Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune disease characterized by the progressive destruction of the synovial joints, including loss of cartilage and bone. If RA is diagnosed early, and treatment with disease-modifying antirheumatic drug (DMARD) therapy is initiated within 3 to 4 months of disease onset, the clinical outlook for patients can be quite favorable. In established RA, the management goals are to keep the disease activity as low as possible with the use of DMARDs and to prevent radiographic joint damage progression, with the aim of alleviating pain, maintaining function for activities of daily living and work, and optimizing quality of life. Approximately 40% of patients with established RA have comorbidities, including cardiovascular events, infection, malignancies, and various organ dysfunctions. Therefore, other important goals in the management of established RA are to keep the toxicity of therapeutic interventions at acceptable levels and to control or prevent RA-related comorbidities. This newsletter will discuss the ongoing management of patients with established RA.

• Differentiate nonbiologic and biologic disease-modifying antirheumatic drug (DMARD) therapies used in rheumatoid arthritis (RA) patients, and understand some of the potential mechanisms of action of approved biologic DMARDs
• Describe the clinical issues that should be considered when initiating or changing DMARD therapy in RA patients
• Describe potential roles of the primary care clinician in the ongoing management of patients with RA
• Describe the possible adverse effects that may be associated with drug therapy

Clifton O. Bingham III, MD
Assistant Professor of Medicine
Divisions of Rheumatology and Allergy
Johns Hopkins University
Baltimore, MD

Joyce P. Carlone, MN, RN, CFNP, CCRC
Nurse Practitioner
Division of Rheumatology
Emory University
Atlanta, GA

Karen H. Costenbader, MD, MPH
Associate Physician
Division of Rheumatology, Immunology, and Allergy
Brigham and Women's Hospital
Boston, MA

David S. Kountz, MD, MBA, FACP
Senior Vice President, Medical and Academic Affairs
Jersey Shore University Medical Center
Neptune, NJ;
Associate Professor of Medicine and Associate Dean
Robert Wood Johnson Medical School
New Brunswick, NJ

Louis Kuritzky, MD
Clinical Assistant Professor
Department of Community Health and Family Medicine
Family Medicine Residency Program
University of Florida
Gainesville, FL

Martin Miner, MD
Clinical Associate Professor of Family Medicine
Warren Alpert School of Medicine
Brown University
Providence, RI;
Clinical Assistant Professor of Family Medicine
Swansea Family Practice Group
Swansea, MA

Michael E. Weinblatt, MD - Program Chair
John R. and Eileen K. Riedman Professor of Medicine
Harvard Medical School;
Co-Director, Clinical Rheumatology
Brigham and Women's Hospital
Boston, MA

Arthur Kavanaugh, MD
Professor of Medicine
University of California School of Medicine, San Diego
Director, Center for Innovative Therapy
UCSD Division of Rheumatology, Allergy, and Immunology
San Diego, CA

David S. Kountz, MD, MBA, FACP
Senior Vice President, Medical and Academic Affairs
Jersey Shore University Medical Center
Neptune, NJ;
Associate Professor of Medicine and Associate Dean
Robert Wood Johnson Medical School
New Brunswick, NJ

The Chatham Institute is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Chatham Institute designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

It is the policy of The Chatham Institute to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. All faculty, planners, and managers who affect the content of medical education activities sponsored by The Chatham Institute are required to disclose to the audience any real or apparent conflict of interest related to the activity. Faculty, planners, and managers not complying with the disclosure policy will not be permitted to participate in this activity.

Program faculty and planners have disclosed the financial relationships with commercial interests cited below. All program content has been peer reviewed for balance and any potential bias. The conflict of interest resolution process aims to ensure that financial relationships with commercial interests and resultant loyalties do not supersede the public interest in the design and delivery of continuing medical education activities for the profession.

Clifton O. Bingham III, MD
Consulting Fees: Abbott Laboratories, Amgen Inc., Bristol-Myers Squibb Company
Contracted Research: Genentech, Inc.
Grant Support: Abbott Laboratories, Amgen Inc., Bristol-Myers Squibb Company, Genentech, Inc.

Joyce P. Carlone, MN, RN, CFNP, CCRC
Advisory Board and Consultant: UCB Pharma, Inc.
Speaker Bureaus: UCB Pharma, Inc., Wyeth Pharmaceuticals

Karen H. Costenbader, MD, MPH
Ownership Interest: Bristol-Myers Squibb Company

Louis Kuritzky, MD
No real or apparent conflicts to report

Martin Miner, MD
No real or apparent conflicts to report

Michael E. Weinblatt, MD
Consulting Fees: Abbott Laboratories, Alza Corporation, Amgen Inc., AstraZeneca Pharmaceuticals, Bioassets Development Corporation, Biogen Idec, Bristol-Myers Squibb Company, Can-Fite BioPharma Ltd., Celgene Corporation, Centocor, Inc., Critical Therapeutics, Inc., Eli Lilly and Company, EntreMed, Inc., F. Hoffman-La Roche Ltd, Genentech, Inc., Gilead, Human Genome Sciences, Merck & Co., Inc., Merrimack Pharmaceuticals, Inc., Millennium Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Pfizer Inc, Praecis Pharmaceuticals, Proprius Pharmaceuticals, Inc., Rigel, sanofi-aventis U.S. LLC, Scios, Inc., Serono Pharmaceutical Company, Synta Pharmaceuticals Corp., Trubion Pharmaceuticals Inc., VBL, Wyeth Pharmaceuticals
Data and Safety Monitoring Boards: F. Hoffman-La Roche Ltd, University of Alabama (Tear Study)
Research Grants: Abbott Laboratories, Amgen Inc., Arthritis Foundation, Bristol-Myers Squibb Company, Genentech, Inc., Millennium/Biogen

Arthur Kavanaugh, MD
Research Grants: Abbott Laboratories, Bristol-Myers Squibb Company, Centocor, Inc., Genentech, Inc., Johnson & Johnson, Pfizer Inc, Roche

David S. Kountz, MD, MBA, FACP
Honoraria: AstraZeneca Pharmaceuticals, Novartis Pharmaceuticals Corporation, Pfizer Inc, sanofi-aventis U.S. LLC

Daniel Duch, PhD
Medical Director, The Chatham Institute
No real or apparent relationships to disclose

Cynthia Fontan, MPA
Education Manager, The Chatham Institute
No real or apparent relationships to disclose

This educational activity is sponsored by The Chatham Institute. Support for this independent educational activity is provided by educational grants from Abbott Laboratories, Centocor, Inc., and Genentech and Biogen Idec.