Maybe It’s NOT Mechanical Back Pain: Get on the Fast Track to Identifying AxSpA A Multimedia eHealth Source™ Educational Initiative

Marina Magrey, MD; Shireesh Bhalerao, MCR, DC; Charis Hill; Angelo Papachristos, BSc PT, MBA; Ben Smith, DMSc, PA-C, DFAAPA

This activity is jointly provided by the Postgraduate Institute for Medicine and Integritas Communications.

This activity is supported by an educational grant from Pfizer, Inc.


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We would like to thank the Spondylitis Association of America for their collaboration and support.

Target Audience

The educational design of this activity addresses the needs of primary care providers (PCPs), including family and internal medicine physicians, nurse practitioners (NPs), and physician assistants (PAs), as well as physiatrists, physical therapists (PTs), chiropractors, orthopedists, and pain medicine specialists.

Statement of Need/Program Overview

This multimedia program is intended to provide continuing medical education/continuing education (CME/CE) to the diverse group of clinicians who are well-positioned to identify and refer patients with axial spondyloarthritis (AxSpA). The proposed multifaceted initiative will provide critical education to improve awareness of AxSpA and knowledge of its presentation, natural history, and impact, with the aim to improve early identification and referral of all patients with diagnosed or suspected AxSpA for specialist evaluation and treatment.

Educational Objectives

After completing this activity, the participant should be better able to:

  • Identify patients with inflammatory back pain and correlate clinical findings with AxSpA historical features, manifestations, and comorbidities
  • Select guideline-recommended imaging modalities for provisional diagnosis of AxSpA
  • Provide early referral of patients with diagnosed or clinically suspected AxSpA to rheumatologists for diagnostic confirmation and targeted treatment of AxSpA
  • Discuss the psychosocial and occupational impacts of AxSpA
  • Participate in interprofessional communication and collaboration to optimize patient care


Marina Magrey, MD
Division Chief, Rheumatology
University Hospitals (UH) Cleveland Medical Center
Case Western Reserve University (CWRU) School of Medicine
Cleveland, Ohio

Shireesh Bhalerao, MCR, DC
Chiropractic Physician & Owner
Equilibrium, LLC
Associate Professor and Chair
Department of Chiropractic Sciences
University of Western States (UWS)
Founder, TULIP Seminars
Portland, Oregon
Adjunct Assistant Professor
Department of Physical Therapy
University of Pittsburgh
Pittsburgh, Pennsylvania

Charis Hill
Disability Advocate
Rheumatology Professional
AxSpA Patient
Sacramento, California

Angelo Papachristos, BSc PT, MBA
Advance Practice Physiotherapist
Unity Health Toronto – St. Michael's Hospital
Clinical Lecturer
University of Toronto
Toronto, Ontario

Ben Smith, DMSc, PA-C, DFAAPA
Associate Director, Assistant Professor
School of Physician Assistant Practice
Florida State University College of Medicine
Tallahassee, Florida
Rheumatology PA
McIntosh Clinic, P.C.
Thomasville, Georgia

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine (PIM) and Integritas Communications. PIM 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.

Physician Continuing Medical Education

PIM designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 1.25 contact hours. Designated for 0.5 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.

Interprofessional Continuing Education

Credit Requirements & IPCE Credit Mark | Joint Accreditation for  Interprofessional Continuing EducationThis activity was planned by and for the healthcare team, and learners will receive 1.25 Interprofessional Continuing Education (IPCE) credits for learning and change.


Continuing Physician Assistant Education

AAPA CME Accreditation - AAPAPIM has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.25 AAPA Category 1 CME credits. Approval is valid until December XX, 2022. PAs should only claim credit commensurate with the extent of their participation.

Instructions to Receive Credit

In order to receive credit for this activity, the participant must complete the preactivity questionnaire, score 75% or better on the posttest, and complete the program evaluation.

Disclosure of Conflicts of Interest

PIM adheres to the policies and guidelines, including the Standards for Integrity and Independence in Accredited CE, set forth to providers by the Accreditation Council for Continuing Medical Education (ACCME) and all other professional organizations, as applicable, stating those activities where continuing education credits are awarded must be balanced, independent, objective, and scientifically rigorous. All persons in a position to control the content of an accredited continuing education program provided by PIM are required to disclose all financial relationships with any ineligible company within the past 24 months to PIM .  All financial relationships reported are identified as relevant and mitigated by PIM in accordance with the Standards for Integrity and Independence in Accredited CE in advance of delivery of the activity to learners. The content of this activity was vetted by PIM to assure objectivity and that the activity is free of commercial bias. 

All relevant financial relationships have been mitigated.

The faculty have the following relevant financial relationships with ineligible companies:

Marina Magrey, MD:  Consulting Fees: AbbVie, Bristol-Myers Squibb, Eli Lilly and Company, Janssen Pharmaceuticals, Novartis International AG, Pfizer, Inc., UCB S.A.; Contracted Research: AbbVie, UCB S.A.

Shireesh Bhalerao, MCR, DC:  Nothing to disclose

Charis Hill:  Consulting Fees: GlaxoSmithKline plc., Janssen Pharmaceuticals, Salix Pharmaceuticals, Inc.

Angelo Papachristos, BSc PT, MBA:  Consulting Fees: AbbVie, F. Hoffmann-La Roche Ltd

Ben Smith, DMSc, PA-C, DFAAPA: Nothing to disclose

PIM and Integritas planners and managers have no relevant financial relationships with ineligible companies.

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


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 or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Fee Information& Refund/Cancellation Policy

There is no fee for this educational activity.

CME Questions – PIM Contact Information

For information about the accreditation of this program, please contact PIM via email at or at

Integritas Contact Information

For all other questions regarding this activity, please contact Integritas via email at

System Requirements

1.4 GHz Intel Pentium 4 or faster processor (or equivalent)
Windows 10, 8.1 (32-bit/64-bit), Windows 7 (32-bit/64-bit)
512 MB of RAM (1 GB recommended)
Microsoft Internet Explorer 11 or later, Windows Edge browser, Mozilla Firefox, and Google Chrome
For HTML Client – Google Chrome (v70.0 & above), Mozilla Firefox (v65.0 & above), and Edge (v42.0 & above) 

1.83 GHz Intel Core Duo or faster processor
512 MB of RAM (1 GB recommended)
MAC OS X 10.12, 10.13 and 10.14
Mozilla Firefox, Apple Safari, Google Chrome
For HTML Client – Google Chrome (v70.0 & above), Apple Safari (v12.0 & above), and Mozilla Firefox (v65.0 & above) 

Click "Begin Activity" to acknowledge that you have reviewed the preamble information for this activity.

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credit amount 1.25

credit type CME/CE

release 12/17/2021

expiration 12/17/2022

type eHealthSource