Stewardship Program in Prescribing DMARDs in Rheumatoid Arthritis

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About Course

RA Stewardship Program: Hone Your Clinical Skills and Build Confidence in Practice

Empowering Future Rheumatologists
A comprehensive training and decision-support program designed for postgraduates, fellows, and MD, MS/DNB students, focused on practical, real-world RA management.

Why join the program?

Evidence-based learning: Learn to make informed treatment decisions using current guidelines and real-world insights.

Practical applications: Sessions based on routine clinical scenarios and real-life challenges.

Treatment tailoring: Monitor and adjust therapies effectively for individual patients.

Safety & side effect monitoring: Identify, anticipate, and manage adverse effects of RA treatments.

Decision-making support: Tools and guidance to optimize patient outcomes.

Program features

Biweekly video sessions: Detailed sessions released once every 15 days.

Point-wise content: Concise, structured, and easy-to-follow learning modules.

Challenging quizzes: Test your understanding and clinical reasoning with scenario-based quizzes.

Interactive learning: Case discussions, practical demonstrations, and guided decision-making exercises.

Who should join?

  • Postgraduate students specializing in Rheumatology
  • Fellowship trainees in autoimmune and inflammatory diseases
  • MD, MS/DNB students aiming to strengthen clinical decision-making in RA
  • Medical professionals involved in RA managementShape

Expected outcomes

  • Strengthen confidence in real-world clinical decision-making
  • Monitor therapy effectiveness and safety with greater precision
  • Tailor RA treatment strategies to individual patient needs
  • Apply guideline-based knowledge in complex, scenario-based learning
  • Recognize treatment responses and anticipate adverse events early
  • Modify DMARD, biologic, or JAK inhibitor therapy based on patient-specific factors
  • Manage treatment failures, flares, and comorbidity interactions effectively
  • Address and prevent medication-related complications
  • Integrate multidisciplinary approaches for comprehensive patient care
  • Translate research evidence into practical, real-world applications
  • Tackle advanced cases such as refractory RA and extra-articular manifestations confidently

Instructions: 

  • Watch the Full Video – You must watch the entire session video without skipping.

  • Take the Quiz – After the video, answer the quiz based on what you learned.

  • Score 70% or More – To move to the next session, you need to score at least 70% on the quiz.

  • Try Up to 20 Times – If you don’t pass, you can retake the quiz up to 20 times.

  • Unlock the Next Session – Once you score 70% or higher, the next video will be available automatically.

📌 Note:
Every session in this series will be available at an interval of every 15 days. Stay tuned and don’t miss out on any session!

Session-12 available now..!

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Course Content

Session-1: Rheumatoid Arthritis (RA) case series
The session emphasizes that a comprehensive RA workup involves laboratory, serological, and imaging investigations to assess disease activity, rule out connective tissue diseases, and identify comorbidities. Early and aggressive DMARD therapy, particularly within the first 3 to 6 months, is crucial to prevent joint damage, control inflammation, and manage anemia or vitamin deficiencies. Treatment decisions including methotrexate, HCQ, steroids, and biologics should be individualized with close monitoring for side effects, pregnancy planning, and regular follow-ups to achieve remission or low disease activity.

  • Session-1: Rheumatoid Arthritis (RA) case series
    01:13:51
  • Quiz for Session-1: Rheumatoid Arthritis (RA) case series

Session-2: RA with comorbidities
The session emphasizes that managing rheumatoid arthritis (RA) in elderly patients requires careful evaluation of comorbidities such as cardiovascular disease, diabetes, renal and hepatic impairment, and infection risk before initiating DMARD therapy. It highlights the importance of tailoring treatment based on functional status, disease severity, and potential drug interactions, with cautious use of corticosteroids, conventional DMARDs, and biologics. The session also underscores regular monitoring, vaccination, and lifestyle interventions to optimize disease control, minimize adverse effects, and improve overall outcomes in elderly RA patients.

Session-3: Rheumatoid Arthritis Case Series
The session presents a case-based discussion on RA–associated interstitial lung disease (RA-ILD), highlighting clinical features, diagnostic evaluation, and differential diagnoses in patients with respiratory symptoms and long-standing RA. It emphasizes the importance of early screening using pulmonary function tests, HRCT, and functional assessments such as the 6-minute walk test to detect and monitor ILD progression. The discussion also outlines treatment strategies based on disease severity, including immunosuppressive therapy, antifibrotic agents, and careful monitoring to improve outcomes in RA-ILD.

Session-4: RA with comorbidity (Liver, Renal Dysfunction)
This session discusses RA complicated by liver and kidney dysfunction, including methotrexate-induced hepatotoxicity, autoimmune hepatitis, NAFLD, NSAID-related nephropathy, diabetic nephropathy, and amyloidosis. Management focuses on early detection, drug adjustment or avoidance, safe DMARD selection, and lifestyle or comorbidity control. Multidisciplinary monitoring of LFTs, renal function, DAS28, and proteinuria ensures disease control while preventing further organ damage

Session-5: Rheumatoid Arthritis (RA) case series
The session highlights the management of RA in complex clinical scenarios involving comorbid infections and liver disease. Case 1 emphasizes RA with active tuberculosis, requiring immediate anti-TB therapy, temporary DMARD modification, and careful biologic selection. Cases 2 and 3 focus on RA in hepatitis B and HIV-positive patients, respectively, stressing antiviral prophylaxis, use of hepatically safe or low-immunosuppressive DMARDs, cautious steroid use, and close monitoring of liver function, viral loads, and infection risk.

Session-6: Comorbidities in Rheumatoid Arthritis (RA) – Focus on Cardiorespiratory Diseases
The session focuses on the comorbid cardiorespiratory complications in RA, including asthma, interstitial lung disease, ischemic heart disease, heart failure, and arrhythmias. Key management principles involve controlling RA activity, careful selection of DMARDs and NSAIDs, regular pulmonary and cardiovascular monitoring, and multidisciplinary collaboration. The session emphasizes inflammation as a central driver of complications, cardiovascular risk assessment, patient counseling, lifestyle modification, and early recognition of atypical or life-threatening presentations.

Session-7: Extra-articular Manifestation of Rheumatoid Arthritis
This session discusses extra-articular manifestations of RA, highlighting neurological and cutaneous complications such as foot drop and vasculitic ulcers. Vasculitic neuropathy presents as acute, asymmetric sensory-motor deficits, while cutaneous ulcers often indicate small or medium vessel vasculitis, requiring aggressive evaluation and management. Early recognition, thorough investigation, and timely escalation of therapy including corticosteroids, DMARDs, or biologics help prevent irreversible deficits and systemic complications.

Session-8: Beyond the Joints: Extra-Articular Manifestations of RA
This session focuses on the management of extra-articular manifestations of RA, including cardiac, hematological, and ocular complications. Pericarditis and myocarditis, though rare, require timely recognition, imaging, and treatment with NSAIDs, corticosteroids, or advanced DMARDs and biologics if refractory. Hematological issues such as anemia of chronic disease are common, while Felty’s syndrome is rare and requires careful evaluation and possible escalation to biologic therapy. Ocular manifestations range from sicca symptoms to necrotizing scleritis, with management tailored according to severity, including local measures, corticosteroids, DMARD escalation, or biologic therapy when vision is threatened.

Session-9: Rheumatoid Arthritis – Planning for Pregnancy
This session discusses the management of RA in women of reproductive age, highlighting the importance of balancing disease control with pregnancy safety. It reviews treatment approaches across different clinical scenarios, including pregnancy, future pregnancy planning, postpartum flares, and inadvertent exposure to teratogenic drugs. The session emphasizes the use of pregnancy-compatible therapies, careful medication selection, preconception counseling, and multidisciplinary care to achieve optimal maternal and fetal outcomes.

Session-10: Refractory RA – An area of unmet clinical need
This session discusses refractory RA, an important unmet clinical challenge affecting a small proportion of patients who fail to respond to conventional therapies. Through complex case scenarios, it highlights factors contributing to treatment resistance, including persistent inflammation, poor compliance, delayed treatment, and extra-articular complications such as vasculitis and Felty’s syndrome. The discussion emphasizes early diagnosis, treat-to-target strategies, personalized therapy with biologics or targeted DMARDs, and multidisciplinary care to improve long-term outcomes.

Session-11: Advanced Erosive Rheumatoid Arthritis: Management and Rehabilitation
This session focuses on the management of advanced and late-presenting RA, where patients often present with severe erosive disease and deformities due to delayed or inadequate treatment. It highlights comprehensive evaluation, control of active inflammation with individualized DMARD strategies, and careful consideration of comorbidities and complications. The session also emphasizes multidisciplinary care including imaging, rehabilitation, physiotherapy, assistive devices, and when appropriate, surgical intervention to preserve function and improve quality of life.

Session-12: Withdrawl of Drug in RA
This session discusses the tapering and withdrawal of disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis who achieve sustained remission. It highlights the importance of careful patient selection, deep and sustained remission, and stepwise tapering, usually starting with biologic or targeted therapies while continuing conventional DMARDs such as methotrexate. The discussion also emphasizes shared decision-making, close monitoring for flares, and individualized treatment strategies based on disease duration, serology, comorbidities, and extra-articular involvement.

Session-13: Role of Counseling in Rheumatoid Arthritis (RA): Key Clinical Perspectives
The session emphasizes that counseling is a key component of RA management, addressing patients’ emotional concerns, treatment fears, and daily challenges of living with a chronic disease. It highlights the importance of patient education, medication adherence, treatment monitoring, and lifestyle guidance from diagnosis through advanced disease stages. It also underscores the need for a holistic, multidisciplinary approach to improve long-term outcomes and quality of life in patients with RA

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