Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Rheumatologists Knowledge, Attitudes and Concerns Regarding Progressive Multifocal Leukoencephalopathy(PML)

Calabrese1,  Leonard H., Molloy2,  Eamonn S., Taege3,  Alan j.

Rheumatic & Immunologic Disease and Infectious Disease. Cleveland Clinic Foundation, Cleveland, OH
Cleveland Clinic, Cleveland, OH
Cleveland Clinic Foundation, Cleveland Ohio


PML is a highly fatal opportunistic infection classically associated with profound immunosuppression in the settings of HIV, cancer and transplantation. PML is increasingly reported with several biologic agents frequently used by rheumatologists. Though genuinely rare, biologic-associated PML has led to an aggressive risk-mitigation program for one agent (natalizumab), the voluntary withdrawal from the market of another (efalizumab) and several 'dear health care provider' letters regarding rituximab and mycophenolate. The risk of PML has added to the complexity of both physicians' and patients' shared decision making in drug selection; thus it is important to know what the level of physician knowledge is regarding this infection as well as prevailing attitudes and concerns in order to identify possible gaps in learning.


A brief 10 question multiple choice survey was crafted to asses the domains of knowledge, attitudes and needs/concerns regarding PML. The survey was distributed via e-mail to a subset of clinical rheumatologists identifying themselves as members of the ACR. An open-ended question provided an opportunity to identify areas of educational need.


176 responses were analyzed representing a calculated 15% response rate. 53% of physicians identified themselves as moderately or extremely aggressive in their use of immunosuppressive and/or biologic therapies. 32% rated themselves as moderate to high in their knowledge of PML while 24% believed they were moderate to extreme in their deficiency of knowledge. When quizzed, only 16.5% could identify the correct answer on the prevalence of JC virus infection in the general population; 41% could not identify the diagnostic test of choice for PML (CSF PCR for JC). Regarding RA/SLE/CTD patients, 43% of respondents were somewhat to extremely concerned about PML as a complication for patients on TNF inhibitors, while 73% were similarly concerned when using rituximab. Only 24% and 31% of respondents felt that PML was somewhat to extremely likely to affect their use of TNF inhibitors or abatacept while 64% were similarly affected in terms of rituximab. Rheumatologists believed that 62% of their patients had somewhat to extreme concern about PML as a complication of their therapy. Finally, only 7% of rheumatologist responded that they have little or no educational needs regarding PML while over 80% felt moderate to extreme needs for education. In the open-ended question regarding specific needs, 93 of 176 responded; the majority identified needs including basic biology and mechanisms, appropriate diagnostic assessment and further understanding of risk-benefit analysis.


1. Rheumatologists have important real and perceived learning gaps regarding PML. 2. Concerns regarding PML appear to affect both physician and patient decisions regarding the use of biologic agents. 3. The vast majority of rheumatologists surveyed describe strong educational needs regarding PML as a complication of anti-rheumatic therapy.

To cite this abstract, please use the following information:
Calabrese, Leonard H., Molloy, Eamonn S., Taege, Alan j.; Rheumatologists Knowledge, Attitudes and Concerns Regarding Progressive Multifocal Leukoencephalopathy(PML) [abstract]. Arthritis Rheum 2009;60 Suppl 10 :130
DOI: 10.1002/art.25213

Abstract Supplement

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