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1. The etiology-pathophysiology of rheumatoid arthritis (RA) includes which of the following:

A. Osteomyelitis of the joint B. Pannus C. Trauma as the inciting cause D. All of the above

2. In regard to the immune system, which of the following are involved in the development of RA?

A. Tumor necrosis factor (TNF) B. B lymphocytes C. Complement (C) D. All of the above

3. From the time of an RA diagnosis, roughly _____% of patients leave the work force within 10 years.

A. 10 B. 25 C. 50 D. 75

4. The goals of treatment of rheumatoid arthritis are which of the following:

A. Control systemic complications B. Prevent loss of joint function C. Improve or maintain quality of life D. All of the above

5. In the Developing Superior Understanding of RA Patients' Needs (DESIGN) study,

A. 37% of patients were dissatisfied or extremely dissatisfied with their level of pain from RA B. 47% of patients were extremely satisfied with their level of pain from RA C. Most patients were found to be in remission and extremely satisfied with their level of pain control D. Only 9% of patients were dissatisfied or extremely dissatisfied with their level of pain from RA

6. Which category of drug is considered first-line therapy for the treatment of a newly diagnosed patient with RA

A. Nonsteroidal anti-inflammatory drugs (NSAIDs) B. Biologic disease modifying antirheumatic drugs (biologic DMARDs) C. Disease modifying antirheumatic drugs (DMARDs) D. Corticosteroids

7. In general, patients on methotrexate (MTX) should also be taking which drug concomitantly?

A. NSAIDs B. Folic Acid C. Corticosteroids D. All of the above

8. Which therapy requires routine ophthalmological assessment?

A. Hydroxychloroquine B. Leflunomide C. Methotrexate D. Suflasalazine

9. Sulfasalizine

A. Is a prodrug B. Can stain body fluids yellowish-orange C. Effectiveness can be altered by concurrent antibiotic use D. All of the above

10. In general, patients considering treatment with an anti-TNF biologic DMARD

A. Should be screened for tuberculosis prior to initiation of therapy B. Should not be treated during the course of an acute infection C. Be made aware that in general routine laboratory monitoring is not required D. All of the above

11. The most current ACR guideline for the treatment of RA recommends an anti-TNF-α agent plus MTX for patients who have

A. High disease activity for 3 months or longer B. A poor prognosis C. No barriers related to treatment cost D. All of the above

12. Which of the following is NOT an anti-TNF therapy:

A. Etanercept B. Infliximab C. Certolizumab D. Abatacept

13. A biologic developed to treat RA that is conjugated with polyethylene glycol (PEG) is

A. Certolizumab B. Infiximab C. Denosumab D. Etanercept

14. A biologic DMARD that involves interleukin-6 (IL-6) is

A. Golimumab B. Anakinra C. Abatacept D. Tocilizumab

15. Which biologic DMARD depletes B-lymphocytes

A. Anakinra B. Abatacept C. Rituximab D. Etanercept

16. Counseling points that should be covered by pharmacists when managing patients with RA include which of the following:

A. The need for constant and regular contact with a rheumatologist B. The importance or reporting any changes in general health as changes could involve disease progression or drug side effects C. The importance of weight reduction, rest, and the appropriate use of assistive devices D. All of the above

17. In regard to treating RA, “tight control” is defined as

A. A treatment strategy that results in a 50% reduction in C-reactive protein serum levels B. A treatment strategy with a goal of achieving remission for a minimum of 5 years C. A treatment strategy with a goal of achieving a predefined level of low disease activity or remission within a certain period of time D. A treatment strategy that results in reversal of joint damage

18. The BeSt Trial demonstrated that in patients with early RA disease activity,

A. Sequential monotherapy was superior B. Oral MTX monotherapy was superior C. Combination therapies were associated with less radiologic damage after 1 year and patients experienced greater functional improvement D. Combined anti-TNF-α therapy, along with IL-1 or IL-6 antagonists therapies, were superior

19. In regard to anti-TNF-α agents for the treatment of RA,

A. 95% of patients have a superior response B. Patients may have no response to an agent or a suboptimal response C. Patients who have a suboptimal response to an anti-TNF-α therapy require the addition of an anti-interleukin or anti-T or B lymphocyte therapy D. Most patients on anti-TNF-α therapy require routine intra-articular injections of corticosteroids

20. Which statement supports the current approach to treating RA?

A. Patients with RA often need to receive triple conventional DMARD therapy to induce remission B. In select patients, switching biologic DMARD therapy is reasonable C. Most RA patients benefit from dual biologic DMARD therapy D. All of the above

Evaluation Questions

21. In an effort to better determine the overall impact of continuing education activities, the Postgraduate Institute for Medicine (PIM) is conducting measurements of educational effectiveness. Listed below are several demographic questions to better identify who is in the audience and several statements for which we would like you to rate your level of agreement/disagreement. All information obtained in this process will be used and reported in aggregate only, without individual attribution. Thank you for your participation. What is your practice type?

A. Pharmacist B. MD/DO C. Pharmacy technician D. Other

22. To what extent do you agree with the following statements? A disease-modifying antirheumatic drug (DMARD) should be included in the treatment plan for every patient newly diagnosed with rheumatoid arthritis.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

23. A patient taking hydroxychloroquine for the treatment of RA that has shown no response to therapy after 3 months is considered to have a primary failure to treatment.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

24. According to current ACR Guidelines, the initial therapy recommended for a newly diagnosed patient with RA presenting with a negative RF test, normal functional status, and a 2.5 month history of persistent synovititis in several joints bilaterally, should be considered for combination therapy with both an anti-TNF agent and methotrexate, providing there are no cost barriers.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

25. Now that you have participated in this activity, how often do you plan to engage in the following practice behavior? Assess for the use of folic acid supplementation in RA patients on methotrexate therapy.

A. Never B. Rarely C. Sometimes D. Very Often E. Always F. Not Within My Scope of Practice

26. Counsel patients taking certolizumab or golibumab to monitor their blood pressure at regular intervals while on these therapies.

A. Never B. Rarely C. Sometimes D. Very Often E. Always F. Not Within My Scope of Practice

27. Educate patients on the need to follow their practitioners' recommendations for nonpharmacological modalities of therapy, including regular physical activity, appropriate rest and use of assistive devices as appropriate.

A. Never B. Rarely C. Sometimes D. Very Often E. Always F. Not Within My Scope of Practice

28. To what extent did the program meet objective #1?

A. Excellent B. Very Good C. Good D. Fair E. Poor F. N/A to Pharmacy Technicians

29. To what extent did the program meet objective #2?

A. Excellent B. Very Good C. Good D. Fair E. Poor F. N/A to Pharmacy Technicians