Conversations in Moderately to Severely Active Rheumatoid Arthritis: Involving Your Patients in Therapy Discussions © Thinkstock by Getty Images
Dear Colleague: As we consider how to approach our decision making in selecting a biologic disease-modifying antirheumatic drug (DMARD), we are confronted with many questions: • Which therapy should I prescribe for each individual patient? • How does maintaining a dialogue with our patients help us select the most appropriate treatment option? • What are our patients' questions, including efficacy and safety issues, for each therapy? • How can we as clinicians better address these questions and educate patients on their disease state and treatments? It is crucial to initiate the conversation with our patients to educate them and select the appropriate therapy for each individual patient. We need to encourage them to feel comfortable enough to express their feelings and ask questions. Additionally, we need to have further discussions to adequately monitor therapies, including by assessing treatment response, disease progression, and adverse events. Sincerely,
Ellen M. Field, MD, FACR FACULTY REVIEWER Ellen M. Field, MD, FACR Rheumatologist Lehigh Valley, Pennsylvania
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hen clinicians decide the most appropriate therapy for their patients with moderately to severely active rheumatoid arthritis (RA), efficacy, safety and the needs of each individual patient should be be taken into account. Guidelines are meant to provide a starting point for therapeutic decision making. However, guideline recommendations cannot sufficiently convey all considerations and nuances of patient care. Treatment options should also be based on specific patient characteristics, as well as efficacy and safety considerations of each therapy. When reviewing the risks and benefits of therapeutic choices, it is important to individualize treatment discussions.1 Both the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) recommend selecting appropriate treatment based on the individual patient.1,2 In order to gain enough information and appropriately conduct a risk-benefit analysis for each patient, two-way communication between healthcare provider and patient is required.2
recommend a specific goal for all patients; however, low disease activity is an acceptable goal based on the individual patient.1 Low disease activity can provide relief from joint pain, stiffness and swelling, and may be obtained by using a biologic disease-modifying antirheumatic drug (DMARD).3 When presenting therapeutic options, patients should be provided with a sufficient understanding of their disease. Be sure they are aware of the nature of the disease state and why they are being prescribed a biologic agent. If patients do not understand the significance of their disease and its progressive nature, they may not feel the need to seek treatment.3
ONCE A CHOICE IS MADE When speaking to your patients about their prescribed therapy, be sure to include the following information: • Treatment goals • How biological therapy may help them reach these goals • Important safety considerations • Potential interactions with concomitant medications PRESENTING THERAPEUTIC • Ongoing monitoring. OPTIONS There are additional counseling points Before explaining treatment options, based on the administration technique the patient’s goals of therapy should be you are considering for your patient discussed. The ACR guidelines do not ( Table 1). Brought to you by Janssen Biotech, Inc.
Dr. Field is a paid consultant for Janssen Biotech, Inc.