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When It's Not Mechanical Back Pain: What the PCP Needs to Know

Managing Back Pain in the Primary Care Setting: Toward the Timely Recognition and Treatment of AxSpA
0.5 AMA PRA Category 1 Credit(s)
Launch Date:
April 28, 2016
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

The intended audience for the activity is primary care physicians and other health care professionals involved in the treatment of patients with back pain.

Relevant Terms:


Lianne S. Gensler, MD

Lianne S. Gensler, MD
Associate Professor of Clinical Medicine
Director, Ankylosing Spondylitis Clinic
University of California, San Francisco
San Francisco, CA

Lianne S. Gensler, MD, is an associate professor of medicine and rheumatology at the University of California San Francisco (UCSF), where she is also director of the Ankylosing Spondylitis Clinic. Dr. Gensler completed medical school at the University of California, Irvine and then did her internship, residency, and chief residency at UCSF, where she stayed to complete her fellowship in rheumatology and became faculty thereafter.

At UCSF, Dr. Gensler teaches medical students, residents, and fellows and is involved in clinical research in spondyloarthritis, including epidemiologic research and clinical trials. Dr. Gensler is the vice-chair of the Spondyloarthritis Research and Treatment Network (SPARTAN), served on the American College of Rheumatology treatment guidelines for axial spondyloarthritis, and serves in several other educational capacities for the college.

Atul A. Deodhar, MD

Atul A. Deodhar, MD
Professor of Medicine
Medical Director, Rheumatology Clinics
Division of Arthritis & Rheumatic Diseases
Oregon Health & Science University
Portland, OR

Through his role on the Executive Committee of the SpondyloArthritis Research and Treatment Network (SPARTAN), Dr. Deodhar has been dedicated to spondyloarthritis research, including epidemiology, diagnosis, and treatment strategies. He has been engaged in clinical trials assessing the efficacy of novel therapies in ankylosing spondylitis and psoriatic arthritis. Together with the Department of Dermatology, he has created the Center for Psoriasis and Psoriatic Arthritis Excellence (CEPPA) at OHSU, a multidisciplinary clinic which has provided care for patients with psoriasis and psoriatic arthritis and allowed the collection and analysis of a CEPPA registry. Dr Deodhar has also published in the field of osteoporosis specifically as it relates to inflammatory arthritis and has been interested in the use of hand bone densitometry to monitor progression of inflammatory arthritis. As a fellow, Dr. Deodhar worked with Dr. Robert Bennett on understanding various aspects of fibromyalgia including its diagnosis and treatment. Dr. Deodhar has completed the Train-the-trainer USSONAR course in musculoskeletal ultrasound and is conducting an ultrasound guided injection clinic that fellows attend.

Walter P. Maksymowych, MD, FRCP(C), FACP

Walter P. Maksymowych, MD, FRCP(C), FACP
Professor, Department of Medicine
Division of Rheumatology
University of Alberta
Alberta, Canada

Walter P. Maksymowych, MD, FRCP(C), FACP, is a Professor and Medical Scientist in the Department of Medicine, Division of Rheumatology at the University of Alberta, Alberta, Canada. He is the 2012 recipient of the Distinguished Investigator Award from the Canadian Rheumatology Association. He is also Chair of the International OMERACT Soluble Biomarker Working Group, the Scientific Chair of the Alberta Rheumatoid Arthritis and Pharmacovigilance Program and Outcomes Research in Therapeutics (RAPPORT) committee. He is past-Chair of the Scientific Committee of the Canadian Rheumatology Association. He founded Canadian Research and Education (CaRE) Arthritis Limited, an Alberta company focused on the development of personalized medicine strategies for patients with arthritis, and now serves as Chief Medical Officer.

Dr. Maksymowych graduated from the University of Manchester School of Medicine, United Kingdom, in 1981 and completed his postgraduate training at the University of Alberta and the Children's Hospital Medical Center, Cincinnati, Ohio. He holds Fellowships in the Royal College of Physicians of Canada and the American College of Physicians. His primary research interests are the imaging, genetics, and treatment of spondyloarthritis, and the clinical validation of biomarker technologies for rheumatic diseases. He has published over 250 research articles and is a member of numerous international societies related to arthritis research. His research activities involve a global network of investigators and major partners in the pharmaceutical, imaging, and biomarker industries. He has spearheaded numerous international collaborative networks that have culminated in the development of multiple scoring systems based on imaging and biomarker technologies for use in both diagnostic and therapeutic settings as well as clinical trials research. Most recently, he co-invented the 14-3-3 biomarker platform which has recently been licensed for diagnostic testing of patients with rheumatoid arthritis.
1. Identify patients with AxSpA based on symptomatic domains, classification criteria, and established guidelines and refer to a specialist as warranted. 
2. Utilize appropriate lifestyle and therapeutic interventions for the management of AxSpA. 

Provider Statement:
This continuing medical education activity is provided by
Support Statement:
This activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.
Credit Information/Accreditation:
Vindico Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation:
Vindico Medical Education designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

This enduring material is approved for 1 year from the date of original release, April 28, 2016 to April 27, 2017.
In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears below.
Lianne S. Gensler, MD
Consulting Fee: AbbVie, Amgen, Janssen, Novartis
Contracted Research: UCB
Atul A. Deodhar, MD
Consulting Fee: AbbVie, Boehringer Ingelheim, Janssen, Novartis, Pfizer, Sun Pharma, UCB
Contracted Research: AbbVie, Amgen, Eli-Lilly, Janssen, Novartis, Pfizer
Walter P. Maksymowych, MD, FRCP(C), FACP
Consulting Fee: AbbVie, Amgen, Boehringer Ingelheim, Eli-Lilly, Pfizer, UCB
Contracted Research: AbbVie, Janssen
External Reviewer:
Leonard H. Calabrese, DO
Consulting Fees: GlaxoSmithKline, Janssen, Pfizer, Sanofi
Speakers Bureau: AbbVie, Bristol-Myers Squibb, Crescendo, Genentech, Janssen
Vindico Medical Education staff report the following relationship(s):
No relevant financial relationships to disclose.
Signed disclosures are on file at Vindico Medical Education, Office of Medical Affairs and Compliance.
Back pain is a very common disorder that affects nearly 80% of adults. Back pain can be caused by mechanical damage to the muscles, ligaments, discs, bones, or inflammation. Axial spondyloarthritis (AxSpA) is an autoimmune disease of the axial skeleton, whose classification is dependent upon the presence of inflammatory back pain (IBP). Since x-rays are often insensitive to early disease diagnosis, there can be a significant delay in assessing the etiology and rendering appropriate treatment. In this activity, leading rheumatologists will identify patients with AxSpA based on symptom domains and diagnostic features, discussing the benefits of therapeutic lifestyle changes as well as medical management.
How To Participate in this Activity and Obtain CME Credit:
To participate in this CME activity, you must read the objectives, answer the pretest questions, view the content, complete the CME posttest, and complete the evaluation. Provide only one (1) correct answer for each question. A satisfactory score is defined as answering 2 of the 3 posttest questions correctly. Upon receipt of the completed materials, if a satisfactory score on the posttest is achieved, Vindico Medical Education will issue an AMA PRA Category 1 Credit(s)™ Certificate.
Unlabeled and Investigational Usage:
The audience is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage. All activity participants will be informed if any speakers/authors intend to discuss either non-FDA approved or investigational use of products/devices.
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