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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
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For the Chapter in the Schwinghammer Handbook, please go to Chapter 4, Rheumatoid Arthritis.
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KEY CONCEPTS
The etiology of rheumatoid arthritis is unknown but is thought to result from a combination of genetic and environmental factors.
Rheumatoid arthritis is a systemic autoimmune condition in which inappropriate activation of innate and adaptive immune responses cause inflammation leading to bone, cartilage, and synovium erosion.
The primary goal of treatment includes targeting disease remission/low disease activity ultimately aiming at enhancing quality of life.
Care should be provided by a rheumatology-trained clinician.
Optimizing mental health and completing physical therapy are both crucial nonpharmacologic therapies in addition to providing comprehensive disease and treatment education.
Drug treatment should be started as soon as a diagnosis is established.
Choice of therapy depends on the level of disease activity, comorbid health conditions, patient preference, and often insurance coverage.
Nonsteroidal anti-inflammatory drugs, analgesics, and corticosteroids are used as adjunctive therapy to disease-modifying antirheumatic drug therapy.
Response to therapy is evaluated by patient subjective reports, physical examination, laboratory markers, and imaging.
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Patient Care Process for Rheumatoid Arthritis
Collect
Patient characteristics (eg, age, sex, pregnancy status, insurance)
Social history (eg, tobacco/alcohol use, activity)
Patient medical history (eg, health conditions, immunizations, recent infections)
Family medical history (eg, autoimmune conditions)
Current medications
Past RA medication trials
Subjective symptom report
Objective data such as blood pressure, labs (eg, ESR, CRP, CBC), imaging (eg, DEXA, x-ray films, ultrasound), physical examination (eg, number of tender/swollen joints)
Assess
Patient subjective report (eg, pain score, duration of morning joint stiffness, adherence to therapy, injection technique/medication storage, side effects to drug therapy, disability, fatigue)
Change in number of tender/swollen joints, labs, or imaging
Cardiovascular risk factors
Infection risk and upcoming procedures
Patient treatment preference (utilize motivational interviewing as appropriate)
Plan*
Drug therapy (see Table 111-2)
Referrals when appropriate (eg, tobacco treatment clinic, podiatry, mental health, social work, physical and/or occupational therapy)
Patient education (eg, dosing, side effects, infection risk management, symptom self-monitoring)
Order follow-up labs based on therapy chosen (see Table 111-4)
Implement*
Provide patient education regarding rationale for and follow-up of treatment plan
Provide patient with written medication changes, time frame for follow-up, and clinic/emergency contact information
Coordinate and schedule follow-up
Follow-up: Monitor and Evaluate
Subjective symptom changes and impact on daily activities
Presence of adverse effects and infections
Laboratory results as indicated for therapy
Patient adherence to treatment plan
Time frame dependent on treatment plan (generally every 1-3 months)
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BEYOND THE BOOK
Direct-to-consumer advertising refers to the marketing of products to patients rather than healthcare professionals. This is a common marketing strategy, particularly for pharmaceutical products. Watch the following advertisements for tofacitinib and adalimumab:
Reflect on the promotional materials ...