Challenges in Managing and Preventing Rheumatoid Arthritis Pain

Yvette C. Terrie, BS Pharm, RPh


US Pharmacist. 2021;46(3):42-48. 

In This Article

The Role of the Pharmacist

When counseling patients, pharmacists can be instrumental in identifying those at risk for or exhibiting the early signs of RA and encourage them to seek medical evaluation if warranted. Pharmacists can also enhance clinical outcomes by educating patients about RA medications, provide information from the various manufacturers about patient savings/financial assistance programs, and direct patients to patient-education/teaching resources (see SIDEBAR). They can also remind patients about the importance of adherence to therapy and routine follow-up with their rheumatologist to monitor response to therapy. Pharmacists can screen for possible drug/drug interactions and potential contraindications, as well as monitor for and educate patients about possible adverse effects.

During counseling, pharmacists should discuss the details of medications with patients regarding dosage, storage, and administration, including injection training, warnings and precautions, and potential adverse effects. They can also educate patients about the black box warnings associated with several classes of DMARDs. For example, some DMARDs are associated with serious infections that can lead to hospitalization or death, including tuberculosis and bacterial infections, invasive fungal, viral, and other opportunistic infections, as well as increased risk of lymphoma and other malignancies. Patients should be advised to watch closely for signs of infection and to alert their rheumatologists immediately if they exhibit any of the following symptoms: fevers, chills, cough lasting more than 3 weeks, coughing up blood, unexplained weight loss, fatigue, or other symptoms that could signify the start of infection.[39]

Prior to initiating therapy, patients should be reminded to discuss with their rheumatologist the recommended tuberculosis screenings, other necessary laboratory tests, and monitoring parameters. Pharmacists should also remind patients that before initiating pharmacologic treatment with either nonbiologic or biologic DMARDs, they should receive not only the pneumococcal, hepatitis, and influenza vaccinations (as indicated in the 2008 ACR recommendations) but also vaccinations for human papillomavirus and herpes zoster virus.[12] Patients should be instructed to avoid live vaccine formulations as indicated in the prescribing information of many DMARDs. Patients should be urged to keep a current list of all medications including prescription medications for other conditions, OTC drugs, nutritional supplements, and alternative remedies and consult their primary care provider before taking any medications to avoid potential drug interactions or contraindications.