Pharmacy Times interviewed Cassie Dolecki, PharmD, BCACP, TTS, clinical pharmacy specialist, department of rheumatology, Allegheny Health Network (AHN), and Lakyn Husinka, PharmD, CTTS, pharmacy manager, specialty pharmacy, AHN, on arthritis treatment and management. Both Dolecki and Husinka emphasized the significant role that pharmacists have—notably in the retail setting—because of their accessibility and ability to educate patients, assist with medication selection, monitoring disease progression, and looking out for potential drug-drug interactions.
Key Takeaways
- Early Detection and Management: Early detection of arthritis, whether osteoarthritis or inflammatory arthritis, is crucial to prevent joint destruction, deformities, and the accompanying pain. Prompt treatment can significantly improve a patient's quality of life by minimizing the impact on daily activities.
- Pharmacists as Accessible Resources: Pharmacists, especially in retail settings, play a critical role in the early detection and management of arthritis. They can assist with medication selection, monitor disease progression, and offer valuable support and education, making them an essential part of the care a patient with arthritis receives.
- Advancements and Support for Patients: The development of biosimilars and enhanced patient support services from pharmaceutical companies, including copay assistance and injection training, are promising advancements in arthritis care. Leveraging social media for education and advocacy can further support patients and raise awareness about the disease.
Pharmacy Times: Can you introduce yourselves?
Cassie Dolecki: My name is Cassie Dolecki. I am a clinical pharmacy specialist in rheumatology for Allegheny Health Network (AHN), department of rheumatology.
Lakyn Husinka: My name is Lakyn Husinka, I am the pharmacy manager of the AHN specialty pharmacy.
Pharmacy Times: Can you provide an overview of arthritis and how it impacts individuals on a day-to-day basis?
Dolecki: So there are two main types of arthritis. One is osteoarthritis, which we typically think of as "wear and tear" arthritis, this typically involves joint destruction from long-term use, especially we see this in older folks. What a person with osteoarthritis might feel is they typically feel worse with activity, worse towards the end of the day.
And the other type of arthritis we typically think of is inflammatory arthritis, and there are multiple different types, depending on the underlying condition. But essentially, it's inflammation causing joint pain, joint swelling, stiffness, and unfortunately, some people can actually have both osteoarthritis and inflammatory arthritis. Inflammatory arthritis typically is worse in the morning or after periods of inactivity and...symptoms typically get better with activity, so it's a little bit different from the osteoarthritis side. And depending on the joints involved, it can impact even the smallest, most basic tasks that we think of, things like buttoning a shirt or opening a jar, opening a door knob, things like that, or even going up and down steps. So, it can impact even the most basic tasks [and] make it incredibly difficult and very painful for patients. And the pain in particular can have an impact on someone's mental health, their school and work attendance, and even unfortunately, kids can get arthritis, and it can impact a kid's ability to play sports or do activities and run around and [do] things that a normal kid should be able to do. So, it can be pretty life changing for a lot of people.
Pharmacy Times: Can you describe the importance of early detection or diagnosis? How might this better help effectively treat or manage arthritis?
Dolecki: So regardless of the type of arthritis, long standing, untreated arthritis can lead to joint destruction and deformities, and a lot of times these can be permanent, so early detection and therefore early treatment can prevent these deformities and this joint destruction, and it can also prevent the accompanying pain and impairments that a person with these destructions and deformities can experience. So, early detection and treatment can really minimize the impact that arthritis has on someone's daily life.
Pharmacy Times: In what ways can pharmacists aid in the treatment and management of arthritis? Is there anything important pharmacists should know?
Husinka: So, I'd say one thing that makes you know pharmacists important in this area is that a lot of times—especially in your retail settings—pharmacists are a lot more readily available or easier for patients to get to than being able to make appointments, so, a lot of times, if you are the pharmacist in that retail setting, when [patients are] coming to pick up their prescriptions, you can kind of start looking and seeing if they're showing any symptoms of, [for example,] the inflammatory arthritis, if they have a hard time with their hands, being able to—like [Cassie]—being able to open their wallet, grab the bag, pay for the medication, open the jars that are going through the pickup area that you're sending back and forth. So, just little signs like that to help with that early detection.
Also, too, there's a lot of different medications that can be used to help treat arthritis, typically, for patients who have mild [arthritis] a lot of it's going to be your over-the-counters, so being able to be there to help them choose the medication that might be the best fit for them. We can look at their other medications on their med list, make sure there's no interactions, kind of help them figure out what should be a best fit with them whether that would be an oral ibuprofen just to kind of help with any of the inflammation or pain. A lot of patients will use a topical corticosteroid gel, so, sometimes that's better for them than taking something orally if they're worried about it interacting. So, just being able to help with those decisions as well.
And then from there, again, just kind of helping to monitor as they start to progress and become maybe more severe, there's different medications that can be chosen. So, just helping, especially for those pharmacists—like Cassie—that are in the office, being able to work with the doctors to help pick the best medication for our severe patients, whether it be a JAK inhibitor or biologic, just making sure that they're able to assist in that role.
Pharmacy Times: Outside of medications or treatment methods, what resources or support are available for patients who have arthritis?
Dolecki: Absolutely, so organizations such as the Arthritis Foundation and other similar organizations depending on the type of arthritis a patient may have—perhaps the Lupus Foundation of America if a patient has lupus-related arthritis—those can be incredibly useful in learning about the disease itself, the treatment options, and a lot of them even have support groups or local and national events where people with arthritis can get together, meet each other, and share their experiences. But a lot of them do have support groups, specifically for specific subsets of patients impacted that can be very helpful. And a lot of these organizations also put on events like I mentioned, so there's often a Walk to Cure Arthritis for the Arthritis Foundation based on local chapters, there's even kids' arthritis camps, where kids with juvenile arthritis can attend and meet others, and just kind of meet other people that have shared experiences and also learn about their conditions, medications...and interact in a safe way.
Pharmacy Times: Is there anything coming in the near future (eg, trials, treatment methods) that you are looking forward to? If not, what would you like to see?
Husinka: For me, I know, as I said, in the recent years for more severe arthritis, we've been looking into the JAK inhibitors, the biologics, and so, coming down the pipeline is [with] a lot of those medications they're working on creating biosimilars just to kind of help decrease costs for patients, so that's really great, too. Adalimumab (Humira; AbbVie, Inc.) is already on the market, they're looking for etanercept (Enbrel; Immunex) alternatives in the biosimilar platform just to really drop patient costs. Again, this is a disease state that we're seeing across all ages, different types, so it's really important that they can keep working towards that so being able to help at with least the cost burden, since this disease is not curable, is something really exciting to see happening.
Dolecki: Yeah, I agree. And along with what Lakyn mentioned, I think the manufacturers of a lot of the medications—in particular, the specialty drugs—are really improving their patient support services, to include not just copay support, but even injection support, they'll send a nurse to your home to teach you how to inject, they provide disease state education, and things like that. And I feel like they're really improving their patient support activities, as well as their office support. It seems like in the last few years too, we've been able to engage with some of the pharma representatives if there are specific payer issues that just seem to really cost the patient a lot of money, and a lot of times, they can be very helpful in specific cases. So, I'm very excited to see the added support that really supports patients.
I think living in the digital age, I think social media can really be leveraged to provide support, provide education from kind of all factors, right? We see a lot of these national organizations with social media presence and promoting their events, promoting their patient education, things like that. And even from the pharmacy side, I feel like we as pharmacists, can promote some of those organizations and things either on social media or also share with patients what resources are legitimate, helpful, and have correct information and can kind of steer away from some that maybe aren't so correct, or not up to date, or something like that. So, you know, I think definitely social media can be leveraged.
Pharmacy Times: What do you think can be or should be done to raise awareness and promote advocacy for those with arthritis?
Dolecki: I think living in the digital age, I think social media can really be leveraged to provide support, provide education from kind of all factors, right? We see a lot of these national organizations with social media presence and promoting their events, promoting their patient education, things like that. And even from the pharmacy side, I feel like we as pharmacists, can promote some of those organizations and things either on social media or also share with patients what resources are legitimate, helpful, and have correct information and can kind of steer away from some that maybe aren't so correct, or not up to date, or something like that. So, you know, I think definitely social media can be leveraged.
Pharmacy Times: Any final or closing thoughts?
Dolecki: I think my only final thought would just be use your pharmacist, right? If someone has a really high copay, the best person to ask is that pharmacist that's right in front of you, like Lakyn mentioned. Don't wait for your appointment, don't wait until after you've paid a really high bill, work with your pharmacist and ask questions. And don't be afraid to ask questions [about] if you're having a potential side effect, your pharmacist can help troubleshoot that and things like that. So, use your pharmacist as a very accessible resource.
Husinka: And like [Cassie] was saying, we are resources, we're here to be able to kind of talk through anything. I think sometimes with some of these disease states, people think it's only going to happen in the older populations, and as we're seeing, it can really affect any age, so, the more informed you can be and the more questions you can be asking sooner than later...there's no cure for it, it just leads to, you know, worse degradation of the joints, so, the earlier you can detect it and start preventing it, the better your outcome is going to be.
