Question:
When can a person on rituximab receive the flu shot?

Answer:
Let me first speak about our biologic treatments for autoimmune conditions in general, where it is fine to get the flu shot as it is not a ‘live’ vaccine and we do not need to interrupt the biologic treatment. If we could pick an ideal time when a person might get a little bit more immune response, it would be 2 weeks before the next biologic dose, as vaccines take 2 weeks to process and this is when the biologic is at its lowest level.

However, people waiting for a ‘perfect’ time often miss the window and never get the vaccine.  So we don’t want to make a person feel a specific time is necessary.

For rituximab, it is a different story.  As B cells are depleted by this treatment, which we need to make antibodies when receiving a vaccine, there will be almost no benefit to getting any vaccine for about 5 – 5 ½ months after a rituximab dose.  It will do a person no harm to receive the vaccine, it just won’t have the benefit. So once the flu shot is available, receiving it  2 weeks prior to the next rituximab dose would be highly suggested.  If you have missed this opportunity, then the best thing a person can do is to ensure all those in close contact with them are vaccinated. We expect the flu vaccine to be available within the first two weeks of October.

Important Update to our Blog…

We have very much enjoyed bringing you this weekly blog for the past few years. As of this month, we will be publishing blogs on a bi-weekly basis. However, if there is critical information that needs to be shared, we will post more often. We also bring you content over on our Facebook and Twitter pages, so you can always tune in there if you miss having us in your inbox as frequently!

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.

We are often asked if it is necessary to have ongoing blood work while on disease modifying treatments for autoimmune conditions. 

Blood work is one part of understanding how well your condition is being managed, as well as watching for any changes that may be due to your treatment. Blood work alone of course, never tells the full story, as your symptoms along with an examination of your joints in the case of arthritic conditions or a scope in the case of inflammatory bowel diseases is needed to understand the full picture.

The reason why we need the blood work on a regular basis (often every 1-3 months) is that there may be changes in your liver or kidney function, white or red blood cells etc., that you cannot feel and by spotting these changes early in your blood work, changes in your treatment can be made before any damage is caused. 

We also use blood work before starting treatments to see if you have any underlying infections that you were unaware of, such as, hepatitis or HIV.  There is even a blood test (Quantiferon Gold) for detecting tuberculosis.  Disease modifying medications, such as biologics do not cause these infections, but if you already unknowingly were infected, they could make these infections worse.  These blood tests are called screening tests and in some patients they may be repeated on an annual basis.

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.

In honour of Arthritis Awareness Month, we thought we would share one of our most popular past blogs on arthritis. In April 2019, we brought you this list of helpful resources. If you didn’t see it then, we hope you enjoy it now.

The original post is as follows…

150 minutes per week of exercise is important for all Canadians. Although some individuals with arthritis may find it hard to find modified activities. At Charlton Health we have compiled a list of community resources and on-line programs for individuals with arthritis to help you to achieve 150 minutes of exercise per week.

To view the entire post in full, click here.

As we have seen in Australia, there is a definite expectation that Canadians will want to be protected against any vaccine preventable infection possible, including influenza. It is known that getting influenza changes the airway lining, increasing the risk of also getting pneumonia and with Covid-19 numbers rising this adds even greater concern. The National Advisory Committee on Immunization is suggesting that when receiving the flu shot this year, other vaccines should be updated at the same time.  There is a large emphasis on the pneumonia vaccines and shingles vaccines being updated; especially in the most vulnerable populations.

Pharmacists anticipate that they will receive the flu vaccine by mid-October. Now could be a good time to consult with them and your family physician about other vaccines that you may require.

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.

Did you know 1 in 5 Canadians live with Arthritis?

Charlton Health would like to recognize September as Arthritis Awareness Month. The Arthritis Society has posted several ways for us to be involved, including information sessions, an online concert, and more. Read more about the ways you can take part in Arthritis Awareness Month here.

This week we’re bringing you the another question submitted by our one of our clients and social media followers! If you have a question you’d like to submit, please email us here.

Question:
Can I have the Shingrix vaccine while on Prolia?

Answer:
Prolia is a biologic medication used to treat osteoporosis.  It is not a immunosuppressive treatment and any vaccine (live or non-live) can be given while on Prolia.  Shingrix is a non-live vaccine so not only is it safe to give with Prolia, it can be given while on other types of biologic therapies, such as those used to treat autoimmune diseases.

This week we’re bringing you the another question submitted by our one of our clients and social media followers! If you have a question you’d like to submit, please email us here.

Question:
How do we know when we achieve pharmaceutical remission? Does remission have any pain?  Fatigue?

Answer:
There are different ways to look at remission. For patients this can mean being pain free, but having no pain does not necessarily mean the disease process is not active.  To truly assess remission, rheumatologists evaluate inflammatory markers in blood work as well as images of the joints such as ultrasound, X-Ray or MRI, in addition to asking questions about your pain, morning stiffness, and ability to function at home, work, and socially. In addition the “hands on” assessment of your joints is also important.  Achieving full remission is easier to achieve when treatments to stop disease progression are started early; ideally within the first year after symptoms are first identified. Remission can also be easier to achieve in non-smokers and those who are not overweight as fat cells produce inflammation themselves.  The goal of treatment ideally is to achieve remission, but as this is not always possible, achieving low disease activity can still make a significant difference in a person’s quality of life and preventing joint damage.

Fatigue can certainly be reduced when disease is under control, however, some people can continue to have fatigue despite their arthritis being well controlled. Pain, inflammation and the stress of illness overtime can place a large burden on the body if a disease has not been well managed. This may lead to adrenal stress, whereby fatigue can remain despite low disease activity. The same can be said for pain. An increased sensitization to pain can occur in people who have experienced untreated pain overtime. If the pain is coming from tissue beyond the joints and it is experienced as a generalized pain sensitivity, then this type of pain may not necessarily resolve even though the inflammatory condition is in good control.

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.

This week we’re bringing you the another question submitted by our one of our clients and social media followers! If you have a question you’d like to submit, please email us here.

Question:
Is it safe to have the Shingles vaccine if you are on Prolia?

Answer:
The shingles vaccine used most often is called Shingrix which is a non-live vaccine.  Prolia is a biologic therapy for the treatment of osteoporosis which does not increase infection risk.  It is fine to receive Shingrix while taking Prolia.

Even when taking a biologic therapy for an autoimmune condition which does increase infection risk, there is no problem in receiving any non-live vaccine including Shingrix.

This week we’re bringing you the another question submitted by our one of our clients and social media followers! If you have a question you’d like to submit, please email us here.

Question:
It is my understanding that many of the vaccines that are being developed for COVID-19 work best with people in the middle age group, i.e., not children and seniors.  Given that many of us who have Rheumatoid Arthritis are seniors, will the vaccines be effective for us too?

Answer:
Thank you for your question regarding vaccination development for COVID-19.  There are currently several vaccines being researched and they are not all produced the same way. It is true that an immature immune system, just as an older immune system or one of an immunocompromised person, may not respond as well to a vaccine than a healthy young adult.  Higher levels of immune response can be generated for all ages, based on the way a vaccine is produced.  Often a vaccine requiring a series of 2 shots may offer a higher level of protection.  Of the vaccines being researched, some will require 2 doses and the processes being used to produce these vaccines is not all the same.  We won’t have the answer to the level of immune protection that each of these vaccines will offer in different age groups or in compromised individuals until the research is complete.  Once vaccines are available, ongoing ‘post-market’ research will be needed to answer many questions, including how long immune protection will last once a vaccine is received.  It may be necessary to repeat certain vaccines annually.

Regardless of which type of vaccine is available to Canadians, the concept of herd immunity is so important!  Based on the rate of transmission of a virus, we calculate what percentage of the population needs to be vaccinated to offer protection to everyone; including the most vulnerable.  This will be a very important calculation to have when we get the COVID-19 vaccine. Immunizing a large portion of the population will be required.

Here is a great summary of how vaccines are made and the types of vaccines under development for COVID-19 currently.