RA-BUILD study.

Dougados M, et al. Ann Rheum Dis. 2017;76(1):88-95.

Rituximab versus an alternative TNF inhibitor in patients with rheumatoid arthritis who failed to respond to a single previous TNF inhibitor: SWITCH-RA, aglobal, observational, comparative effectiveness study.

Emery P, et al. Ann Rheum Dis. 2015;74(6):979-984.

Sarilumab and nonbiologic disease-modifying antirheumatic drugs in patients with active rheumatoid arthritis and inadequate response or intolerance to tumor necrosis factor inhibitors.

Fleischmann R, et al. Arthritis Rheumatol. 2017;69(2):277-290.

Improvements in remission and low disease activity are achieved with ongoing sarilumab treatment, in patients with rheumatoid arthritis in 2 phase 3 studies.

Genovese MC, et al. Arthritis Rheumatol. 2017;69(suppl 10):Abstract 2480.

Efficacy and safety of tofacitinib monotherapy, tofacitinib with methotrexate, and adalimumab with methotrexate in patients with rheumatoid arthritis (ORAL Strategy): a phase 3b/4, double-blind, head-to-head, randomised controlled trial.

Fleischmann R, et al. Lancet. 2017;390(10093):457-468.

Sarilumab plus methotrexate in patients with active rheumatoid arthritis and inadequate response to methotrexate: results of a phase III study.

Genovese MC, et al. Arthritis Rheumatol. 2015;67(6):1424-1437.

Comparison of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: the AMBITION study.

Jones G, et al. Ann Rheum Dis. 2010;69(1):88-96.

Filgotinib (GLPG0634/GS-6034), an oral selective JAK1 inhibitor, is effective as monotherapy in patients with active rheumatoid arthritis: results from a randomised, dose-finding study (DARWIN 2).

Kavanaugh A, et al. Ann Rheum Dis. 2017;76(6):1009-1019

Tocilizumab inhibits structural joint damage in rheumatoid arthritis patients with inadequate responses to methotrexate: results from the double-blind treatment phase of a randomized placebo-controlled trial of tocilizumab safety and prevention of structural joint damage at one year.

Kremer JM, et al. Arthritis Rheum. 2011;63(3):609-621.

Cycling versus swapping in patients with rheumatoid arthritis with an inadequate response to at least one tumor necrosis factor alpha inhibitor: asystematic review and meta-analysis of observational study.

Lopez-Olivo MA, et al. Arthritis Rheumatol. 2017;69(suppl 10):Abstract 2483.

Pathogenetic insights from the treatment of rheumatoid arthritis.

McInnes IB, Schett G. Lancet. 2017;389(10086):2328-2337.

Power Doppler ultrasonography detects superior efficacy of non-TNF biologics compared to cycling of TNF inhibitors in RA patients’ inadequate response to first TNF inhibitors.

Nishino A, et al. Arthritis Rheumatol. 2017;69(suppl 10):Abstract 238.

Sarilumab improves patient-reported outcomes in rheumatoid arthritis patients with inadequate response/intolerance to tumour necrosis factor inhibitors.

Strand V, et al. RMD Open. 2017;3(1):e000416.

Sarilumab plus methotrexate improves patient-reported outcomes in patients with active rheumatoid arthritis and inadequate responses to methotrexate: results of a phase III trial.

Strand V, et al. Arthritis Res Ther. 2016;18:198. 

Filgotinib (GLPG0634/GS-6034), an oral JAK1 selective inhibitor, is effective in combination with methotrexate (MTX) in patients with active rheumatoid arthritis and insufficient response to MTX: results from a randomised, dose-finding study (DARWIN 1).

Westhovens R, et al. Ann Rheum Dis. 2017;76(6):998-1008.

Activity
World Arthritis Day And Global Implications Of “Don’t Delay, Connect Today”

Module 1

Activity
Treating To Target Post Methotrexate

New Horizons in RA Therapy From the 2017 ACR/ARHP Annual Meeting

Activity
Longitudinally Managing Rheumatoid Arthritis

Module 3

Activity
JAK Inhibitors in the Management of Rheumatoid Arthritis

Module 4

Activity
Inhibition of IL-6 Signaling in the Management of Rheumatoid Arthritis

Module 5

Activity
New Insights Into Rheumatoid Arthritis Pathophysiology

Module 6

Relevant Resources

Clinical Updates in Systemic Lupus Erythematosus

Improved Diagnostic and Management Strategies

Advances in Immunosupressive Therapy for Solid Organ Transplantation

Long-Term Management Strategies to Improve Patient Outcomes

Clinical Updates on the Management of Gout

Evidence-Based Strategies for Improved Patient Outcomes

Managing Gout in Primary Care

Evolving Strategies for Diagnosis and Long-Term Management

Improving Outcomes in Rheumatoid Arthritis

Treating to Target, IL-6-Directed Therapies, and Evolving Management Algorithms

Clinical Updates in Rheumatoid Arthritis

Evolving Treatment Algorithms and Expert Perspectives on Biosimilars

Going Deeper on Atopic Dermatitis

Pathophysiology to the Management of Moderate-to-Severe Disease

Looking Beneath The Surface In Atopic Dermatitis

Targeting Immune Dysregulation and Delivering Comprehensive Care

Clinical Updates in Rheumatoid Arthritis

New Perspectives on Targeting Remission and Individualizing Therapy

A Better Look at Rheumatoid Arthritis

Using Imaging to Improve Patient Outcomes

Clinical Issues in Rheumatoid Arthritis

Discussions and Debates on the Evolving Roles of Targeted Synthetic DMARDs

Pathways to Better Outcomes in Systemic Lupus Erythematosus

Translating Pathophysiology into Targeted Treatments

The Big Picture of IBD

An Interactive Experience Highlighting Recent Clinical Advances

Clinical Issues in Rheumatoid Arthritis

Debates & Discussions on the Evolving Role of JAK Inhibitors

Clinical Issues in Rheumatoid Arthritis

The Evolving Role of JAK Inhibitors

JAKi in RA Practice

Unpacking the Evidence for Their Use Today and Tomorrow

What’s New in Systemic Lupus Erythematosus?

Unlocking Novel Paths to Patient Care

Expert Views on the Changing Landscape in RA

The Increasing Role of JAK Inhibitors

Updates in Systemic Lupus Erythematosus

Unlocking Novel Paths to Patient Care

Swimming Upstream in Severe Asthma

New Pathways to Patient Management

Optimizing Advanced Therapies in Ulcerative Colitis: Is Your Practice Up to Date?

A Focus on Clinical Evidence and Guideline Recommendations

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Action params
  •  => 
Render methodrenderPartial
View file themes/desktop/views/common/elasticsearch.php
View data
    null
Context YiiDebugToolbarResourceUsage
Context class YiiDebugToolbarResourceUsage
Inheritance CWidget » CBaseController
Defined in file protected/extensions/malyshev/yii-debug-toolbar/widgets/YiiDebugToolbarResourceUsage.php
Context properties
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  •  => 
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Render methodrender
View file protected/extensions/malyshev/yii-debug-toolbar/widgets/views/resources.php
View data
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SQL Queries from 1 connection (21/0.028161s)

Connection ID: db (CDbConnection)

Driver mysql
Server Version 5.5.59-0ubuntu0.14.04.1
Uptime 17w 4d 0h 1m 2s
Threads 1
Questions 48167209
Slow queries 17
Opens 210
Flush tables 1
Open tables 176
Queries per second avg 4.532
Query Count Total (s) Avg. (s) Min. (s) Max. (s)
SHOW COLUMNS FROM `activities`
1 0.005736 0.005736 0.005736 0.005736
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
1 0.004056 0.004056 0.004056 0.004056
SELECT r.id, COUNT(r.id) relevance FROM resources r join `resource_topics` rtj on rtj.`resource_id`=r.id WHERE rtj.`topic_id` in (SELECT topic_id from `resource_topics` rt where rt.`resource_id`=:rid AND rt.topic_id>0) AND r.id <> :rid AND r.status = 'active' Group by r.id order by relevance DESC, r.`createDate` DESC
1 0.003178 0.003178 0.003178 0.003178
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2539444
1 0.002952 0.002952 0.002952 0.002952
SELECT * FROM `resources` `t` WHERE `t`.`id` IN (170, 169, 167, 164, 153, 149, 131, 127, 110, 98, 97, 95, 86, 82, 78, 77, 67, 60, 58, 46, 35, 28, 22, 5)
1 0.002420 0.002420 0.002420 0.002420
SELECT `activities`.`id` AS `t1_c0`, `activities`.`group_id` AS `t1_c1`, `activities`.`resource_id` AS `t1_c2`, `activities`.`title` AS `t1_c3`, `activities`.`type` AS `t1_c4`, `activities`.`facultyNames` AS `t1_c5`, `activities`.`shortDescription` AS `t1_c6`, `activities`.`fullDescription` AS `t1_c7`, `activities`.`creditAmount` AS `t1_c8`, `activities`.`shortAddress` AS `t1_c9`, `activities`.`creditType` AS `t1_c10`, `activities`.`startDate` AS `t1_c11`, `activities`.`finishDate` AS `t1_c12`, `activities`.`sponsors` AS `t1_c13`, `activities`.`status` AS `t1_c14`, `activities`.`createDate` AS `t1_c15`, `activities`.`image` AS `t1_c16`, `activities`.`image_featured` AS `t1_c17`, `activities`.`archived` AS `t1_c18`, `activities`.`managers_list` AS `t1_c19`, `activities`.`is_send_pp_email` AS `t1_c20`, `activities`.`muvi_sync_date` AS `t1_c21`, `activities`.`expert_questions` AS `t1_c22` FROM `activities` `activities` WHERE (`activities`.`resource_id`=:ypl0)
1 0.001822 0.001822 0.001822 0.001822
SHOW COLUMNS FROM `resources`
1 0.001353 0.001353 0.001353 0.001353
SHOW COLUMNS FROM `users`
1 0.001149 0.001149 0.001149 0.001149
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
2 0.001044 0.000522 0.000436 0.000608
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
2 0.001021 0.000510 0.000203 0.000818
SHOW COLUMNS FROM `resource_videos`
1 0.000952 0.000952 0.000952 0.000952
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
2 0.000752 0.000376 0.000166 0.000586
SELECT * FROM `resources` `t` WHERE `t`.`id`=75 LIMIT 1
1 0.000461 0.000461 0.000461 0.000461
SHOW CREATE TABLE `users`
1 0.000322 0.000322 0.000322 0.000322
SHOW CREATE TABLE `activities`
1 0.000271 0.000271 0.000271 0.000271
SHOW CREATE TABLE `resources`
1 0.000252 0.000252 0.000252 0.000252
SHOW CREATE TABLE `resource_videos`
1 0.000230 0.000230 0.000230 0.000230
SELECT `videos`.`id` AS `t1_c0`, `videos`.`vzaar_id` AS `t1_c1`, `videos`.`title` AS `t1_c2`, `videos`.`description` AS `t1_c3`, `videos`.`resource_id` AS `t1_c4`, `videos`.`type` AS `t1_c5` FROM `resource_videos` `videos` WHERE (`videos`.`resource_id`=:ypl0)
1 0.000191 0.000191 0.000191 0.000191
# Query Time (s)
0
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000818
1
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
0.000586
2
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000203
3
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
0.000166
4
SHOW COLUMNS FROM `resources`
0.001353
5
SHOW CREATE TABLE `resources`
0.000252
6
SELECT * FROM `resources` `t` WHERE `t`.`id`=75 LIMIT 1
0.000461
7
SHOW COLUMNS FROM `resource_videos`
0.000952
8
SHOW CREATE TABLE `resource_videos`
0.000230
9
SELECT `videos`.`id` AS `t1_c0`, `videos`.`vzaar_id` AS `t1_c1`, `videos`.`title` AS `t1_c2`, `videos`.`description` AS `t1_c3`, `videos`.`resource_id` AS `t1_c4`, `videos`.`type` AS `t1_c5` FROM `resource_videos` `videos` WHERE (`videos`.`resource_id`=:ypl0)
0.000191
10
SHOW COLUMNS FROM `activities`
0.005736
11
SHOW CREATE TABLE `activities`
0.000271
12
SHOW COLUMNS FROM `users`
0.001149
13
SHOW CREATE TABLE `users`
0.000322
14
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000608
15
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
0.004056
16
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000436
17
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2539444
0.002952
18
SELECT `activities`.`id` AS `t1_c0`, `activities`.`group_id` AS `t1_c1`, `activities`.`resource_id` AS `t1_c2`, `activities`.`title` AS `t1_c3`, `activities`.`type` AS `t1_c4`, `activities`.`facultyNames` AS `t1_c5`, `activities`.`shortDescription` AS `t1_c6`, `activities`.`fullDescription` AS `t1_c7`, `activities`.`creditAmount` AS `t1_c8`, `activities`.`shortAddress` AS `t1_c9`, `activities`.`creditType` AS `t1_c10`, `activities`.`startDate` AS `t1_c11`, `activities`.`finishDate` AS `t1_c12`, `activities`.`sponsors` AS `t1_c13`, `activities`.`status` AS `t1_c14`, `activities`.`createDate` AS `t1_c15`, `activities`.`image` AS `t1_c16`, `activities`.`image_featured` AS `t1_c17`, `activities`.`archived` AS `t1_c18`, `activities`.`managers_list` AS `t1_c19`, `activities`.`is_send_pp_email` AS `t1_c20`, `activities`.`muvi_sync_date` AS `t1_c21`, `activities`.`expert_questions` AS `t1_c22` FROM `activities` `activities` WHERE (`activities`.`resource_id`=:ypl0)
0.001822
19
SELECT r.id, COUNT(r.id) relevance FROM resources r join `resource_topics` rtj on rtj.`resource_id`=r.id WHERE rtj.`topic_id` in (SELECT topic_id from `resource_topics` rt where rt.`resource_id`=:rid AND rt.topic_id>0) AND r.id <> :rid AND r.status = 'active' Group by r.id order by relevance DESC, r.`createDate` DESC
0.003178
20
SELECT * FROM `resources` `t` WHERE `t`.`id` IN (170, 169, 167, 164, 153, 149, 131, 127, 110, 98, 97, 95, 86, 82, 78, 77, 67, 60, 58, 46, 35, 28, 22, 5)
0.002420
Log Messages
Message (details) Level Category Time