If you have Crohn’s disease or ulcerative colitis (IBD), you might also have joint pain—and it may not be a coincidence. This type of joint pain could be linked to your IBD and is called enteropathic arthritis. It is more common than you may think and affects more than half of people with IBD.

Enteropathic arthritis can show up in different ways. The most common kind affects big joints like your knees, wrists, or elbows, and it often flares up when your IBD does. A less common type affects smaller joints (like the ones in your hands) and doesn’t always follow the same pattern as your gut symptoms.

It’s important to know that your joint pain could be part of your IBD, because it can change how your treatment is managed. Some IBD medications – for example, infliximab (i.e. Remicade) or adalimumab (i.e. Humira) – can also help with joint pain. But on the contrary, common arthritis medications, such as NSAIDs (ex. ibuprofen) can make IBD worse, so they would need to be avoided. In some cases, other treatments like methotrexate or azathioprine may be added to help with both joint and gut inflammation.  People with both conditions often see a gastroenterologist and rheumatologist who coordinate the choice of treatments. 

Besides medication, gentle activities like swimming, yoga, or biking can help keep your joints from feeling stiff and improve movement.

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. 

Though HIV and autoimmune diseases both involve the immune system, they operate very differently. Autoimmune diseases occur when the immune system mistakenly attacks the body’s own healthy cells, often requiring immunosuppressant treatments to control inflammation and prevent further harm. On the other hand, HIV is a virus that specifically targets and destroys immune cells, weakening the body’s defense against infections and leading to increased susceptibility to various illnesses. Understanding this distinction is vital for understanding the nature of these conditions and the different treatment methods available.

Autoimmune diseases are typically managed with medications that suppress the immune system’s overactivity. In contrast, HIV treatment focuses on antiretroviral therapy (ART) to lower the viral load and improve immune function, preventing the progression to acquired immunodeficiency syndrome (AIDS). Although individuals with HIV may have autoimmune-like symptoms, HIV is not classified as an autoimmune disease. However, the long-lasting immune activation and damage caused by HIV can increase the risk of developing certain autoimmune conditions. Regular monitoring and individualized treatment plans are key for effectively managing both HIV and autoimmune diseases.

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 day, Charlton pharmacists counsel patients on advanced therapies for many immune-mediated conditions. Some of this discussion focuses on how the medication works to treat a particular condition. We discuss the risks and benefits of treating vs. not treating a condition. It is important to note that if the benefits of any treatment do not outweigh the risks, the medication is not approved by Health Canada. Patients may respond differently because of their individual characteristics, medical histories, other medications, and their level of disease. However, an expert health professional who understands the disease and medications can effectively put all the risks and benefits into context, allowing patients to make an informed decision about their care.

It is common for some patients to rely on information from various internet sites, including “chat groups” where certain adverse effects of a medication are highlighted by others who have used the treatment. This can often lead people to avoid treatments that could be beneficial for them. It is important to note that the thousands of people who are doing well may not be sharing their experiences on these sites. This results in a skewed sense of the actual risk.  

Keep in mind that not all internet sites are misleading. In fact, there are many sites that are validated by medical experts and are excellent sources of general information.

For example, The Arthritis Society, The American College of Rheumatology, and the Crohn’s and Colitis Foundation of Canada are great websites run by medical experts. See a full list of our recommended resources here.

Remember, we are here to answer your questions. If you read something that concerns you, reach out to fully understand the context of this information and how it may or may not impact you.

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.

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

Ustekinumab was first launched in Canada in 2008 under the name Stelara by the manufacturer Janssen. It is a protein-based treatment, which we refer to as a biologic. It treats many immune-mediated conditions such as psoriasis, psoriatic arthritis, Crohn’s, and Ulcerative Colitis. Depending on the condition being treated, standard dosing is based on injections given every 8-12 weeks. When the patent for the original Stelara expired, it allowed other pharmaceutical companies to produce ustekinumab after studies were conducted to show it was as effective and safe as the originator product. Health Canada has now approved a few biosimilars of ustekinumab.

Until now, ustekinumab has only been available as a standard pre-filled syringe from either the original manufacturer or from other companies making a biosimilar. Patients self-inject using a traditional syringe or get assistance from a medical professional.

Wezlana is an ustekinumab biosimilar made by the manufacturer Amgen, and they have just launched the first ustekinumab as an autoinjector. This device is referred to as the Confipen. Most biologic medication manufacturers offer a pen option. Patients appreciate that it can make injections at home easier and reduces anxiety for those with a fear of seeing a needle. We are excited that a pen option now exists for ustekinumab. For patients currently using the syringe format of ustekinumab who would benefit from a pen, you can reach out to your specialist to see if a change in prescription is appropriate. There is no cost difference between the pen and syringe, and private insurance plans that cover the syringe have now added the pen as a benefit. Government-based plans such as the seniors plan (ODB) and Trillium are likely to cover the Confipen soon. We will post an update when the pen becomes a benefit for these plans.

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.

Charlton Health is pleased to support Colorectal Cancer Awareness Month. Each Friday, staff who are donating are entitled to wear blue jeans to work. Colorectal cancer is the 4th most diagnosed cancer in Canada, and there is a 90% cure rate when found early.

As outlined on the Colorectal Cancer Canada website, the fecal immunochemical test (FIT) is a screening test for colorectal cancer. It detects small amounts of blood in your stool that are not visible to the naked eye. You can do it at home in a few minutes. It is: easy, painless, private, and free. Individuals between the ages of 50 and 74 without a personal or family history of colorectal cancer are suggested for testing. If you do not have a family doctor to access the FIT test kit, you can call 1-866-828-9213 to access a home test kit. Those with a higher risk for colorectal cancer may be referred for a colonoscopy instead of a FIT for their screening.  The main message is to get tested, as early detection is the 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.

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

Pharmacy Appreciation Month is celebrated each March as a time to highlight the growing role pharmacy professionals play in our healthcare system and thank them for their extraordinary efforts. Pharmacists are the most accessible health professional and serve a vital role as part of the healthcare team. At Charlton Health, we are fortunate to have a team of dedicated, knowledgeable, and caring professionals who have great passion for their profession. It gives us great pleasure to educate patients on their specialty medications and the conditions they treat. Some of our pharmacists are involved in teaching at the University of Toronto, writing journal articles, serving on committees of the Ontario College of Pharmacists, and lecturing to health professionals across Canada.

The Canadian Pharmacists Association has launched a contest called #MyFavePharm. They are asking the public to share with them why they love their pharmacy team. Those who complete and submit nomination forms before 11:59pm ET on March 21 will be entered into a draw for an opportunity to win a tablet for both them and their favourite pharmacy team member! Open to residents of Canada. Enter here: #MyFavePharm contest

Pharmacists work in hospitals, long-term care facilities, community pharmacies, specialty pharmacies, and the pharmaceutical industry providing medical information and conducting research. They are educators in universities and colleges, and often conduct presentations for the public. Pharmacists usually complete an undergraduate degree in science followed by four years at a faculty of pharmacy along with an internship. Graduates obtain a PharmD designation which is a clinical doctorate in pharmacy. At Charlton Health we are proud to support the education of future pharmacists by offering internship placements to students completing their final year of study.

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.

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

As we end the month of February, it is a good time to reflect on the importance of the heart. I recently asked a group of women what the word ‘heart’ meant to them. I received many answers, such as being at the core of a thought or issue, being kind to ourselves and others, and heart health. Working with patients with immune-mediated conditions, we think about heart health regularly since increased inflammation in the body can lead to increased inflammation in 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 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 is a part of reducing risk to the 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.

The National Advisory Committee on Immunization (NACI) provides vaccination recommendations for Canadians. Each province considers these recommendations and its budget to decide which vaccines will be publicly funded. Part of the decision process is considering which population members are at greatest risk of a particular infection. Pneumococcal vaccination has been available through public health for adults of any age who are compromised adults based on condition or treatment along with all adults age 65 and older. Pneumococcal vaccination is also part of the childhood immunization schedule.

In the newest guidelines, the two pneumonia vaccines approved by Health Canada that offer the greatest protection are Prevnar 20 by Pfizer and Capvaxive by Merck. In a previous blog post, we mentioned that Capvaxive offered 8 different strains compared to Prevnar 20 and that these strains were more prevalent in adults hospitalized with pneumonia. Since 2019, there has been a shift in the most prevalent pneumonia strains. This means that the overall protection, although slightly different between vaccines, is just over 70% regardless of which vaccine is used, resulting in an equal recommendation to receive either vaccine. In Ontario, Prevnar 20 is the only one funded for adults through public health and supplied to family doctor’s offices.   

If you had a different pneumonia vaccine in the past, such as Prevnar 13 or Pneumovax, then it is suggested you wait one year since the older vaccine was given to upgrade to Prevnar 20 or Capvaxive. If someone is going on highly compromising therapy and the update is required sooner, Prevnar 20 or Capvaxive should be given a minimum of eight weeks after a previous older vaccine. Should you have received either of the newer vaccines, no booster dose is suggested. Of course, with research and new vaccines always on the horizon, this guidance may continue to change.

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.

During a recent Ontario-wide educational session, leading pain expert Dr. Andrea Furlan provided valuable insights into the benefits of pain reprocessing therapy. Dr. Furlan, a renowned researcher and engaging educator known for her popular online videos for patients, is the author of 8 Steps to Conquer Chronic Pain. She has successfully integrated pain reprocessing therapy into her clinical practice. This approach is based on the understanding that a significant portion of chronic pain and symptoms are neuroplastic, meaning the brain is responsible for triggering and perpetuating them*.

In the world of immune-mediation conditions, we do find that some patients may continue to have pain even when advanced treatments are managing their inflammation. Treating an immune-mediated condition to prevent irreversible damage to tissue from excess inflammation is the foundation of treatment.  When there is pain beyond that, addressing how the brain processes pain can provide additional benefits for overall well-being. 

One of the leaders in this field of PRT is Dr. Alan Gordon, who authored, The Way Out. Nicole Sachs is also a great resource who hosts regular podcasts on the subject, as well as chronic anxiety. You can learn more about her work here and look out for her new book, Mind Your Body.   “Curable” is another podcast that many people have found valuable. 

* What is Pain Reprocessing Therapy? — Pain Psychotherapy Canada Inc.

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.

Charlton Health specializes in supporting the management of many autoimmune and immune-mediated conditions. Recently, a treatment has become available for vitiligo, an autoimmune condition with a great unmet need.

Vitiligo is an autoimmune condition in which the immune system targets and destroys the skin cells that make pigment (colour). As a result, individuals with vitiligo may develop white patches of skin that can appear anywhere on the body (e.g. face, hands, feet). The hair may also turn white in the affected areas. This condition can greatly impact an individual’s confidence and mental health due to this change in appearance.

Recently, a new topical treatment, Opzelura (ruxolitinib), has been made available to manage a specific type of vitiligo. Opzelura is part of a class of medications that are referred to as JAK inhibitors. JAK inhibitors are treatments that disrupt the signaling for excessive inflammation and help control autoimmune and immune-mediated conditions. Opzelura is a cream-based treatment designed to be applied to the affected areas. This is different from the other JAK inhibitors which are only available in tablet form to be swallowed. Opzelura is meant to be applied as a thin layer twice daily to the affected areas and patients may see the benefit within 24 weeks.

Interestingly, Opzelura may also be used for an immune-mediated condition, known as Atopic Dermatitis (eczema), adding to the growing list of advanced therapies for this condition. For atopic dermatitis, patients are likely to see benefits within 8 weeks.

Charlton Health is excited to be offering this new treatment to eligible patients. Please speak with your specialist to check if this treatment is appropriate for you.

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics.