RHEUMATOID ARTHRITIS: PRIMARILY AN AUTOIMMUNE DISEASE JOHNATHON DUFTON, MD

RHEUMATOID ARTHRITIS: PRIMARILY AN AUTOIMMUNE DISEASE ACTIVITY DESCRIPTION Rheumatoid arthritis (RA) is an inflammatory type of arthritis characterized by severe joint pain, inflammation and loss of mobility -- particularly within the hands of middle age to elderly women. Symptoms often come and go and can affect other body parts, such as the eyes, mouth and lungs. The causes of RA is unknown, although it's categorized as an autoimmune disease because it appears that the immune system is attacking its own tissues. Genetics, hormones, environment, diet and gastrointestinal health are all related factors. An estimated 1.5 to 2 million American adults currently suffer from RA. There are natural remedies, lifestyle changes and pharmaceutical treatments that help reduce the symptoms of RA and slow its progression. TARGET AUDIENCE The target audience for this activity is pharmacists, pharmacy technicians, and nurses in hospital, community, and retail pharmacy settings. LEARNING OBJECTIVES After completing this activity, the pharmacist and nurse will be able to: Describe the pathophysiology, frequency and implications of rheumatoid arthritis (RA) Outline the non-pharmacological methods used to treat RA Compare and contrast the most common pharmaceuticals used to treat RA, including mechanism of action and potential side effects ACCREDITATION PHARMACY PharmCon, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. NURSING PharmCon, Inc. is approved by the California Board of Registered Nursing (Provider Number CEP 13649) and the Florida Board of Nursing (Provider Number 50-3515). Activities approved by the CA BRN and the FL BN are accepted by most State Boards of Nursing. CE hours provided by PharmCon, Inc. meet the ANCC criteria for formally approved continuing education hours. The ACPE is listed by the AANP as an acceptable, accredited continuing education organization for applicants seeking renewal through continuing education credit. For additional information, please visit http://www.nursecredentialing.org/renewalrequirements.aspx Universal Activity No.: 0798-0000-13-252-H01-P&T Credits: 1 contact hour (0.1 CEU) Release Date: July 21, 2014 Expiration Date: July 21, 2016 ACTIVITY TYPE Knowledge-Based Home Study Webcast FINANCIAL SUPPORT BY Pharmaceutical Education Consultants, Inc. After completing this activity, the pharmacy technician will be able to: List signs and symptoms of Rheumatoid Arthritis (RA) List pharmacological and nonpharmacological treatments for RA 1

ABOUT THE AUTHOR Johnathon Dufton M.D. is a physician and previously was employed at Queen's University, Ontario, Canada in the Department of Radiology. He is also on the Editorial Board of the Journal of the Canadian Chiropractic Association (JCCA) where his roles include editing and reviewing text books. He is a researcher who enjoys writing and speaking about the pathophysiology and pharmacological treatment of diseases and conditions. Johnathon Dufton, MD Medical Writer & Speaker, Wellness Partners FACULTY DISCLOSURE It is the policy of PharmCon, Inc. to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer of any commercial product(s) and/or service(s) discussed in an educational activity. Johnathon Dufton reports no actual or potential conflict of interest in relation to this activity. Peer review of the material in this CE activity was conducted to assess and resolve potential conflict of interest. Reviewers unanimously found that the activity is fair balanced and lacks commercial bias. Please Note: PharmCon, Inc. does not view the existence of relationships as an implication of bias or that the value of the material is decreased. The content of the activity was planned to be balanced and objective. Occasionally, authors may express opinions that represent their own viewpoint. 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 or pharmacy management. Conclusions drawn by participants should be derived from objective analysis of scientific data presented from this monograph and other unrelated sources. 2

ACTIVITY TEST 1. What is the most common type of arthritis? A. Osteoarthritis B. Rheumatoid arthritis C. Gout D. Degenerative arthritis of the ankle 2. What part of the joint does RA primarily inflame? A. The lining of synovial joints, called the synovium B. The liquid of synovial joints, called the synovial fluid C. The cartilage of all joints D. The tendons and ligaments surrounding synovial joints 3. How frequently does RA affect organs such as the lungs, eyes or heart? A. In virtually all cases B. Estimates are between 5-10% of cases C. Estimates are between 15-25% of cases D. In about 50% of cases 4. What type of autoimmune disease is RA usually classified as? A. Type I B. Type II C. Type III D. Type IV 5. How much more common is RA among women compared to men? A. 15% more common in women B. 25% more common in women C. 1.5X more common in women D. 2-3X more common in women 13

6. Which of the following herbal remedies is NOT commonly used for RA symptoms? A. Turmeric root B. Oak bark C. Devil s claw D. Thunder god vine 7. What percentage of RA cases are seronegative (no rheumatoid factors found)? A. 5% B. 15-20% C. 30-40% D. 55% 8. Which class of drug is used as a bridge therapy (in low doses) for RA? A. Narcotics / opioids B. DMARDs C. Corticosteroids D. TNF-alpha inhibitors 9. Which of the following drugs can only be injected? A. Diclofenac B. Oxycodone C. Methadone D. Tramadol 10. Which NSAID drug is NOT linked to increased risk of cardiovascular disease such as heart attack? A. Mll biologics (biologic response modifiers) B. Methotrexate C. Corticosteroids D. JAK inhibitors Please submit your final responses on freece.com. Thank you. 14