From dietary advice to medications, tips to aid RA patients.
As with many chronic conditions, rheumatoid arthritis (RA) needs to be managed even when there are no symptoms.
“When providing consultation to patients with RA, pharmacists should remind patients that even though they may feel fine, daily management with medication helps lessen the impact of RA,” says Prem Shah, PharmD and EVP of specialty pharmacy at CVS Health. “In addition, pharmacists should discuss activity and the importance of regular exercise and movement, as well as ensure patients keep up with routine monitoring such as blood tests and x-rays recommended by their physician.”
RA medications include NSAIDS, corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biologic agents.
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“The medication regimens are fairly complex and require very close monitoring for safety,” says Jessica Farrell, PharmD, associate professor of pharmacy at Albany College of Pharmacy and Health Sciences. “It is important that patients are being treated by a rheumatologist or at least co-managed by their doctor and a rheumatologist.”
Potential side effects of RA medications may require immediate attention.
“Some of the RA drugs have some pretty severe side effects, so that’s always something that the pharmacist can help the patient understand,” says Lisa Schwartz, PharmD and senior director of professional affairs, National Community Pharmacists Association (NCPA).
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“You may need to speak to patients about their pain level and additional medications to manage the pain they’re experiencing, what is appropriate with their other medications, as well as the supplements they can take and their diet,” said Elise Damman, PharmD, executive resident, NCPA.
A non-inflammatory diet, which has been shown to help moderate RA severity, features ample fruits, veggies, and cold water fish, plus whole grains, beans, and lentils.
Data suggests that fish oil and turmeric may help treat inflammatory disease, while RA patients may also benefit from vitamin D supplementation to prevent bone loss.
“Everyone experiences bone loss as they age, but if someone is taking medication, a steroid in particular, to control RA flares, long term use can accelerate that bone loss,” said Schwartz.
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Regular physical activity is recommended, but in moderation.
“Weight bearing and strenuous exercise can sometimes cause an exacerbation or flare-up of their disease,” said Farrell. “Water exercises are really good because they are not weight bearing and strengthen muscles around the joints to help stabilize them.” Preventing joint deformity and protecting mobility are important goals in managing RA.
On a practical level, pharmacists can help RA patients cope with limited mobility through gestures as simple as fitting medication with easy open caps.
“It is something the patient has to request, but it is helpful to remind folks with RA medications that it might be a good conversation to have,” said Schwartz. “A lot of community pharmacies tend to carry unique medical equipment that will help RA patients as their disease progresses, such as reachers, grab bars, and raised toilet seats. We have things that may make daily living a little easier when you are having a bad day with your RA.”