Rheumatology conditions for health professionals
Up-to-date information and tools for specialists, pharmacists, nurses and hospitals to optimise the safety and health outcomes of biological disease-modifying antirheumatic drugs (bDMARDs) and other specialised medicines for inflammatory arthritis.
Rheumatoid arthritis key points
- Methotrexate is the medicine of choice for most patients with rheumatoid arthritis (RA). Early treatment with conventional synthetic DMARDs (within 3 months of diagnosis) is associated with higher rates of disease remission and reductions in long-term complications.
- Consider stepwise reduction in the dose of bDMARDs and other specialised medicines for people with RA who have had sustained low disease activity or been in remission for at least 6 months. Continue dose reduction until cessation is achieved or the lowest effective bDMARD or other specialised medicine dose is identified, as long as the treatment target is maintained. Abrupt cessation of bDMARDs and other specialised medicines without prior dose reduction is not recommended.
- Biosimilars are safe and equally effective alternatives to an originator.
- Glucocorticoids and opioids have a limited role in the long-term management of RA and should be used with caution.
Video: Value in prescribing bDMARDS program for rheumatologists
Professor Catherine Hill, ARA President and rheumatologist, outlines how the bDMARDs program will help specialists and their patients, the gaps the program will cover and some of the useful resources that will be available.
Specialists
bDMARDS down-titration algorithm
This clinical decision support tool provides guidance on when and how to reduce the dose of bDMARDs for patients in remission or with low disease activity.
bDMARDs down-titration strategies used in clinical trials
This table accompanies the down-titration algorithm, providing a summary of the bDMARD down-titration strategies used in randomised controlled trials and controlled clinical trials.
Find the down-titration strategies from clinical trials here
bDMARDs down-titration patient decision aid
Use this shared decision-making tool to support patients to feel more informed and clearer about what matters most when considering reduction of bDMARDs.
An Australian living guideline for the pharmacological management of inflammatory arthritis
The objective of this living guideline is to present the best available, current scientific evidence for pharmacological management of the most common forms of inflammatory arthritis (namely RA, PsA and axial SpA), including choice of DMARD, switching, combination therapy and down-titration of treatment. The guideline will be continuously updated as relevant new evidence emerges and is available via MagicApp.
Video: A new living guideline to provide direction for the pharmacological management of inflammatory arthritis
Dr Sam Whittle, Cochrane MSK Alliance member and rheumatologist, introduces the living guideline, explaining how it is developed and the gaps in the evidence it will address.
PBS Practice Review
The PBS Practice Review feedback report was mailed to rheumatologists and selected immunologists in October, providing them with data about their individual prescribing of DMARDs and other specialised medicines for rheumatoid arthritis, and comparing it with that of their peers across Australia. Prescribers can use this report to reflect on their prescribing and the time they spend to review and adjust their practice meets Category 3 CPD requirements.
Pharmacists
Webinar: Low-dose methotrexate for the treatment of inflammatory arthritis
This webinar presented by the Society of Hospital Pharmacists of Australia (SHPA) features Professor Susanna Proudman, Head of Rheumatology, Royal Adelaide Hospital.
The CPD accredited session provides an overview of the myths associated with the use of methotrexate and outlines key practice points for pharmacists to consider when they are interacting with patients with inflammatory arthritis.
Disease-modifying antirheumatic drugs and inflammatory arthritis
Optimising pharmacotherapy for patients with RA, PsA and AS requires an understanding of the risks and benefits of available treatments, and also an appreciation of how the medicine ‘fits in’ with the patient’s life.
This article from the Pharmaceutical Society of Australia (PSA) will discuss the role of MTX and b/tsDMARDS in the management of RA, PsA and AS, and highlight the role of pharmacists in supporting these patients to improve their quality of life and activities of daily living.
Note: Non-members of the PSA will need to create a free account to access this article.
Online learning module
Optimising the use of biological and targeted synthetic disease modifying antirheumatic drugs – the key role of pharmacists
This interactive online module from the Pharmaceutical Society of Australia will allow pharmacists to follow a patient as they transition between different care settings, from the point of their diagnosis with RA to the initiation of bDMARD therapy.
At several points along their journey, pharmacists will need to make clinical decisions to help optimise their medication management.
All health professionals
Supporting safe practices for low-dose methotrexate: Position statement on the use of low-dose methotrexate
This position statement from the Council of Australian Therapeutic Advisory Groups (CATAG) provides guidance to health professionals and medicines governance committees on dispensing and administering low-dose methotrexate (oral and subcutaneous dosage forms). It aims to provide clear information on safety for those dispensing and administering low-dose methotrexate and assists them with providing reassurance to people undergoing treatment with low-dose methotrexate.
Find the position statement here
NPS MedicineWise opioids program
The NPS MedicineWise Opioids, chronic pain and the bigger picture program aims to equip health professionals with tools and resources to reduce the harms of opioids while ensuring adequate pain management and quality of life for patients with chronic non-cancer pain. It also aims to empower consumers to make more informed decisions about opioids. Useful resources include:
- Opioids: Communication videos support effective conversations between health professionals and patients about the use of opioids
- Animated information video for people who may be considering taking opioids for chronic (ongoing) non-cancer pain
- Opioid tapering algorithm
- Starting a conversation about opioid tapering with patients
- Medicinewise News: 5 steps to tapering opioids for patients with chronic non-cancer pain
- Medicinewise News: If not opioids, then what?
- Practice Review – Opioids: Prescribing in chronic non-cancer pain
Webinars
Opioids and inflammatory arthritis - The current state of evidence and use in Australia
Join a panel of rheumatology and pain experts as they discuss how to reduce inappropriate opioid use. Professor Catherine Hill, ARA President, presents data on opioid use in rheumatology and talks with Dr Sam Whittle, Rheumatologist and ANZMUSC Practitioner Fellow, about the evidence, including the new Living Guideline for Opioids for Pain Management in inflammatory arthritis. A/Professor Michael Vagg, Pain Specialist, will also present ways in which rheumatologists and other allied health professionals can support general practitioners and their rheumatology patients who are on opioids, including practical tips and suggested resources. The presenters are then joined by Dr Richard Kwiatek, Rheumatologist, and Professor Simon Bell, Pharmacist, for a panel discussion.
Australian Living Guideline: Down-titration of b/tsDMARDs in rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis
Professor Rachelle Buchbinder is joined by Dr Huai Leng Pisaniello, Rheumatologist, and Dr Sam Whittle, Rheumatologist and ANZMUSC Practitioner Fellow, to discuss the Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis. The discussion focuses on the recommendations for bDMARD tapering for patients with rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. Dr Premarani Sinnathurai, Rheumatologist and NPS MedicineWise medical advisor, also presents new resources for clinicians and patients to support down-titration.
Podcast
The contemporary role of methotrexate and glucocorticoids in RA
In this episode of ARA Audio Rheum, ARA President Prof. Catherine Hill talks to Prof. Liana Fraenkel. Prof. Fraenkel is the principal investigator of the 2020 ACR Guidelines for pharmacological management of rheumatoid arthritis (RA). In this podcast they discuss the contemporary role of methotrexate and glucocorticoids in RA.
ARA Podcast: Down-Titration Living Guidelines
Join the conversation between Professor Rachelle Buchbinder, Monash University, and Professor Christopher Edwards, University of Southampton, UK, discussing the new Down-titration Living Guidelines.
Rheumatology conditions for consumers
Helping consumers and health professionals make safe and wise therapeutic decisions about biological disease-modifying antirheumatic drugs (bDMARDs) and other specialised medicines. Funded by the Australian Government Department of Health through the Value in Prescribing bDMARDs Program Grant.
Psoriatic arthritis key points
- Methotrexate is a recommended disease-modifying medicine for people with psoriatic arthritis (PsA). Early treatment with conventional synthetic DMARDs (within 3 months of diagnosis) is associated with higher rates of remission and reductions in long-term complications.
- Do not routinely reduce the dose of bDMARDS and other specialised medicines for patients with PsA. Abrupt cessation of bDMARDs and other specialised medicines is not recommended.
- Biosimilars are safe and equally effective alternatives to an originator.
- Glucocorticoids and opioids have a limited role in the long-term management of PsA and should be used with caution.
Specialists
An Australian living guideline for the pharmacological management of inflammatory arthritis
The objective of this living guideline is to present the best available, current scientific evidence for pharmacological management of the most common forms of inflammatory arthritis (namely RA, PsA and axial SpA), including choice of DMARD, switching, combination therapy and down-titration of treatment. The guideline will be continuously updated as relevant new evidence emerges and is available via MagicApp.
Video: A new living guideline to provide direction for the pharmacological management of inflammatory arthritis
Dr Sam Whittle, Cochrane MSK Alliance member and rheumatologist, introduces the living guidelines, explaining how they are developed and the gaps in the evidence they will address.
Pharmacists
Webinar: Low-dose methotrexate for the treatment of inflammatory arthritis
This webinar presented by the Society of Hospital Pharmacists of Australia (SHPA) features Professor Susanna Proudman, Head of Rheumatology, Royal Adelaide Hospital.
The CPD accredited session provides an overview of the myths associated with the use of methotrexate and outlines key practice points for pharmacists to consider when they are interacting with patients with inflammatory arthritis.
Disease-modifying antirheumatic drugs and inflammatory arthritis
Optimising pharmacotherapy for patients with RA, PsA and AS requires an understanding of the risks and benefits of available treatments, and also an appreciation of how the medicine ‘fits in’ with the patient’s life.
This article from the Pharmaceutical Society of Australia (PSA) will discuss the role of MTX and b/tsDMARDS in the management of RA, PsA and AS, and highlight the role of pharmacists in supporting such patients to improve their quality of life and activities of daily living.
Note: Non-members of the PSA will need to create a free account to access this article.
All health professionals
Supporting safe practices for low-dose methotrexate: Position statement on the use of low-dose methotrexate
This position statement from the Council of Australian Therapeutic Advisory Groups (CATAG) provides guidance to health professionals and medicines governance committees on dispensing and administering low-dose methotrexate (oral and subcutaneous dosage forms). It aims to provide clear information on safety for those dispensing and administering low-dose methotrexate and assists them with providing reassurance to people undergoing treatment with
low-dose methotrexate.
Find the position statement here
NPS MedicineWise opioids program
The NPS MedicineWise Opioids, chronic pain and the bigger picture program aims to equip health professionals with tools and resources to reduce the harms of opioids while ensuring adequate pain management and quality of life for patients with chronic non-cancer pain. It also aims to empower consumers to make more informed decisions about opioids. Useful resources include:
- Opioids: Communication videos support effective conversations between health professionals and patients about the use of opioids
- Animated information video for people who may be considering taking opioids for chronic (ongoing) non-cancer pain
- Opioid tapering algorithm
- Starting a conversation about opioid tapering with patients
- Medicinewise News: 5 steps to tapering opioids for patients with chronic non-cancer pain
- Medicinewise News: If not opioids, then what?
- Practice Review – Opioids: Prescribing in chronic non-cancer pain
Webinars
Opioids and inflammatory arthritis - The current state of evidence and use in Australia
Join a panel of rheumatology and pain experts as they discuss how to reduce inappropriate opioid use. Professor Catherine Hill, ARA President, presents data on opioid use in rheumatology and talks with Dr Sam Whittle, Rheumatologist and ANZMUSC Practitioner Fellow, about the evidence, including the new Living Guideline for Opioids for Pain Management in inflammatory arthritis. A/Professor Michael Vagg, Pain Specialist, will also present ways in which rheumatologists and other allied health professionals can support general practitioners and their rheumatology patients who are on opioids, including practical tips and suggested resources. The presenters are then joined by Dr Richard Kwiatek, Rheumatologist, and Professor Simon Bell, Pharmacist, for a panel discussion.
Australian Living Guideline: Down-titration of b/tsDMARDs in rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis
Professor Rachelle Buchbinder is joined by Dr Huai Leng Pisaniello, Rheumatologist, and Dr Sam Whittle, Rheumatologist and ANZMUSC Practitioner Fellow, to discuss the Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis. The discussion focuses on the recommendations for bDMARD tapering for patients with rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. Dr Premarani Sinnathurai, Rheumatologist and NPS MedicineWise medical advisor, also presents new resources for clinicians and patients to support down-titration.
Podcast
ARA Podcast: Down-Titration Living Guidelines
Join the conversation between Professor Rachelle Buchbinder, Monash University, and Professor Christopher Edwards, University of Southampton, UK, discussing the new Down-titration Living Guidelines.
Rheumatology conditions for consumers
Helping consumers and health professionals make safe and wise therapeutic decisions about biological disease-modifying antirheumatic drugs (bDMARDs) and other specialised medicines. Funded by the Australian Government Department of Health through the Value in Prescribing bDMARDs Program Grant.
Axial spondyloarthritis key points
- Consider stepwise reduction in the dose of bDMARDs and other specialised medicines for people with axial spondyloarthritis who have had sustained low disease activity or been in remission for at least 6 months. Continue dose reduction until cessation is achieved or the lowest effective bDMARD or other specialised medicine dose is identified, as long as the treatment target is maintained. Abrupt cessation of bDMARDs and other specialised medicines without prior dose reduction is not recommended.
- Biosimilars are safe and equally effective alternatives to an originator.
- Glucocorticoids and opioids have a limited role in the long-term management of axial spondyloarthritis and should be used with caution.
Specialists
An Australian living guideline for the pharmacological management of inflammatory arthritis
The objective of this living guideline is to present the best available, current scientific evidence for pharmacological management of the most common forms of inflammatory arthritis (namely RA, PsA and axial SpA), including choice of DMARD, switching, combination therapy and down-titration of treatment. The guideline will be continuously updated as relevant new evidence emerges and is available via MagicApp.
Video: A living guideline to provide direction for the pharmacological management of inflammatory arthritis
Dr Sam Whittle, Cochrane MSK Alliance member and rheumatologist, introduces the living guideline, explaining how it is developed and the gaps in the evidence it will address.
Pharmacists
Disease-modifying antirheumatic drugs and inflammatory arthritis
Optimising pharmacotherapy for patients with RA, PsA and AS requires an understanding of the risks and benefits of available treatments, and also an appreciation of how the medicine ‘fits in’ with the patient’s life.
This article from the Pharmaceutical Society of Australia (PSA) will discuss the role of MTX and b/tsDMARDS in the management of RA, PsA and AS, and highlight the role of pharmacists in supporting these patients to improve their quality of life and activities of daily living.
Note: Non-members of the PSA will need to create a free account to access this article.
All health professionals
NPS MedicineWise opioids program
The NPS MedicineWise Opioids, chronic pain and the bigger picture program aims to equip health professionals with tools and resources to reduce the harms of opioids while ensuring adequate pain management and quality of life for patients with chronic non-cancer pain. It also aims to empower consumers to make more informed decisions about opioids. Useful resources include:
- Opioids: Communication videos support effective conversations between health professionals and patients about the use of opioids
- Animated information video for people who may be considering taking opioids for chronic (ongoing) non-cancer pain
- Opioid tapering algorithm
- Starting a conversation about opioid tapering with patients
- Medicinewise News: 5 steps to tapering opioids for patients with chronic non-cancer pain
- Medicinewise News: If not opioids, then what?
- Practice Review – Opioids: Prescribing in chronic non-cancer pain
Webinars
Opioids and inflammatory arthritis - The current state of evidence and use in Australia
Join a panel of rheumatology and pain experts as they discuss how to reduce inappropriate opioid use. Professor Catherine Hill, ARA President, presents data on opioid use in rheumatology and talks with Dr Sam Whittle, Rheumatologist and ANZMUSC Practitioner Fellow, about the evidence, including the new Living Guideline for Opioids for Pain Management in inflammatory arthritis. A/Professor Michael Vagg, Pain Specialist, will also present ways in which rheumatologists and other allied health professionals can support general practitioners and their rheumatology patients who are on opioids, including practical tips and suggested resources. The presenters are then joined by Dr Richard Kwiatek, Rheumatologist, and Professor Simon Bell, Pharmacist, for a panel discussion.
Australian Living Guideline: Down-titration of b/tsDMARDs in rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis
Professor Rachelle Buchbinder is joined by Dr Huai Leng Pisaniello, Rheumatologist, and Dr Sam Whittle, Rheumatologist and ANZMUSC Practitioner Fellow, to discuss the Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis. The discussion focuses on the recommendations for bDMARD tapering for patients with rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. Dr Premarani Sinnathurai, Rheumatologist and NPS MedicineWise medical advisor, also presents new resources for clinicians and patients to support down-titration.
Podcast
ARA Podcast: Down-Titration Living Guidelines
Join the conversation between Professor Rachelle Buchbinder, Monash University, and Professor Christopher Edwards, University of Southampton, UK, discussing the new Down-titration Living Guidelines.
Rheumatology conditions for consumers
Helping consumers and health professionals make safe and wise therapeutic decisions about biological disease-modifying antirheumatic drugs (bDMARDs) and other specialised medicines. Funded by the Australian Government Department of Health through the Value in Prescribing bDMARDs Program Grant.