Every day we get questions in our infusion clinics. Today’s blog features one of those questions…

Rituximab (Rituxan) is a biologic therapy that depletes a specific type of B cell in the immune system. This B cell is responsible for generating antibodies that will promote long term protection against the virus or bacteria the person is being vaccinated for. When available, any needed vaccines should be given two weeks before receiving rituximab as this is the time needed for a vaccine to be effective. Alternatively, you must wait until 5-6 months after the dose for vaccination, as it can take this long for a person to replace their B cells after a Rituxan infusion.

If you are just getting an infusion now and the flu vaccine for this season is not yet available, then you will need to wait until the New Year (5-6 months from now). This will leave you more vulnerable to the flu until that time. Therefore, ensuring your family members and close contacts receive their flu vaccine is very important. Hand washing is one of our best protections from the spread of infection.

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.

• Ensure you have eaten a full meal prior to your infusion.
• Drink plenty of water to be well hydrated. This should begin the night before your infusion.
• Always bring a current list of medications to each infusion. New medications or a change in your health status must always be reported to your infusion nurse.
• If you are unwell and are unsure if you should come for your infusion, please call ahead.
• Wear a loose-fitting shirt. This allows the nurse to easily and properly monitor your vital signs.
• Bring a blanket and/or sweater.
• Bring something to help pass time (book, laptop, tablet, handiwork). Ensure you have earphones if listening to music/movie so you can be mindful of others in the clinic.
• Please refrain from wearing perfume or other fragranced products.
• If you receive Benadryl or Gravol as a pre-medication, it is the policy of the clinic that you do not drive yourself. Please arrange transportation in advance.
• Kindly inform us of any allergies.

Today we bring you another update from the European rheumatology conference (EULAR). 

Sarcopenia is a condition that increases naturally with aging. It occurs when there is a muscle mass decline accompanied by muscle weakness and in the most severe cases, affects physical function such as walking speed. Walking speed has been a determinant in longevity. The incidence of this in people over 65 is 7-11%, in rheumatoid arthritis is 15-32%, in psoriatic arthritis and ankylosing spondylitis is 20-34% and in osteoarthritis is 22-30%. 

In fact, joint damage only accounts for 21% of the cause of reduced walking speed in rheumatoid arthritis; whereas muscle wastage plays a large part. The worst outcomes occur when there is excess body fat along with low muscle mass. This altered body composition has great detriment to overall health and is more common in people with rheumatoid arthritis than just having low muscle mass alone. 

Protein helps build muscle mass, yet with aging and increased inflammation, the ability to generate muscle building from protein can be altered. The type of protein in food that is chosen can make a difference on the ability to build muscle. 

The research presented at this conference suggested fast digested whey proteins and leucine rich proteins are best at providing muscle building. Muscle mass is also promoted by having vitamin D supplementation. Research has also shown that omega-3 fish oil is helpful in promoting muscle mass and helped to improve walking speed. The addition of omega-3 has also shown to enhance rates of remission in people taking disease modifying therapies for rheumatoid arthritis. Further benefits were seen with regular exercise, which is suggested at 150 minutes per week. On average, only 17% of patients with rheumatoid arthritis achieve this goal. 

The main messages from this presentation were to prevent muscle wastage and excess fat storage consider the following: 

• reduce inflammation, 
• adjust the diet to include fast absorbing proteins, 
• add omega-3,and vitamin D supplementation 
• regular exercise

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.

An update from the European rheumatology conference in Madrid (EULAR) as reported by our pharmacist Carolyn Whiskin.  

A review of 56,000 patients from the Mayo Clinic databank was reviewed to determine what common disease states people had prior to their diagnosis of rheumatoid arthritis and which ones they were more likely to develop as a result of having the condition.

The findings of this data assessment showed that prior to the diagnosis of rheumatoid arthritis the following diseases are more likely to be present then in the normal population: inflammatory bowel disease, Type 1 diabetes, epilepsy, osteoarthritis, and thyroid disease. Once a diagnosis of rheumatoid arthritis has been made, conditions that are more likely to develop then in the general population include: cardiovascular disease, congestive heart failure, deep vein thrombosis, obstructive sleep apnea, and lymphoma. The risk of developing these other conditions often is increased when disease activity is higher and the person has carried the burden of inflammation for a long period of time. The risk of plaque formation in blood vessels is greater in those who also have high blood pressure and diabetes.

This shows the importance of good screening for other conditions that may have a greater likelihood in people with high levels of inflammation. It also underscores the importance of disease control and being on treatments that will lower the burden of inflammation as soon as the condition is diagnosed. 

Autoimmune conditions such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis are much more involved than what is happening in the joints or on the skin. 

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 bring you another update from the European rheumatology conference held in Madrid (EULAR) which was attended by our pharmacist Carolyn Whiskin. 

When a person carries excess weight, there is an increase in the production of inflammatory substances referred to as cytokines. In addition, excess weight on joints leads to a bio-mechanical stress resulting in micro damage to the joints. In one study where patients had a BMI (body mass index) of 33 or greater, they were put on a restricted diet for 12-16 weeks. More food was slowly re-introduced thereafter. At the end of six months the average BMI dropped to 30 and measures of fatigue, inflammation disease activity and quality-of-life all significantly improved. In addition, blood pressure, lipids and blood sugar levels all improved with weight loss. It is well known that higher BMI leads to greater tender and swollen joints and increased levels of inflammation measured in the blood. Higher BMI equates to higher disease activity including skin involvement in psoriasis and psoriatic arthritis. Treatments such as anti-TNF biologic therapies do not work as well in obese patients. This speaks to the importance of weight-loss being part of a treatment regimen for all types of inflammatory arthritis.

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.

Today we bring you another update from the European Rheumatology Conference (EULAR). Certain types of infections can lead to arthritis, such as Lyme Disease and Chikungunya.

Lyme disease, which is spread through deer ticks, has become more prevalent over the last several years, specifically in north eastern areas of North America. Among the many consequences of this disease, including skin lesions, joints can also be affected. Often inflammation in joints occurs with redness and extensive swelling where the knee is the most common area. However a shoulder, ankle elbow, wrist, hip or a joint of the hands or feet could be involved. Normally, less than five joints would affected. Methotrexate has shown to have the most promise in putting the arthritis under control and may only need to be used for a short period until the arthritis is in remission. Untreated, Lyme disease arthritis can resolve on its own but it may take several years. 

Chikungunya is a viral infection spread through a specific type mosquito. It has spread from South America and the Caribbean although some cases have been locally detected in Florida and Texas. It starts with a fever which is often followed by an arthritis which can be extremely painful and disabling, affecting multiple joints in the hands and feet. There is no antiviral treatment available and therefore rest, fluids and anti-inflammatories have been the main treatment. It appears that after the infection is gone the arthritis can remain. Methotrexate seems to be the best therapy in controlling this type of arthritis.

Our World Hepatitis Day event is coming up July 26th from 9am to 3pm at Gore Park in Hamilton. We will be be back testing people in the community for hepatitis C so that treatment can be offered to them.

Come visit us at our booth and invite your friends to be tested. We have highly effective treatments at Charlton Health that offer a cure. It is so important that we identify the people who could benefit from this treatment.

This event will be lead by the Shelter Health Hep C Team and is sponsored by Gilead Sciences Canada Inc and Merck Canada. Other organizations included at the event are: Hamilton Public Health Services, The AIDS Network, Liver Care Canada, PASAN, OATC/CATC, Canadian Liver Foundation.

We hope you can join us:

World Hepatitis Day in Gore Park
Friday July 26, 2019
9AM-3PM
Gore Park, Hamilton (Directions)

Another update from the recent European rheumatology conference (EULAR)...

There are many inflammatory substances that can be produced in the body. TNF (tumour necrosis factor) and IL-6 (interleukin 6) are known to be high in Rheumatoid arthritis. Biologic Treatments for rheumatoid arthritis have focused on lowering TNF or IL-6 levels. Knowing which type of treatment to use can be difficult as there are no current markers in the blood tests that will determine if one treatment may be better over another. 

One area that is being looked at is the impact that interleukin-6 elevation has on increasing fatigue, cardiovascular disease, insulin resistance and anemia of chronic disease. In one study of healthy athletes, IL-6 was given which caused a significant increase in fatigue. This was reversed when therapy that decreased IL-6 was given. It was also seen that healthy people who are deprived of sleep have an increase in IL-6, which can cause pain in people who previously had no pain.  

There are two approved biological therapies for Rheumatoid arthritis in Canada that specifically reduce IL-6. Based on research shared in this educational session, for people in which fatigue and mood changes have been a significant part of their arthritis, this may be an aspect to consider in treatment selection. 

Today we bring you another update from the recent European Rheumatology Conference: EULAR that our Pharmacy Manager Carolyn Whiskin attended in June.

Inflammation can have an impact on memory and emotional well-being. It is well known that when inflammation is high there is an increase in depression. Rheumatoid arthritis treatments are less successful in those that are depressed, as inflammation affects the nervous system. 

One study of patients with rheumatoid arthritis showed an improvement in dementia when on methotrexate. 

When cognitive behavioural therapy was used and depression levels fell, there was a decrease in pain and fatigue, and markers of inflammation in the blood decreased as well. Biological therapies used to treat rheumatoid arthritis, although having great impact on joints, are not as successful at lowering depression. So it appears that depression must be managed independently in people who have rheumatoid arthritis to ensure the best outcomes for both mental health, pain and inflammation.

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.