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Five health care professionals provide insight into rheumatoid arthritis and its effect on patients and their functionality.

Educational objectives:

Upon completion of this activity, participants should be able to:

  • Improve outcomes for patients with rheumatoid arthritis by implementing a "treat to target" strategy of patient care that includes objective measures of disease activity
  • Improve patient outcomes by identifying activity limitations and participation restrictions and making appropriate recommendations and referrals
  • Identify how signs and symptoms affect function for patients with RA
  • Discuss 4 ways in which patients with RA adapt activities to continue to function
  • Describe methods to assess functional limitations in patients with RA
  • Discuss educational strategies that physicians and nurses can use to help RA patients improve their communication of functional capabilities to health care providers
  • Perform an office based assessment of function on a patient with RA using the MDHAQ as an anchor

Reading Resources:

  1. Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Annals of Rheumatic Diseases. 2010;69(4):631-7.
  2. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham COr, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheumatism. 2010;62(9):2569-81.
  3. Felson DT, Smolen JS, Wells G, Zhang B, van Tuyl LH, Funovits J, et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis & Rheumatism. 2011;63(3):573-86.
  4. Grigor C, Capell H, Stirling A, McMahon AD, Lock P, Vallance R, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet. 2004;364(9430):263-9.
  5. Stucki, G., Cieza, A., Geyh, S., Battistella, L., Lloyd, J., Symmons, D., Kostanjsek, N., Schouten, J. (2004). ICF Core sets for rheumatoid arthritis. Journal of Rehabilitation Medicine, 44 Suppl, 87-93.
  6. World Health Organization (2001). International Classification of Functioning, Disability and Health. Geneva: WHO
  7. Furst GP, Gerber LH, Smith CC, Fisher S, Shulman B. A program for improving energy conservation behaviors in adults with rheumatoid arthritis. Am J Occup Ther 1987;41:102-11.
  8. Hammond A, Lincoln N, Sutcliffe L. A crossover trial evaluating an educational-behavioural joint protection programme for people with rheumatoid Arthritis. Patient Educ Couns 1999;37:19-32.
  9. Neuberger GB, Smith KV, Black SO, Hassanein R. Promoting self-care in clients with arthritis. Arthritis Care Res 1993;6:141-148.
  10. Smolen JS, Aletaha D, Koeller M, et al. New therapies for treatment of rheumatoid arthritis. Lancet. 2007;370:1861-1874.
  11. van der Heijde DM, van 't Hof MA, van Riel PL, van de Putte LB. Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol. 1993;20:579-581.
  12. Prevoo ML, van 't Hof MA, Kuper HH, et al. Modified disease activity scores that include twenty-eight-joint counts: development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44-48.
  13. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 2005;52:3381-3390.
  14. Bakker MF, Jacobs JW, Verstappen SM, Bijlsma JW. Tight control in the treatment of rheumatoid arthritis: efficacy and feasibility [published correction appears in Ann Rheum Dis. 2008;67:140]. Ann Rheum Dis. 2007;66(suppl 3):iii56-60.
  15. Fuchs HA, Brooks RH, Callahan LF, Pincus T. A simplified twenty-eight-joint quantitative articular index in rheumatoid arthritis. Arthritis Rheum. 1989;32:531-537.
  16. Standring S, ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 39th ed. Edinburgh: Elsevier Churchill Livingstone; 2005.
  17. Rauch, A., Kirchberger, I., Boldt, C., Cieza, A., & Stucki, G.  (2009).  Does the comprehensive international classification of functioning, disability and health (ICF) core set for rheumatoid arthritis capture nursing practice?  A delphi survey.  International Journal of Nursing Studies, 46(10), 1320-1334.
  18. Dewing, K. A., Fritz, J., Furfaro, N. M., Kortan, J. M., & Ruffing, V.  (2010).  The evolving role of the rheumatology nurse.  Rheumatology Nurse Newsletter, 3(4), 3-12.
  19. van Eijk-Hustings, Y., van Tubergen, A., Bostrom, C., Braychenko, E., Buss, B., Felix, J., … Hill, J.  (2012).  EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis.  Annals of the Rheumatic Diseases, 71, 13-19.  doi:10.1136/annrheumdis-2011-200185
  20. The Multi-Dimensional Health Assessment Questionnaire (MDHAQ)


Dr. Nancy Baker, Dr. Schlenk, Dr. Rogers, and Dr. Starz have no relevant relationships with any entities producing healthcare goods or services.

Dr. Levesque has financial interests with the following any entity or entities producing health care goods or services as indicated below:

  • Grant/Research Support: Genentech (Grant, CME), Amgen (Grant), UCB (CME)
  • Consultant: Genentech, UCB, CRESCENDO

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.1) continuing education units (CEU) which are equivalent to 1.0 contact hours.

For your credit transcript, please access our website 4 weeks post-completion at and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 4/19/2012 | Last Modified On: 4/19/2012 | Expires: 4/18/2013

This course has been expired.