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Disease Management Clinical Decisions

Alternatives to Methotrexate Therapy for Rheumatoid Arthritis

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Release Date: January 1, 2019
Expiration Date: January 1, 2022

Estimated Time of Completion:  1 hour


Each lesson in the Disease Management Clinical Decisions series provides a brief, case-based review of management strategies related to the topic. Questions and multiple-choice answers about the case presented include the rationale for the correct answer. Throughout this case-based lesson, you may proceed to the next question once you answer the question correctly.

Learning Objectives

After completing this case the reader should be able to:

  • Critically assess efficacy and side effects of methotrexate use in patients with rheumatoid arthritis.
  • Describe potential alternatives to methotrexate for patients with active RA.
  • Identify the pros and cons regarding treat-to-target strategies in rheumatology.
  • Describe the efficacy and side effects of JAK-inhibitor therapy for RA, and devise strategies to prevent them.
  • Recognize the effect of RA on patients’ sleep and fatigue, and describe strategies to address these in clinical practice.

Target Audience

Directed to primary care physicians including family practitioners and internists.


In support of improving patient care, Cleveland Clinic Center for Continuing Education is jointly accredited 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.

The Cleveland Clinic Foundation Center for Continuing Education designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Participants claiming CME credit from this activity may submit the credit hours to the American Osteopathic Association for Category 2 credit.

Activity Director and Faculty

Activity Director

Anthony Fernandez, MD, PhD
Director, Medical and Inpatient Dermatology
W.D. Steck Chair of Clinical Dermatology
Co-Medical Director, Center for Continuing Education
Cleveland Clinic
Cleveland, OH


Leonard H. Calabrese, DO
Professor of Medicine
Cleveland Clinic Lerner College of Medicine
R.J. Fasenmyer Chair of Clinical Immunology
Orthopaedic and Rheumatologic Institute
Cleveland Clinic
Cleveland, OH

CME Disclaimer

The information in this educational activity is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition. The viewpoints expressed in this CME activity are those of the authors/faculty. They do not represent an endorsement by The Cleveland Clinic Foundation. In no event will The Cleveland Clinic Foundation be liable for any decision made or action taken in reliance upon the information provided through this CME activity.


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 have indicated that they have no relationship which, in the context of their presentation, could be perceived as a potential conflict of interest:

Leonard H. Calabrese, DO
  Abbvie Pharmaceuticals; BMS; Genentech/Roche; Janssen; Novartis Consulting; Teaching and Speaking
  Crescendo Teaching and Speaking
  GSK; Horizon Pharma; Pfizer; Regeneron; Sanofi Aventis; UCB Consulting
Anthony Fernandez, MD, PhD
  Novartis Consulting; Independent contractor (including contracted research); Teaching and Speaking
  Abbvie Pharmaceuticals Consulting; Teaching and Speaking
  Pfizer, Inc. Independent contractor (including contracted research)
  Celgene Corporation Consulting
  Mallinckrodt Inc. Independent contractor (including contracted research);
Teaching and Speaking
  Roche Pharmaceuticals Principal Investigator for a Phase III Clinical Trial


This CME activity was produced by The Cleveland Clinic Foundation
Center for Continuing Education.