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Elevating Rheumatic Disease Care: Case Challenges in Understanding and Addressing Health Disparities

  • Authors: Iris Navarro-Millán, MD, MSPH
  • CME / ABIM MOC / CE Released: 12/28/2022
  • Valid for credit through: 12/28/2023, 11:59 PM EST
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    Nurses - 1.00 ANCC Contact Hour(s) (0.25 contact hours are in the area of pharmacology)

    IPCE - 1.0 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for rheumatologists, dermatologists, primary care physicians (PCPs), nurse practitioners (NPs), physician assistants (PAs), nurses, and other healthcare professionals (HCPs) who provide care to patients with rheumatic disease.

The goal of this activity is for learners to be better able to recognize health disparities in rheumatologic care, specifically among patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) and mitigate inequities in their own practice through the application of evidence-based tools and strategies.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Assessment of social determinants of health for patients with rheumatic disease
    • Patient communication strategies
  • Have greater competence related to
    • Individualizing care for patients with rheumatic disease
  • Demonstrate greater confidence in their ability to
    • Provide equitable team-based care to patients with rheumatic disease


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All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.

Disclosures for additional planners can be found here.


  • Iris Navarro-Millán, MD, MSPH

    Assistant Professor of Medicine
    Weill Cornell Medicine
    Hospital for Special Surgery
    New York, New York


    Iris Navarro-Millán, MD, MSPH, has the following relevant financial relationships:
    Other: Served on an advisory board for Swedish Orphan Biovitrum


  • Karen Badal, MD, MPH

    Senior Medical Education Director, Medscape, LLC


    Karen Badal, MD, MPH, has no relevant financial relationships.

  • Ashley Stumvoll, MRes

    Associate Medical Writer, Medscape, LLC


    Ashley Stumvoll, MRes, has no relevant financial relationships.

Compliance Reviewer/Nurse Planner

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

Accreditation Statements


Interprofessional Continuing Education

In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.


This activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) credit for learning and change.

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  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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    For Nurses

  • Awarded 1.0 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.25 contact hours are in the area of pharmacology.

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

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Elevating Rheumatic Disease Care: Case Challenges in Understanding and Addressing Health Disparities

Authors: Iris Navarro-Millán, MD, MSPHFaculty and Disclosures

CME / ABIM MOC / CE Released: 12/28/2022

Valid for credit through: 12/28/2023, 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.

Case 1: Isabel

Isabel, a 67-year-old patient, presents to your rheumatology clinic reporting persistent joint pain and swelling in her hands and feet. She reports some fatigue but no other symptoms. She also reports that pain, stiffness, and swelling of her hands are most severe in the morning. She denies any previous history or related trauma. The pain has been present for almost 1 year, with worsening severity. Onset was unknown. Isabel was referred to your clinic by her primary care physician, who started her on prednisone for her pain and swelling. She has a medical history of prediabetes and hypertension, for which she takes lisinopril. She has no allergies, no known family history, and is up to date on her immunizations. She does not smoke or drink alcohol.

Isabel immigrated from Guatemala over 30 years ago and is now a naturalized citizen, but she is still less confident in her ability to communicate in English rather than in her native language of Spanish. Isabel’s daughter, Pía, accompanies her to the appointment to assist. Pía reports that Isabel was referred to your clinic 3 months ago but had been unable to get an initial appointment until now.
On physical exam, her blood pressure is 110/70 mm Hg, heart rate 81 bpm, and her temperature is 99.5°F. Joint counts confirm the presence of 24 tender joints and 22 swollen joints, in a symmetrical pattern. No skin findings or nodules. Other body systems appear normal. Based on her history and presentation, you order further workup.

  • Laboratory studies are significant for an erythrocyte sedimentation rate (ESR) of 35 mm/h (normal range, 0 to 20 mm/h), C-reactive protein (CRP) of 4 mg/dL (normal range, 0.08 to 3.1 mg/dL), and positivity for rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA).
  • Ultrasonography and x-ray findings also show changes of RA in the metacarpophalangeal and proximal interphalangeal joints of the hands, and the metatarsophalangeal and proximal interphalangeal joints in the feet.

Based on these findings, a diagnosis of RA is made.

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