March 8^th marked International Women’s Day.  As a certified menopause practitioner, I have the privilege to work with many women in helping them navigate times of hormonal change. In my role as a pharmacist specializing in immune-mediated inflammatory diseases, I see these two specialty fields overlap. 

At the time of menopause, estrogen levels plummet, which can cause an increase in inflammation. A surge in joint and muscle pain and stiffness is now referred to as the musculoskeletal syndrome of menopause. This can result in an increase in flares for women with conditions such as rheumatoid arthritis and psoriatic arthritis, but it can also be a time of new diagnoses. We also see an increase in dryness as women transition to menopause, which can be even more difficult for women with conditions like Sjogren’s.  Falling estrogen also impacts blood vessels, leading to greater cardiovascular disease as women age. High inflammation in blood vessels can also increase this risk for women with many immune- mediated inflammatory diseases. Fracture risk also increases after menopause, and it is known that when rheumatoid arthritis is poorly controlled, osteoporosis risk is greater. 

With all of this in mind, a proper understanding of these risks is important, and connecting with your health professional to manage changes as hormones fall is key.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

As it continues to get colder outside, many people living with immune-mediated conditions may notice their symptoms worsening. Cold weather can cause blood vessels to tighten, which can lead to more joint pain, stiffness, and discomfort in the hands and feet. For example, this may cause people with rheumatoid arthritis to feel increased joint pain on colder days.

Winter can also affect the skin and immune system, thus affecting those living with psoriasis. Less sunlight and dry indoor air can trigger psoriasis flares, making skin more itchy, dry, or inflamed. Lower vitamin D levels have also been linked to worse symptoms in many immune-mediated conditions, namely rheumatoid arthritis,  psoriasis, and inflammatory bowel diseases. In addition to this, the shorter days of sunlight can lower mood and increase stress, which may further contribute to flares.

It is important to stay warm, protect your skin, supplement with Vitamin D, and limit time in extreme cold to help reduce winter flares. Do not neglect your biologic during this season and make sure you are reaching out to your pharmacist at Charlton Health or your specialist if symptoms become harder to manage.

Joyce Ayad is a pharmacist at Charlton Health who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. 

As we begin the month of February, it is a good time to reflect on the importance of the heart. Many groups focus on heart health in February, and just this week, I spoke at the women’s PROBUS club meeting. One of the questions asked about the difference between men and women regarding signs of a heart attack or stroke. The Heart and Stroke Foundation of Canada provides great guidance on this.  Learn more here.

At Charlton Health, we work with patients with immune-mediated conditions and think about heart health regularly.  Increased inflammation in the body can lead to increased inflammation in the blood vessels that supply the heart muscle. People with inflammatory arthritis (such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) and those with psoriasis have a greater cardiovascular risk when their immune-mediated condition is not well controlled, and inflammation is high. With that in mind, being on treatments that keep your condition in a low disease state is very important. Ensuring blood pressure and cholesterol are well controlled is also important in reducing this risk.  Of course, healthy eating and exercising for a minimum of 150 minutes a week is a guideline for all of us – whether we live with immune-mediated conditions or not. Similarly, lowering stress and having a healthy sleep routine are both parts of reducing the risk to your heart. Remember, being kind to yourself and doing what you can to support your well-being should be a priority, as we all need to take time to do the things that provide the greatest fulfillment. 

Be kind to yourself and be kind to your heart!

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that can be very painful and difficult to manage. Inflammation of the sweat glands around hair follicles is where the inflammation occurs (eg, armpits, groin, and buttocks). Trapping and removing excess inflammatory substances made by immune cells in these areas is one place where biologic treatments can be very effective. Adalimumab (Humira and its many biosimilars) lowers the inflammatory substance TNF (tumor necrosis factor) and has been a very effective treatment for HS.  Secukinumab (Cosentyx) lowers the inflammatory substance IL-17a (interleukin-17) and is also an approved biologic therapy for this condition. 

Health Canada has now approved bimekizumab (Bimzelx) as another biologic treatment option for adults with moderate to severe HS who have not responded well to conventional systemic therapies, such as antibiotics (eg, doxycycline) or steroids (eg, prednisone). Bimzelx lowers the level of IL-17a and IL-17f. 

For HS, Bimzelx is given as an injection at a dose of 320 mg every 2 weeks for the first 16 weeks, followed by every 4 weeks thereafter. This can be administered as one 320 mg injection or two 160 mg injections, using either a prefilled syringe or an autoinjector.

This new indication for Bimzelx adds to its existing approvals for use in psoriasis, psoriatic arthritis, and axial spondyloarthritis. Charlton Health is excited to offer another important option for patients living with HS.

Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. 

As the year comes to a close, we wish you a joyful holiday season filled with comfort, health, and peace. Thank you for trusting us with your care.

From all of us at Charlton Health, Happy Holidays!

Pulmonary arterial hypertension occurs when there is increased pressure in the small blood vessels that send blood to the lungs. It is characterized by symptoms such as shortness of breath, chest discomfort, or fatigue. Since these symptoms are closely related to other lung conditions, PAH can be further diagnosed using blood tests, scans, clinical tests, but the best way to confirm is by doing a heart catheterization. It is important to note that if PAH is left untreated, it can become life-threatening.

Until now, PAH has mainly been managed with medications like Opsumit or Revatio to help relax the blood vessels. These medications can help with symptoms, but many patients find that their condition may continue to progress despite being on multiple oral medications for their symptoms. 

A new treatment option is now available: Winrevair (sotatercept). It is the first injectable medication for PAH. Instead of simply relaxing blood vessels, Winrevair targets the cell overgrowth that causes lung vessels to narrow in the first place. By doing this, it helps improve blood flow and reduce pressure in the lungs. For now, Winrevair is used in addition to standard PAH therapy, not in place of it.

In clinical studies, patients on Winrevair walked 40 meters farther during the six-minute walk test and had improvements across all key measures, which shows a significant benefit! Common side effects of this medication include nosebleeds, headache, diarrhea, and small visible blood vessels (telangiectasias). Increases in hemoglobin and decreased platelets can occur as well, which is why regular blood work is done. 

Winrevair is a weight-based injection given every 3 weeks. The goal is for patients to self-inject, but if you need support, your Charlton Health team can help. Our pharmacists can train you for your first dose, or we can arrange ongoing injections with one of our nurses. 

For more information on PAH, visit Pulmonary Hypertension Association Canada.

Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. 

Polymyalgia rheumatica (PMR) is an inflammatory condition that causes widespread joint and muscle pain along with stiffness, especially in the shoulders and hips. Symptoms often affect both sides of the body and can appear sudden or develop over several days to weeks. It mostly affects adults over age 50 and is more common in people over 65. Corticosteroids such as prednisone have been the standard treatment for PMR, but despite their use, many patients flare while tapering, relapse after discontinuation, or require long-term steroid use. Long-term exposure to corticosteroids increases the risk of weight gain, diabetes, high blood pressure, weakening of bones and fractures, cataracts, and more.

Kevzara (sarilumab) is a biologic medication that has commonly been prescribed by rheumatologists for moderate to severe rheumatoid arthritis. Recently, Kevzara has also been approved for use in adults with PMR,  who have had a poor response to prednisone or for whom prednisone cannot be tapered without having a flare. Using Kevzara will allow for tapering of prednisone over a shorter period of time with a reduced chance of flares.  

If you are a patient with PMR, Kevzara could be a treatment to consider with your rheumatologist.  Charlton Health is pleased to support patients using biologic treatments for many immune-mediated conditions. 

Parvinder Sahota is a clinical pharmacist and a graduate from the University of Toronto. He enjoys learning about the ever-evolving field of autoimmune conditions and their treatment options.  

Respiratory Syncytial Virus (RSV) is a common virus that can cause serious lung infections, particularly in older adults and those with underlying health conditions. Because there is no treatment for RSV (which can cause severe coughing, phlegm, and shortness of breath for months after infection), vaccination is an important preventive measure. Vaccination can help prevent severe illness and hospitalization.

Abrysvo® (Pfizer’s RSV vaccine) was previously approved only for adults aged 60 and older and for pregnant women. Health Canada has now expanded its use to include adults aged 18–59 who are at increased risk of RSV-related lung disease. This includes individuals with chronic heart or lung disease (such as asthma or COPD), diabetes, weakened immunity, kidney or liver disease, certain neurological conditions, or class 3 obesity (BMI ≥40).

Arexvy® (GSK’s RSV vaccine) remains approved for adults 50–59 at risk and all adults 60 and older, though eligibility may expand in the future. 

Both Abrysvo® and Arexvy® remain publicly funded only for those 75 years and older and those between 60-74 years old who are considered ‘high risk’ for RSV. Some of those individuals include those living in seniors’ residences and long-term care homes. However, many people will receive this vaccine through private insurance or may decide to pay out of pocket. Check with your pharmacist or primary care provider to see if you are eligible for public coverage. 

With more adults now eligible, it’s a good time to ask your healthcare team whether RSV vaccination should be part of your protection plan! 

Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. 

Health Canada has recently approved Rinvoq (upadacitinib) for adults living with Giant Cell Arteritis (GCA). Rinvoq is the first and only once-daily, non-steroidal pill approved to treat this condition. GCA causes inflammation in blood vessels, often leading to headaches, jaw pain, or vision problems, making quick treatment important to prevent serious complications.

Until now, treatment for GCA has relied mostly on long-term steroid (prednisone) therapy. Prednisone works effectively; however, it can cause side effects like elevated blood sugar, increased infection risk, weight gain, high blood pressure, and bone loss. Rinvoq offers a new option for GCA patients to taper off steroids faster—in about 6 months instead of a full year—while still controlling inflammation. In a major clinical trial, nearly half of patients on Rinvoq stayed in remission for a year, compared to less than one-third of those using steroids alone. Many also began to feel better as early as 3 months into treatment.

This approval represents meaningful progress for patients with GCA. It will provide an effective oral therapy that may help maintain remission, protect vision, and reduce the burden of long-term steroid use. Rinvoq is already used in Canada for other immune-mediated diseases such as rheumatoid arthritis, Crohn’s disease, and ulcerative colitis, and now offers hope for those managing this serious form of vasculitis.

Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. 

Every year on October 12, World Arthritis Day raises awareness about the millions of people living with arthritis and related joint conditions. In Canada alone, more than 6 million people are affected by some form of arthritis. The most common include osteoarthritis, caused by deterioration of cartilage, and rheumatoid arthritis, an immune-mediated condition where the body’s immune system attacks its own joints. Psoriatic arthritis and ankylosing spondylitis are also part of the arthritis family, driven by immune cells moving to joints and causing inflammation.

While arthritis cannot always be prevented, early diagnosis and treatment can significantly impact joint health and overall quality of life. Staying active, maintaining a healthy lifestyle, and avoiding smoking and excessive alcohol can all help reduce risk and ease symptoms.

But before we mark World Arthritis Day, World Mental Health Day (October 10) reminds us that mental and physical health go hand-in-hand. Chronic pain can affect mood and sleep, while stress and anxiety can worsen physical symptoms. It’s important to care for both—by staying active within your limits, reaching out for emotional support, and talking openly with your healthcare team about how arthritis affects your overall well-being.

This week is a chance to raise your voice, learn, and show support for those living with chronic conditions. Whether it’s joining an awareness event, reading resources available on Arthritis Society Canada, or simply checking in on a loved one, every action helps move toward a future where joint and mental health are equally prioritized.

Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more.