Improving Outcomes for Patients With Gout

This activity is jointly provided by Global Education Group and Integritas Communications.

This activity is supported by an educational grant from AstraZeneca.

This event is not a part of the official AAFP FMX. Approved for 1.5 Prescribed credits.

CME/MEDICAL COMMUNICATIONS INQUIRIES info@integritasgrp.com integritasgrp.com

MICHAEL H.

FACULTY

FACULTY

Pillinger, MD

Professor Department of Medicine Department of Biochemistry and Molecular Pharmacology New York University School of Medicine Director of Rheumatology VA New York Harbor Healthcare System New York, New York Dr. Michael Pillinger is Professor of Medicine and Professor of Biochemistry and Molecular Pharmacology at New York University School of Medicine, where he directs the Rheumatology Fellowship Training Program as well as the Masters of Science in Clinical Investigation Program. A longtime investigator in inflammation and crystal diseases including gout, he is the author of more than 100 original research articles, reviews, and book chapters.

PAUL P.

Doghramji, MD, FAAFP Family Physician Collegeville Family Practice Medical Director of Health Services Ursinus College Collegeville, Pennsylvania Paul Doghramji, MD, FAAFP, is senior family practice physician at Collegeville Family Practice, and the Medical Director of health services at Ursinus College, both in Collegeville, Pennsylvania. He is also an attending physician in family practice at Pottstown Memorial Medical Center in Pottstown, Pennsylvania. He is past and present co-chair of the National Sleep Foundation’s Sleep and Health Safety Course, and has devoted almost 3 decades to sleep science and education.

Dr. Doghramji received his medical degree from Jefferson Medical College in Philadelphia, Pennsylvania, in 1982. He then completed his residency in family practice at Chestnut Hill Hospital in 1985. A member and fellow of the American Academy of Family Physicians and the Pennsylvania Academy of Family Physicians, he has received the American Medical Association’s Physician Recognition Award 8 times.

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FACULTY

Dr. Doghramji has published over 50 papers in peer-reviewed journals, including The American Journal of Medicine, Current Medical Research and Opinion, and Postgraduate Medicine. He is also coauthor of the textbook, Clinical Management of Insomnia.

N. LAWRENCE

Edwards, MD, MACP, FACR Professor of Medicine Division of Rheumatology and Clinical Immunology Program Director, Internal Medicine Residency Vice Chairman, Department of Medicine University of Florida Gainesville, Florida Dr. N. Lawrence Edwards is Professor of Medicine, Division of Rheumatology and Clinical Immunology, as well as Program Director of Internal Medicine Residency and Vice Chairman of the Department of Medicine at the University of Florida in Gainesville.

Dr. Edwards obtained his undergraduate degree from the University of Notre Dame and his medical degree from the University of Miami School of Medicine. He completed his training in Rheumatology at the Rackham Arthritis Research Center and the Clinical Research Center, University of Michigan in Ann Arbor, where he remained on the faculty as Director of Education and Training in the Division of Rheumatology. In 1983 he transferred to the University of Florida, where he served as Chief of the Division of Rheumatology and Clinical Immunology and Rheumatology Program Director for 15 years. He has held his current positions for the past 12 years.

Dr. Edwards is an active member of many professional organizations, including the American College of Rheumatology, the College of Physicians, and the Association of Program Directors in Internal Medicine. He is on the Executive Board of the Florida Chapter of the American College of Physicians, the Co-chair of the Gout Interest Group for OMERACT (Outcomes Measures in Rheumatology), and the Chairman and Chief Executive Officer of the Gout and Uric Acid Education Society, a nonprofit, patient education organization. He is also a Master in the American College of Physicians. He has authored more than 150 scientific articles, book chapters and reviews on the topics of hyperuricemia, gout, and purine metabolism.

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TARGET AUDIENCE The educational design of this activity addresses the needs of family physicians and other primary care providers involved in managing patients with hyperuricemia and gout.

Gout is a chronic arthropathy caused by hyperuricemia, which is abnormally high uric acid levels in the blood that can lead to monosodium urate crystal deposition in tissues and joints.1 The overall prevalence has been estimated at 4%—or approximately 8.3 million Americans—and may reach 12% to 13% in certain subpopulations.2 Gout is expected to become more common, owing in part to an aging population and increased rates of comorbidities that predispose individuals to hyperuricemia (eg, metabolic syndrome, type 2 diabetes mellitus, chronic kidney disease).3 Despite the availability of effective therapies, including inhibitors of the urate-producing enzyme xanthine oxidase, gout management is often inadequate.3,4 Patients commonly suffer from short- and long-term disability, may develop permanent joint damage, and often land in the emergency room.5,6 Moreover, a gout diagnosis has been independently linked to total and cardiovascular mortality, with higher risks observed with rising urate levels.7 Thus, there is a significant need for greater clinician awareness of best practices for diagnosis as well as new agents that target various processes in urate homeostasis, such as uric acid reabsorption in the kidney.4,8 During this Interactive Exchange™ program, expert faculty will highlight the pathophysiology, diagnosis, and treatment of gout, with an emphasis on multimodal treatment regimens, urate-lowering therapies, and strategies for therapeutic tailoring.

REFERENCES 1. Neogi T. Clinical practice. Gout. N Engl J Med. 2011;364(5):443-452.

2. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136-3141.

3. Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 2012;64(10):1431-1446.

4. Doherty M, Jansen TL, Nuki G, et al. Gout: why is this curable disease so seldom cured? Ann Rheum Dis. 2012;71(11):1765-1770.

5. Garg R, Sayles HR, Yu F, et al. Gout-related health care utilization in US emergency departments, 2006 through 2008. Arthritis Care Res. 2013;65(4):571-577.

6. Wertheimer A, Morlock R, Becker MA. A revised estimate of the burden of illness of gout.

Curr Ther Res Clin Exp. 2013;75:1-4.

7. Stack AG, Hanley A, Casserly LF, et al. Independent and conjoint associations of gout and hyperuricaemia with total and cardiovascular mortality. QJM. 2013;106(7):647-658.

8. Edwards NL, So A. Emerging therapies for gout. Rheum Dis Clin North Am. 2014;40(2):375-387.

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PREAMBLE

STATEMENT OF NEED/PROGRAM OVERVIEW

EDUCATIONAL OBJECTIVES FACULTY

After completing this activity, the participant should be better able to: •• Discuss the pathophysiologic mechanisms that contribute to the development of gout •• Identify patients with gout based on hyperuricemia, joint assessment, podagra, and relevant risk factors •• Compare current and emerging gout therapies that can reduce hyperuricemia and prevent acute gout attacks •• Individualize treatment regimens for patients with gout over time •• Educate patients about gout as a chronic disease, therapeutic goals and options, and the need for treatment adherence

PROGRAM AGENDA 11:00 am – 11:30 am

Registration, Meal, Preactivity Outcomes Assessment

11:30 am – 11:50 am

Pathophysiology of Gout

11:50 am – 12:20 pm

Burdens of Gout and Keys to Diagnosis

12:20 pm – 12:50 pm

Build-a-Case Collaboration

12:50 pm – 1:00 pm

Postactivity Assessment and Question and Answer Session

PHYSICIAN CONTINUING MEDICAL EDUCATION This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

This CME activity complies with all requirements of the federal Physician Payment Sunshine Act. If a reportable event is associated with this activity, the accredited provider managing the program will provide the appropriate physician data to the Open Payments database.

PHYSICIAN CREDIT DESIGNATION Global Education Group designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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AAFP CREDIT DESIGNATION This live activity, Improving Outcomes for Patients With Gout: Updates on Diagnosis and Evidence-Based Management, with a beginning date of 9/29/2015, has been reviewed and is acceptable for up to 1.5 Prescribed credit(s) by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

FEE INFORMATION & REFUND/CANCELLATION POLICY There is no fee for this educational activity.

PREAMBLE

For information about the accreditation of this program, please contact Global at 303-395-1782 or inquire@globaleducationgroup.com

INSTRUCTIONS TO RECEIVE CREDIT In order to receive credit for this activity, the participant must complete the program evaluation form.

DISCLOSURE OF CONFLICTS OF INTEREST Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity: Michael H. Pillinger, MD Grant/Research Support (Takeda Pharmaceutical Company Ltd.); Honoraria (AstraZeneca; Crealta Pharmaceuticals, Inc.) Paul P. Doghramji, MD, FAAFP Consultant (AstraZeneca, Iroko Pharmaceuticals, LLC, Takeda Pharmaceutical Company Ltd.); Speakers Bureau (AstraZeneca, Takeda Pharmaceutical Company Ltd.) N. Lawrence Edwards, MD, MACP, FACR Consultant/Independent Contractor (AstraZeneca, Crealta Pharmaceuticals, Inc., CymaBay Therapeutics Inc., Takeda Pharmaceutical Company Ltd.)

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The planners and managers reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity: Amanda Glazar, PhD Nothing to disclose Andrea Funk

Nothing to disclose

Jim Kappler, PhD

Nothing to disclose

PREAMBLE

DISCLOSURE OF UNLABELED USE This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity.

Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

DISCLAIMER Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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GUIDELINES »» 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia.

Khanna D, et al. Arthritis Care Res (Hoboken). 2012;64(10):1431-1446. http://onlinelibrary.wiley.com/doi/10.1002/acr.21772/epdf

»» 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis.

Khanna D, et al. Arthritis Care Res (Hoboken). 2012;64(10):1447-1461. http://onlinelibrary.wiley.com/doi/10.1002/acr.21773/epdf

»» Evolution of management of gout: a comparison of recent guidelines.

Khanna PP, FitzGerald J. Curr Opin Rheumatol. 2015;27(2):139-146. http://www.ncbi.nlm.nih.gov/pubmed/25611299

»» 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.

Neogi T, Jansen TL, Dalbeth N, et al. Ann Rheum Dis. 2015;74(10):1789-1798. http://www.ncbi.nlm.nih.gov/pubmed/26359487

»» What Is Gout? Fast Facts: An Easy-to-Read Series of Publications for the Public A brochure in simplified language from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health http://www.niams.nih.gov/health_info/gout/gout_ff.pdf

»» Gout Patient brochure from the American College of Rheumatology http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Gout

»» Gout Education for Patients Patient information from the Gout & Uric Acid Education Society http://gouteducation.org/patient/education/

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RESOURCE CENTER

EDUCATIONAL MATERIAL for PATIENTS and THEIR FAMILIES

SUGGESTED READING »» The emerging role of biotechnological drugs in the treatment of gout.

Cavagna L, Taylor WJ. BioMed Res Int. 2014. doi: 10.1155/2014/264859. Epub 2014 Apr 16.

»» Imaging in gout: a review of the recent developments.

Chowalloor PV, et al. Ther Adv Musculoskelet Dis. 2014;6(4):131-143.

»» New medications in development for the treatment of hyperuricemia of gout.

Diaz-Torné C, et al. Curr Opin Rheumatol. 2015;27(2):164-169.

»» Pharmacodynamic, pharmacokinetic and tolerability evaluation of concomitant administration of lesinurad and febuxostat in gout patients with hyperuricaemia.

Fleischmann R, et al. Rheumatology. 2014;53(12):2167-2174.

»» The pathophysiology of hyperuricaemia and its possible relationship to cardiovascular disease, morbidity and mortality.

Gustafsson D, Unwin R. BMC Nephrology. 2013;14:164.

»» Emerging therapies for gout.

Edwards NL, So A. Rheum Dis Clin North Am. 2014;40(2):375-387.

»» The association of gout with socioeconomic status in primary care: a crosssectional observational study.

Hayward RA, et al. Rheumatology (Oxford). 2013;52(11):2004-2008.

»» The crystallization of monosodium urate.

Martillo MA, et al. Curr Rheumatol Rep. 2014;16(2):400.doi:10.1007/s11926-013-0400-9.

»» Racial and gender disparities in patients with gout.

Singh JA. Curr Rheumatol Rep. 2013;15(2):307.doi:10.1007/s11926-012-0307-x.

RESOURCE CENTER

»» Gout and its comorbidities: implications for therapy.

Stamp LK, Chapman PT. Rheumatology (Oxford). 2013;52(1):34-44.

»» Improved health-related quality of life and physical function in patients with refractory chronic gout following treatment with pegloticase: evidence from phase III randomized controlled trials.

Strand V, et al. J Rheumatol. 2012;39(7):1450-1457.

»» Recent advances in management of gout.

Suresh E, Das P. QJM. 2012;105(5):407-417.

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Please visit the CLINICAL RESOURCE CENTER for additional information and resources

www.ExchangeCME.com/GoutResources15

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