How pharmacists can support patients with arthritis

Arthritis Australia has launched a National Strategic Action Plan which resolves to prevent arthritis, invest in research, and improve treatment and support for people living with the condition.

Arthritis is a leading cause of chronic pain in Australia. Around four million Australians live with the condition.¹ In the Action Plan, Arthritis Australia has identified three strategic areas to help reduce the impact of arthritis:

1. awareness, prevention and education
2. high-value, person-centred care and support
3. research evidence and data.¹

Arthritis is often mistakenly thought of as a single condition only found in the elderly, according to Arthritis Australia. But misconceptions such as this can impact prevention, early diagnosis and management. The majority (two-thirds) of people living with arthritis have reported that their condition is not being managed adequately. Pharmacists have an important role to play in mitigating these limitations.¹

Consultant pharmacist and former PSA Pharmacist of the Year Dr Jenny Gowan says an early arthritis diagnosis is paramount. ‘With a person who has inflammatory arthritis such as rheumatoid arthritis, the sooner they can get to a specialist and get a diagnosis, the sooner they can begin taking disease-modifying anti-arthritic medicines, rather than persisting for years and years until they start to experience erosion of the joints and extreme pain.’

Rheumatologists expect pharmacists to be at the forefront, referring patients as early as possible if there is a suspicion of the inflammatory condition, according to Dr Gowan. Pharmacists should encourage at-risk patients to see their GP to get a correct diagnosis and appropriate blood tests.

Screening

Asking questions about family history can help pharmacists identify arthritis, particularly rheumatoid, says Dr Gowan. When a patient presents with pain, pharmacists should ask how long they have been experiencing it, and whether the pain is due to an injury or has been developing on a gradual basis.

This will help with preliminary diagnosis of the condition, so the most appropriate treatment can be started without delay. Treatment could be initiated with medicines along with addressing modifiable risk factors, such as weight reduction and increased exercise. Pharmacists should also be asking how the pain is affecting the patient’s lifestyle.

Treatment advice

Pharmacists should be aware of the resources in their own community, so they can confidently refer patients to appropriate services – such as a community health centre, local hydrotherapy pool, physiotherapist or occupational therapist.

Dr Gowan, who works in a community health centre with pain management groups in conjunction with physiotherapists, has described these programs as extremely beneficial.

‘I have found that the groups I have been working with have not progressed to opioids, even though they experience severe pain. They’ve stayed on really low levels of medicines – whether that be paracetamol, or occasionally non-steroidal anti-inflammatories (NSAIDs) or rubs. They find great benefits from the exercises that are set by the physiotherapists, which is really encouraging.’

Some patients with osteoarthritis may wish to take complementary medicines. Recent research has shown promise for turmeric (curcumin), Boswellia serrata extract, methylsulfonylmethane (MSM), and pine bark extract (Pycnogenol). However, the Royal Australian College of General Practitioners (RACGP) does not currently make recommendations for or against their use in osteoarthritis. Further research is needed before firm recommendations can be made.

Pharmacists can help patients in the selection of safe and effective complementary medicines for short-term management of osteoarthritis. They should keep up-to-date with complementary medicine information to give the most current advice to patients.

‘If people want to try these medicines, pharmacists should suggest a trial for a few months and advise patients to keep a pain diary. Pain diaries are useful when trialling medicines, but it’s important that patients do not get too focused on their pain,’ says Dr Gowan.

Long-term management of osteoarthritis requires a multimodal approach with long-term goals. The RACGP osteoarthritis guidelines recommends exercise (such as strengthening exercises), weight loss if needed, and self-management education as first-line strategies. Medication may be added if required.

While these strategies are useful for patients with osteoarthritis or chronic back pain, patients with rheumatoid arthritis usually need more intensive pharmacological treatment with medicines such as disease modifying anti-arthritic agents.

Dr Gowan encourages pharmacists to support patients with rheumatoid arthritis by checking in that they are taking their medicines, having their regular blood tests and receiving medical assistance if they have an infection.

Person-centred care

Dr Gowan emphasises the importance of patient-centred, individualised care in arthritis management.

‘Each person is an individual who has different needs. Look at each case and identify whether it’s appropriate that the patient lose weight. What sort of diet do they have, what modifications can they make and how can they be helped?’

If patients live alone, they may not be eating correctly, says Dr Gowan. Some will also need an aid for daily living, such as a walking aid, and it must be ensured that they are using it correctly and that it is correctly adjusted. It should also be considered whether patients might benefit physiotherapy or occupational therapy assistance.

For more information on treating osteoarthritis, including options for relieving and reducing pain, refer to the recent CPD article Osteoarthritis: non-surgical approaches.

Attend the osteoarthritis masterclass at the PSA19 conference in Sydney from 26–28 July. Register now.

References

1. Department of Health. National Strategic action plan for arthritis. 2019 At: https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2019/03/2019-National-Strategic-Action-Plan-for-Arthritis.pdf