Arthritis Care

According to the Centers for Disease Control and Prevention (CDC), one in four U.S. adults have some form of the more than 100 types of arthritis. The most common form is osteoarthritis, which affects approximately 30.8 million adults in the U.S. and costs up to $81 billion annually. Rheumatoid arthritis is next in line, with about one out of every five people suffering from swelling, pain, and stiffness in joints.

Rheumatologists are busy, and with limited time to spend with patients, it’s not uncommon for patients to have more medication questions after they’ve left the doctor’s office. This is where community pharmacists like you can help bridge that gap. You see patients up to five times more frequently than primary-care doctors. This means you are a critical part of your patients’ treatment plans. And as a healthcare provider, you are perfectly prepared to guide your patients to various forms of treatment and management for their arthritis or joint pain.

“Pharmacists have a major role in the care of patients’ arthritis,” Dr. Paul S. Schmidt, University of Kansas Health System rheumatologist, said. “They’re able to facilitate communication with patients, doctors’ offices, and other players who might be involved, such as insurance companies.

“Adding a pharmacist to our team was a beneficial change to the practice. We’re lucky to have our pharmacist on staff. We’re now able to utilize their skills in patient education as it relates to the medications, injection techniques, or newer products. There are so many new arthritis therapeutics, and it’s hard to keep up with what specific devices there are, and which medications. Pharmacists are the ones who have the best exposure and can provide the best information for the patient,” he said.

He also agrees that having pharmacists handle the details of medication therapy saves rheumatologists a lot of time and makes patients feel more comfortable. Their help with the prior authorization (PA) process is also helpful. For doctors, the process of obtaining a prior authorization can be time consuming. You, however, are equipped to assist with the PA process for prescription medications and health plans in real time. And when you do, you’re able to speed up the process of dispensing the prescription. It also allows you to determine if the patient can afford the medication, thanks to the expansion of electronic prior authorization (ePA) by the National Council for Prescription Drug Programs.

“The prior-authorization process is out of hand in the U.S. right now. It’s an enormous hurdle for doctors’ offices and patients to have to contend with,” said Dr. Schmidt. “Pharmacists are very well equipped to help handle the PA process. They have all the background of the medications and a better working knowledge of how insurance works.”

In addition to educating your patients on medications, you can offer injection training. You can also answer specific questions about drug interactions they may have, show them the appropriate dosage, and demonstrate how they should store and take the medication.

“I think independent pharmacies’ capabilities are quite wide,” said Dr. Schmidt. “A lot of it is medication education, helping patients with medication interactions, potential interactions, or concern when interaction may arise. They could be utilized when it comes to patients that have concerns about side effects or potential side effects, and both in terms of sorting out if the patients’ problems are truly related to the side effect. What happens far too often is a patient is dealing with a side effect not realizing that it is a common side effect of medicine.”

You’re also able to help rheumatologists combat the opioid epidemic. Because you’re on top of your patients’ medications, you can suspect a patient who may be abusing or misusing their medication and help them taper off and find an alternative. After all, research has shown that opioids are no better at controlling chronic back or arthritis pain than non-opioid drugs.

“There are a lot of types of arthritis. I think the pharmacists are well equipped to help identify when a patient might not be doing well and talk with them about querying their providers to be sure they’re getting the help they need,” he said.

Checklist for Pharmacotherapy Consideration

  • Patient has tried non-Rx but pain persists (e.g. weight loss, increased activity, thermal modalities)
  • Arthritis education has been provided
  • Current medications and supplements have been reviewed
  • Medication allergies have been discussed
  • Acetaminophen (mild-moderate pain) —Maintain < 4 grams per 24 hours from all sources

(Source: Osteoarthritis Action Alliance)

Community-based arthritis programs can also be a great asset to patients seeking pain relief and social support. They can get a lot of benefit from participating in self-management and physical activity programs in the community, such as recreation centers, senior centers, YMCAs, and residential communities. Programs like these can help improve arthritis symptoms such as pain or limitations in function. Plus, they’re widely available in communities across the U.S.

“We’re moving away from pain control as the goal and moving towards functionality. I think that’s a good way pharmacists could hopefully help patients adopt a more holistic approach to management of arthritis that doesn’t necessarily involve medications,” Dr. Schmidt said.

The following two websites are for you to use or suggest to patients looking for arthritis programs in their community.

What You Can Do

Here are some of the many ways you can help your pharmacy patients with arthritis:

  • Discuss details of medication therapy with patients.
  • Provide them with information about their medication, including possible side effects and interactions with other medications.
  • Manage their pain and symptoms by recommending OTC pain relievers.
  • Manage pain by suggesting lifestyle modifications, such as exercise and dietary changes.
  • Look into alternative therapies.
  • Ensure their medication regimen is optimized to their special needs.
  • Monitor patients for any potential adverse effects or drug interactions.

Nonpharmacological Treatment Options

  • Arthritis education
  • Physical activity
  • Information regarding community-based resources
  • Exercise (non-weight bearing on the affected joint(s))
  • Weight loss (if overweight)
  • Assistive walking devices (e.g. cane)
  • Corrective footwear
  • Hot or cold therapy
  • Referral to physical therapy and/or occupational therapy

(Source: Osteoarthritis Action Alliance)

From the Magazine

This article was published in our quarterly print magazine, which covers relevant topics in greater depth featuring leading experts in the industry. Subscribe to receive the quarterly print issue in your mailbox. All registered independent pharmacies in the U.S. are eligible to receive a free subscription.

More articles from the June 2023 issue:

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