Saturday, June 10, 2023
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Biopharmaceutical Consultant
Adjunct Clinical Professor
Division of Immunology and Rheumatology
Stanford University
Palo Alto, California
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The goal of this activity is to increase clinicians' competence and confidence in managing patients with moderate to severe rheumatoid arthritis (RA).
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As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
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.
Biopharmaceutical Consultant
Adjunct Clinical Professor
Division of Immunology and Rheumatology
Stanford University
Palo Alto, California
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.
This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.
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CME / ABIM MOC Released: 10/20/2021
Valid for credit through: 10/20/2022
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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.
