Patients Need Holistic Remedies for Rheumatoid Arthritis—Pharmacies Can Promote Healing
Walk a mile in the shoes of people with rheumatoid arthritis and you’d marvel at their strength and perseverance. Janice has to take morning meds and stand in a long, hot shower before she can move well enough to put on clothes or make coffee. Buttons and zippers are a thing of the past and every other common item, from keys to silverware, have adaptive knobs so she can hold onto them. Holistic remedies for rheumatoid arthritis offer hope for optimal outcomes. Diet, exercise and medical treatments work together to halt RA progression. Community pharmacies can promote healing by offering comprehensive guidance to RA patients.
Updated Rheumatoid Arthritis Treatment Guidelines
The “2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis” provides extensive evidence-based recommendations, yet the top suggestion isn’t pharmaceutical—it advises clinicians to follow a treat-to-target approach for all patients. This focus reflects the goal of the new guidelines, which aim to direct a dialogue of treatment choices. While this is only a small portion of the total recommendations, the guidelines suggest:1
- First line pharmaceutical treatment for early and established RA remains monotherapy with disease-modifying antirheumatic drugs (DMARDs), preferably methotrexate.
- Following treatment with DMARDs, if disease activity is in the moderate to high range, replace monotherapy with combination DMARDs or a tumor necrosis factor inhibitor(TNFi), or a non-TNF biologic. Tofacitinib is added to the list for patients with established RA (longer than six months).
- Corticosteroids: The new guidelines conditionally recommend the use of low-dose, short-term corticosteroids—less than 10 milligrams of prednisone equivalent as add-on therapy for patients with moderate to high disease activity or for flares.
- Remission or ongoing low disease activity: Patients should continue their current therapy. Even when in remission, all RA treatments should not be discontinued, although tapering one medication at a time is an option.
What Treat-to-Target Means for Compounding Pharmacists
Treat-to-target emphasizes shared decisions made between patients and clinicians in order to minimize disease progression and prevent irreversible joint damage. For patients with RA the stakes are high, as it makes the difference between maintaining mobility versus increasing disability. Yet decisions aren’t easy when patients face many pharmaceutical options:
- Traditional DMARDs: methotrexate, hydroxychloroquine, sulfasalazine, leflunomide, cyclophosphamide and azathioprine
- TNF inhibitors: Etanercept, adalimumab, infliximab, golimumab
- JAK Inhibitors:
- Tofacitinib, primarily a JAK3 inhibitor, is currently recommended. A once-daily extended-release tablet was approved in March 2016.
- Baricitinib, a selective JAK1 and JAK2 inhibitor, has performed well in clinical trials and application for its approval was made to the FDA in January 2016.
Pharmacists implement a type of treat-to-target approach in their everyday practice, so of course they’ll reach out to educate RA patients about their primary medications. But these patients may not be aware of other health concerns or adverse effects. And don’t forget, they probably don’t know about the benefits—or even the existence of—compounded treatments. Compounding pharmacists can take treat-to-target to the next level with patient counseling that targets:
- Corticosteroid use: When RA patients take corticosteroids, their risk for bone demineralization increases. Talk with them about taking supplements to ensure they get their recommended dietary allowance for calcium and vitamin D.2
- NSAID concerns and options: Screen RA patients for use of NSAIDs, whether over-the-counter or prescription. Since RA increases the risk of cardiovascular events, these patients should not take oral NSAIDs unless they’re assessed for additional CV risk factors. While pharmacists can gauge weight and ask about family history, hypertension and dyslipidemia, if you have any concerns, recommend a consultation with their physician. Talk to these patients about compounded options such as transdermal diclofenac sodium.
- Topical pain treatment: Aerobic conditioning and isometric exercises to restore and maintain strength are essential elements of RA treatment. But these components can only be successful when the patient is free of pain. Reach out to those purchasing OTC products containing salicylate, counterirritants or capsaicin and talk about the benefits of compounded topical treatments, which can combine the best mix of pain relievers for each person.
Redefine the Role of Your Pharmacy in the Community
It’s one thing to say that holistic remedies for rheumatoid arthritis are vital—it’s altogether different to assimilate them into a compounding pharmacy. Yet a community pharmacy is the natural place to create a true holistic center for patients with RA. Recent studies highlight the significance of including lifestyle guidance along with RA medications:
- Emotional health and cardiovascular risk: Screening for—and treating—psychological disorders may lower the risk of cardiovascular disease because depression and anxiety are associated with atherosclerosis in RA patients.3
- Role of serotonin: A study published in March 2016 in the American Journal of Pathology implicates serotonin in the pathophysiology of RA. In serotonin-deficient mice, RA disease was worse than controls and RA symptoms were offset when serotonin agonists were administered.4
- Changes in weight: Long-term outcomes worsen when RA patients have a low body mass index. Choice of medication may make a difference. An analysis of the national Veterans Affairs pharmacy databases found that methotrexate, TNFi and especially prednisone often cause weight gain, while leflunomide leads to weight loss.5
While compounding pharmacists can address all of these health concerns during scheduled medication reviews, you can establish a role in the community—and subsequently build your business—by finding a way to promote an integrated rheumatoid arthritis center. It may take some rearranging of shelf space and a little time at the start, but once you get it started, upkeep shouldn’t be time-consuming. Here are a few ideas to get you started:
- Put some pedometers on display along with a poster saying, “Ask the pharmacist why wearing a pedometer benefits RA.” In a recent study, RA patients wearing a pedometer engaged in more physical activity, which in turn reduced fatigue.6
- Designate an area as the RA center and showcase a variety of applicable products. Pull samples from other areas of the store that work for RA. You might include dietary supplements, sleeping aids, assistive devices—whether generic wrist splints or other RA-specific items—or even a few pedometers.
- May is National Arthritis Awareness Month, so take advantage of that time to collaborate with local specialists and host an event or offer your expertise to other community events.
Promote Long-Term Health with Holistic Remedies for Rheumatoid Arthritis
Your pharmacy already carries diverse products that promote wellness, but instead of simply leaving them for patients to find and buy, you can choose to showcase holistic remedies for rheumatoid arthritis and include them as an integral part of the conversation when you dispense medications. When you shift the emphasis to healing the whole person, your business becomes a place for community rather than just the community pharmacy.
Pharmaceutica North America provides a variety of compounding solutions for your patients with rheumatoid arthritis. Whether you need prescription diclofenac sodium, high-quality bulk pharmaceuticals, OTC dietary supplements or emollient bases, we’re here to talk and answer your questions, so don’t hesitate to contact us today.
- “2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis,” January 2016, http://www.rheumatology.org/Portals/0/Files/ACR%202015%20RA%20Guideline.pdf ↩
- “Updated RA Guidelines: Implications for Self-Care,” March 2016, http://pharmacytoday.org/article/S1042-0991%2816%2900338-8/fulltext ↩
- “Depression, Stress, Anxiety and Anger Compound Risk of Cardiovascular Disease in Rheumatoid Arthritis Patients,” August 2015, https://www.sciencedaily.com/releases/2015/08/150813074508.htm ↩
- “Serotonin is Involved in Autoimmune Arthritis Through Th17 Immunity and Bone Resorption,” March 2016, http://ajp.amjpathol.org/article/S0002-9440%2816%2900020-1/abstract ↩
- “Changes in Body Mass Related to the Initiation of Disease Modifying Therapies in Rheumatoid Arthritis,” March 2016, http://onlinelibrary.wiley.com/doi/10.1002/art.39647/abstract ↩
- “Pedometers: The New Prescription for Rheumatoid Arthritis,” November 2015, https://www.sciencedaily.com/releases/2015/11/151107172942.htm ↩