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

According to the Canadian Society of Obstetricians and Gynaecologists, 1 in 5 Canadian women had an unplanned pregnancy in 2016. Therefore, it is recommended that all women of child bearing potential take a pregnancy test prior to starting methotrexate and use reliable birth control while taking methotrexate.

The most effective form of birth control is an intrauterine device (IUD). If a woman is of child bearing potential and taking methotrexate, they should either be using an IUD or a different method of contraception plus a condom.

Taking methotrexate and breastfeeding is not recommended, as the drug may be passed to the newborn.

If you are a woman of child bearing potential and taking methotrexate, it is important to discuss birth control options with your physician. If you are planning pregnancy and taking methotrexate, please discuss this with your rheumatologist as your treatment will need to be altered and methotrexate discontinued.

This week’s blog was written by Janice Maretzki and Brittany Cook. Janice Maretzki is a pharmacist at Charlton Health who recently attended the Canadian Rheumatology Association meeting in Montreal. Brittany Cook is a 4th year pharmacy student completing one of her final rotations at Charlton Health. During her schooling has been extensively involved in arthritis care. She has participated in pharmacy practice research and is the recipient of various awards and scholarships.

Pregnancy can be magical time but also has its challenges; especially when living with a chronic disease. For patients with arthritis, it is important to discuss various issues with your rheumatologist, from planning a pregnancy, preparing for flares that may occur over the 9 months, medication choices, etc.. Some medications may need to be stopped up to 3 months before family planning.

While many women (approximately 70-80%) with inflammatory arthritis will go into remission by week 12 of pregnancy, 90% may flare in the postpartum period. Dealing with a newborn and accompanying lack of sleep becomes a greater struggle when a parent is not well. Drawing on the experience and ideas presented in the below mentioned blogs/websites may be just the resource a new mom needs, providing ‘life hacks’ for such daily necessities as using infant car seats, dressing a baby, or changing a diaper. Protecting the baby when one’s mobility is limited, understanding the need to maintain one’s own wellness, and knowing when to ask for help are all addressed. It is helpful for the new parent to know they are not alone and that there are creative solutions for many daily tasks.

Helpful websites:

https://arthritispatient.ca/pregnancy-parenting

http://mamasfacingforward.com

https://creakyjoints.org

Janice Maretzki is a pharmacist at Charlton Health who recently attended the Canadian Rheumatology Association meeting in Montreal.

One of the sessions at the Canadian Rheumatology Association meeting held last month focused on the Association’s recently created Position Statement on the use of Medical Cannabis in Rheumatic Disease. Patients seen by rheumatologists who report using cannabis, indicate pain as being the most common reason for using medical cannabis, however there are no trials and limited information on its’ use  for this patient group. Recognizing that better pain control is needed and the fact that this drug is now legal in Canada, it is necessary to address this issue. It is important to recognize that medical cannabis is not a replacement for disease modifying therapies prescribed by rheumatologists that prevent the progression of conditions such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Many other modalities for treating arthritis such as physiotherapy are part of the foundation for joint health. Cannabis would be seen as an additional therapy to augment evidence based treatments.

With that in mind, the recommendation is that medical cannabis be avoided in patients under 25, as neurological development continues into the early 20s. Use before this age may impact brain maturation, and has an impact on lifetime achievement. The product chosen should have a low THC to high CBD ratio.   It is important that smoking/edibles are avoided as oil is preferred to avoid harm to the lungs and to offer a uniform reliable amount per dose. There is not one ideal ratio as each person’s response can be different, so starting with low doses and gradually increasing the amount is suggested. Most people will use 1-3 grams/day. It important to try both prescription and non prescription methods to relieve pain prior to trying medical cannabis, as the long term effects of medical cannabis for this patient group are unknown. The use of opioid pain killers is not suggested for treating arthritic conditions.

For more information, please see the Canadian Rheumatology Association Position Statement on Medical Cannabis Use in Rheumatic Disease January 2019.

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.

A common misconception is that arthritis only affects adults. Although about 24,000 Canadian children are currently living with some form of arthritis.  Here are some resources for children who are currently living with arthritis.

Brittany Cook is a 4th year pharmacy student completing one of her final rotations at Charlton Health. During her schooling has been extensively involved in arthritis care. She has participated in pharmacy practice research and is the recipient of various awards and scholarships.

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.

Brittany Cook is a 4th year pharmacy student completing one of her final rotations at Charlton Health. During her schooling has been extensively involved in arthritis care. She has participated in pharmacy practice research and is the recipient of various awards and scholarships