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.

One of the risk factors for rheumatoid arthritis has been linked to periodontal disease. A study from Japan was presented at the recent European Rheumatology Conference (EULAR). It found that people who had rheumatoid arthritis along with periodontal disease had a greater level of disease activity in regards to their arthritis. There were less people in the periodontal disease group that were able to reach remission and there was also a greater risk of infection including pneumonia and shingles in this group. This underlines the importance of good dental care, especially in populations that suffer from rheumatoid 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.

At the European rheumatology conference, known as EULAR, there were several sessions held simultaneously over the four day meeting. There were over 16,000 people in attendance. One of the sessions focused on safety. United States physician Dr. Kevin Winthrop outlined the importance of vaccination and preventing infection while on immunosuppressive therapy.  We have written several blogs on vaccinations that should be given prior to the administration of drugs that suppress the immune system. Despite recommendations from health professionals, the level of vaccinations given prior to the initiation of these treatments is quite poor internationally. Emphasis was made on the importance of vaccines for pneumonia and shingles.

In regards to adverse affects of treatments while people were on biologic therapies, the most reported instances were from the use of anti-inflammatories or steroids needed to control flares. These were at a much higher incidence than any adverse effects from biologics themselves.

Stay tuned for more updates in the blogs to follow…

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.

Our pharmacist Carolyn Whiskin is in Madrid this week attending the largest Rheumatology conference in the world (EULAR).  She will be reporting back on the newest findings reported at this meeting over the next several weeks. There will be over 1000 research posters presented at this event.

If you are interested in learning more, the EULAR App is available at no charge for anyone wishing to download it. It allows you to see the breadth of sessions offered and many of the abstracts from the posters are available for viewing.

Stay tuned to our #WiseWordsWednesday blog for updates once she returns!

Skyrizi (risankizumab) is a new biologic for treating psoriasis. The first dose in Canada was injected at Charlton Health.  This treatment is given by injection as 2 prefilled syringes starting at week 0, week 4 and then every 12 weeks.  It works by blocking IL-23, a cytokine that promotes production of  IL-17 in skin cells.  The results in achieving complete skin clearance are impressive.  This is the second medication in this family of biologics.

We are always proud to be on the front lines with new treatments. Make sure to stay tuned to our #WiseWordsWednesday blog to always be kept in the loop about these new innovations.

Approximately 14% of Canadians suffer from osteoarthritis. While there are currently 17 approved medications for preventing the progression of rheumatoid arthritis, there are none for OA. This is a multidimensional disease and in the past there has been resistance to treating it early. Ideally, treatment should begin prior to the appearance of radiographic evidence (X-ray, ultrasound etc.), but this occurs rarely. The main preventative strategy for OA is exercise and weight reduction.  The prevalence of OA of the knee is expected to rise due to age, obesity, and sports injuries.

A new medication, Zilretta, is coming. This is a long-acting corticosteroid (triamcinolone acetonide extended release injectable suspension) which is a single injection to manage the pain of OA in the knee. The injection continuously releases microspheres of the medication into the knee for approximately 3 months. Side effects tend to be mild and include sinusitis, cough, and contusions.  It was approved by the US FDA in October 2017. This non-opioid medication that may have significant benefit for the pain associated with OA of the knee with greater effectiveness than our current shorter acting corticosteroid injections. Remember the number one thing you can do for your joints is to keep moving and injections such as the one mentioned above,  can help decrease the pain to allow more movement to happen. Exercise is our best treatment.

Janice Maretzki, Charlton Health pharmacist, attended the  Canadian Rheumatology Association Meeting in Montreal in February and prepared this summary of one of the sessions.

The Indian Act came into being in 1876, and in 1996 the last residential school in Canada closed. Canada has a long history of racism and colonization towards Indigenous people, which has resulted in multigenerational impacts on their quality of life. The social determinants of health include economic, personal, environmental, and social factors. Overcrowding, poor housing, unsanitary drinking water, high unemployment, and the destruction of culture and tradition have contributed to a reduced health status in Canada’s Indigenous people.

For example, Hepatitis C rates are believed to be approximately 1-18% amongst Inuit and First Nations people vs 0.5-2% in the rest of the Canadian population (Hepatitis C Education and Prevention Society). To read more about how Indigenous populations and Hepatitis C recommendations, click here.

Reciprocity is a unifying force which will provide healing and connectedness. It is important for health care providers to work within the framework of equity, where race has no impact on socioeconomic outcome.

June 21, 2019, is National Indigenous Peoples Day. This date was chosen because it is also summer solstice. Many generations of Indigenous people have celebrated their culture on this, the longest day of the year.

Janice Maretzki, Charlton Health pharmacist, attended the  Canadian Rheumatology Association Meeting in Montreal in February and prepared this summary of one of the sessions.

DigiSplint is a Canadian company that designs custom made splints to stop the progression of deformities. This business caught my eye recently at the Canadian Rheumatology Association meeting in Montreal, where they had a booth.

As a pharmacist at Charlton Health, I often see patients with RA and their hand appearance can often reflect the impact of their disease. Not only is pain, disability, and grip strength a concern for these people, there is also concern about the appearance of the hands. We are grateful to the advances in medicine that our newer disease modifying therapies such as biologics have prevented joint damage and deformities.  However, for many patients who had RA before newer therapies were available, living with joint damage and tissue deformities can be a reality.  Examples of this range from flexor tenosynovitis, ulnar deviation, boutonniere deformity, and swan neck deformity.  In addition to exercise programs developed by an occupational therapist, splinting is a method to improve function and slow the progression of disease deformity. Surgery is a more drastic option.

Metal ring splints are a way to reduce the progression of deformity. DigiSplint is a business in Guelph, Ontario. Derek, the owner, is a goldsmith by trade, and his beautiful selection of splint jewelry on display at this conference was a testament to his experience in creating beautiful yet purposeful jewelry.

For the person with RA who wishes to combine fashion with purpose, you may wish to visit Derek at www.digisplint.ca