Online Monograph

Estimated Time of Completion

Description

Rheumatologists are accustomed to monitoring liver function in patients receiving treatment for rheumatoid arthritis (RA), largely because of the risks associated with methotrexate (MTX). Now, after more than a decade of use, a clearer picture of the liver effects of biologic agents is developing. These effects appear to include a variety of uncommon toxicities such as the potential to activate latent tuberculosis (TB), demyelinating disorders, and certain neoplasms. On the other hand, evidence suggests that some biologics might offer the opportunity for benefit in the treatment of autoimmune and certain forms of viral hepatitis, in conjunction with standard antiviral therapy. These issues are at the forefront of new research into immune system biology. They formed the basis for an in-depth discussion between rheumatologist Dr. Leonard Calabrese and hepatologist Dr. Nizar Zein. This monograph is a detailed report of that discussion into the hepatic effects of biologic agents in the treatment of rheumatoid arthritis and their potential for the treatment of viral hepatitis.

Objectives

At the conclusion of this activity, the participant will be able to:

1. Identify mechanisms underlying the role of cytokines in host-defense and propagation of liver disease.
2. Adapt clinical decision making to new information about the relative risks and possible benefits of biologic therapy on forms of chronic hepatitis.
3. Apply new screening and monitoring guidelines for the use of biologic therapy in patients at risk or affected by chronic liver disease.

Target Audience

Rheumatologists, rheumatology fellows, and other health care professionals who care for patients with rheumatoid arthritis.

Accreditation

The Cleveland Clinic Foundation Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Cleveland Clinic Foundation Center for Continuing Education designates this educational activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity may be submitted for American Osteopathic Association Continuing Medical Education credit in Category 2.

Activity Director

Leonard H. Calabrese, DO
Professor of Medicine
Cleveland Clinic Lerner College of Medicine
   of Case Western Reserve University
Vice Chairman
Department of Rheumatic & Immunologic Diseases
R.J. Fasenmyer Chair of Clinical Immunology
Orthopaedic & Rheumatologic Institute
Cleveland Clinic
Cleveland, Ohio

Faculty

Leonard H. Calabrese, DO (Activity Director) ; Nizar N. Zein, MD

Faculty Disclosure

In accordance with the Standards for Commercial Support issued by the Accreditation Council for Continuing Medical Education (ACCME), The Cleveland Clinic Foundation Center for Continuing Education requires resolution of all faculty conflicts of interest to ensure CME activities are free of commercial bias.

The following faculty has indicated that he may have a relationship, which in the context of his discussion could be perceived as a conflict of interest:

The following faculty has indicated that he has no relationship which, in the context of his discussion, could be perceived as a potential conflict of interest.

Nizar N. Zein, MD