Conversations in Moderate to Severe 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 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, including comorbidities, concomitant medications, and economic factors, 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 to meet these needs and appropriately conduct a riskbenefit analysis for each patient, two-way communication between healthcare provider and patient is required.2 PRESENTING THERAPEUTIC OPTIONS Before explaining treatment options, the patient’s goals of therapy should be discussed. The ACR guidelines do not 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
RA patients’ previous experiences may lead them to have differing opinions about drug choice recommended by the prescribing physician.4 In order to reduce this discrepancy, 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 • Ongoing monitoring. There are additional counseling points based on the administration technique you are considering for your patient ( Table 1). It is important to ensure that patients who have no prior experience in self-injecting biologics understand the responsibilities that are involved, including properly storing the injection devices and safely disposing of them after use. Patients should self-inject after physician approval and proper training. At minimum, patients need to learn about the injection sites and proper injection techniques. Injection devices vary for each medication; it’s critical for the patient to
Brought to you by Janssen Biotech, Inc. Dr. Field is a paid consultant for Janssen Biotech, Inc.