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Case Challenges in Rheumatoid Arthritis: Practice Your Skills

  • Authors: Vibeke Strand, MD
  • CME / ABIM MOC Released: 10/20/2021
  • Valid for credit through: 10/20/2022, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for an identified target audience of rheumatologists, primary care physicians, and obstetricians/gynecologists.

The goal of this activity is to increase clinicians' competence and confidence in managing patients with moderate to severe rheumatoid arthritis (RA).

Upon completion of this activity, participants will:

  • Have greater competence related to
    • Identifying active disease in patients being treated for RA
    • Selecting appropriate therapy for patients with uncontrolled moderate to severe RA


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Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • Vibeke Strand, MD

    Biopharmaceutical Consultant
    Adjunct Clinical Professor
    Division of Immunology and Rheumatology
    Stanford University
    Palo Alto, California


    Disclosure: Vibeke Strand, MD, has the following relevant financial relationships:
    Advisor or consultant for: AbbVie, Inc; Amgen; Arena; AstraZeneca; Bayer; Bristol Myers Squibb; Boehringer Ingelheim; Celltrion; Eli Lilly; Galapagos; Genentech; Gilead; GlaxoSmithKline; Horizon; Ichnos; InMedix; Janssen; Kiniksa; Merck; Myriad Genetics; Novartis; Pfizer; Regeneron; Rheos; Roche; R-Pharma; Samsung; Sandoz; Sanofi; Scipher; Setpoint; Sun Pharma; UCB


  • Karen Badal, MD, MPH

    Senior Medical Education Director, Medscape, LLC 


    Disclosure: Karen Badal, MD, MPH, has disclosed no relevant financial relationships.

  • Christina T. Loguidice

    Medical Writer, Medscape, LLC


    Disclosure: Christina T. Loguidice has disclosed no relevant financial relationships.

CME Reviewers

  • Amy Bernard, MS, BSN, RN-BC, CHCP

    Director, Accreditation and Compliance, Medscape, LLC


    Disclosure: Amy Bernard, MS, BSN, RN-BC, CHCP, has disclosed no relevant financial relationships.

  • Susan L. Smith, MN, PhD

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Disclosure: Susan L. Smith, MN, PhD, has disclosed no relevant financial relationships.

None of the nonfaculty planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

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    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

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Case Challenges in Rheumatoid Arthritis: Practice Your Skills

Authors: Vibeke Strand, MDFaculty and Disclosures

CME / ABIM MOC Released: 10/20/2021

Valid for credit through: 10/20/2022, 11:59 PM EST


The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.


Anna is a 26-year-old graduate student who presents to her primary care physician after a 1-month history of morning stiffness in the joints of her fingers, particularly in her dominant hand. The stiffness usually lasts a few hours and is accompanied by polyarticular pain and swelling. She reports some fatigue but no other symptoms and has no significant medical or family history. She does not smoke or drink alcohol. Laboratory studies are significant for an erythrocyte sedimentation rate (ESR) of 40 mm/h (normal range, 0-20 mm/h), C-reactive protein (CRP) of 5 mg/dL (normal range, 0.08-3.1 mg/dL), and positivity for rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA). Ultrasonography shows inflammation in both hands. In her dominant hand, there is significant synovitis (swelling and tenderness) across her proximal interphalangeal (PIP) joints, her metacarpophalangeal (MCP) joints, and in her carpal bones and wrist. The findings are similar in her nondominant hand, but the inflammation is not quite as severe. X-ray also shows well-defined bony erosions in the carpal bones and metacarpal bases. Based on these findings, a diagnosis of rheumatoid arthritis (RA) is made. She is started on oral methotrexate, 15 mg weekly, as well as 2 capsules of celecoxib 200 mg daily.

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