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Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours

Release Date: August 13, 2014
Expiration Date: August 13, 2015

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon above.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:

1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD
Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP
Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 9, has been reviewed and is acceptable for up to 15.25 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 5, 2014. Term of approval is for one year from this date. Each EBM Focus is approved for .25 Prescribed credits. Credit may be claimed for one year from the date of each update. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour(s) of continuing education by the American Association of Nurse Practitioners. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

Program ID: 1405237M

Last week 512 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 183 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article was selected by the DynaMed Editorial Team.

Hydroxychloroquine May Not Improve Symptoms of Primary Sjogren Syndrome in Adults
Reference: JAMA 2014 Jul 16;312(3):249 (level 2 [mid-level] evidence)

Sjogren syndrome is a chronic autoimmune disorder characterized by exocrine gland dysfunction resulting in dryness, pain, and fatigue (BMC Med. 2013 Apr 4;11:93 full-text). Hydroxychloroquine is an immunomodulator that is frequently prescribed for patients with primary Sjogren syndrome who present with general symptoms such as fatigue, arthralgia, and myalgia. However, despite its widespread use, clinical data supporting the efficacy of hydroxychloroquine are very limited. A recent randomized trial of 120 adults with primary Sjogren syndrome compared hydroxychloroquine 400 mg orally daily vs. placebo for 24 weeks.

All patients had been taking stable doses of NSAIDs, oral corticosteroids, pilocarpine, or topical cyclosporine for at least 4 weeks, and concurrent use of these agents was allowed throughout the trial. The primary outcome was a ≥ 30% decrease in symptom scores on at least 2 of 3 scales assessing each of dryness, pain, or fatigue. The proportion of patients achieving the primary outcome was 17.9% with hydroxychloroquine vs. 17.2% with placebo (odds ratio 1.01, 95% CI 0.37-2.78). Hydroxychloroquine was associated with a nonsignificant decrease in mean pain scores (p = 0.06), but there were no significant differences in mean scores for either fatigue or dryness. Serious adverse events were reported in 3.6% with hydroxychloroquine vs. 4.9% with placebo (no p value reported).

Clinical evidence supporting hydroxychloroquine for primary Sjogren syndrome has mostly been confined to small open-label studies. A randomized crossover trial previously failed to demonstrate any symptomatic improvement associated with hydroxychloroquine despite improvements in surrogate markers of disease (Ann Rheum Dis 1993 May;52(5):360 full-text). However, that trial was limited by a very small sample size. The results from this new and much larger trial confirm the previous findings and provide more compelling evidence that hydroxychloroquine does not appear to improve symptoms of primary Sjogren syndrome. Furthermore, use of hydroxychloroquine requires periodic ophthalmologic exams due to a dose-related risk of retinopathy (Ophthalmology 2002 Jul;109(7):1377).

For more information see the Sjogren syndrome topic in DynaMed.

Earn CME Credit for reading this e-Newsletter. For more information on this educational activity, see the CME sidebar.

EBSCO Health Launches Pediatric Clinical Information Mobile App

PEMSoft Now Available For iPhone, iPad, and Android Devices

A mobile app designed specifically for pediatricians, emergency department physicians, physicians-in-training and other medical providers caring for children with acute illnesses and injury, is now available from EBSCO Health, the leading provider of clinical decision support solutions for the healthcare industry.

Designed by pediatricians, emergency physicians and other medical specialists, PEMSoft is a pediatric evidence-based point-of-care medical reference tool for hospitals, emergency departments, clinics, pediatric group practices, transport services, and medical schools. The vast content in PEMSoft addresses the entire spectrum of neonatal, infant, child, adolescent and young adult health. PEMSoft authors adhere to a strict evidence-based editorial policy focused on systematic identification, evaluation and consolidation of practice-changing clinical literature.

The PEMSoft Mobile app includes explicit step-by-step emergency critical care procedures, information about common pediatric signs and symptoms and content covering pediatric injuries and management approaches. More than 3,000 evidence-based pediatric topics and a similar number of medical illustrations, clinical images and videos are also available via the mobile app.

The PEMSoft Mobile App is accessible from both Apple and Android devices.

Visit the PEMSoft page for more information.

Call for Peer Reviews

We are currently seeking subspecialty reviewers for our Patient Education Resource Center (PERC). PERC provides fact sheets and discharge instructions for patients leaving the hospital or emergency room. These hand-outs fulfill the meaningful use requirements for the Medicare & Medicare Services Incentive Programs.

Click here to speak with us about becoming a peer reviewer.

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