Up-to-date information and resources for specialists, pharmacists, nurses and hospitals to optimise the safety and health outcomes of biological disease-modifying antirheumatic drugs and other specialised medicines for inflammatory arthritis.
For health professionals
Key points
- Optimise first-line disease modifying therapy before starting a biological/targeted synthetic disease modifying antirheumatic drug (b/tsDMARD).
- Subcutaneous methotrexate is more efficacious and generally better tolerated than oral methotrexate.
- Consider stepwise reduction in the dose of b/tsDMARDs for people with rheumatoid arthritis (RA) or axial spondyloarthritis (axial SpA) who have been in remission or sustained low disease activity for at least 6 months, but do not stop b/tsDMARDs suddenly.
- Biosimilars are safe and equally effective alternatives to the reference biologic.
- Glucocorticoids and opioids have a limited role in the long-term management of inflammatory arthritis and should be used with caution.
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.
Information and resources for health professionals
- Supporting safe practices for low-dose methotrexate: Position statement on the use of low-dose methotrexate
- Guiding principles for the governance of biologics and their biosimilars in Australian hospitals
- Guiding principles for the governance of high-cost medicines in Australian hospitals
- SHPA bDMARDs Quick Reference Guide
- PBS Practice Review – Rheumatoid arthritis
- Tocilizumab (Actemra) shortage: Patient management
- Down-titration algorithm for b/tsDMARDs
- bDMARDs down-titration strategies used in clinical trials
- Biologics, biosimilars and PBS sustainability
- Avoiding the nocebo effect: talking to your patients about biosimilars
Webinars and podcasts
Webinars
- Australian Living Guideline: Down-titration of b/tsDMARDs in rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis
- Opioids and inflammatory arthritis - The current state of evidence and use in Australia
- The Real Risks of Glucocorticoids, What Australia Says!
- ARA webinar: "The Great Debate: To triple therapy or not to triple therapy in RA? That is the question"
Podcasts
Resources to use with your patients
- Action plan: Low-dose methotrexate for rheumatoid arthritis and psoriatic arthritis
- Action plan: Managing your arthritis flare
- Down-titration decision aid: My rheumatoid arthritis is under control – what should I do about my medicine?
- Fact sheet: Safe use of low-dose methotrexate
- Fact sheet: My rheumatoid arthritis is well controlled with a biological or targeted medicine: can I take less medicine?
- Online content: Understanding biosimilars
- Triple therapy fact sheet and decision aid: Helps you decide whether to start taking methotrexate on its own, or take it with one or two other medicines
- Video: Living with rheumatoid arthritis: Suzanne’s story
- Roadmaps:
- Translated resources: inflammatory arthritis resources translated into Arabic, simplified Chinese (Mandarin) and Vietnamese.
In focus
The Australian Living Guideline for inflammatory arthritis
This living guideline presents the best available, current scientific evidence for pharmacological management RA, PsA and axial SpA, including choice of DMARD, combination therapy and down-titration of treatment. The guideline will be continuously updated as relevant new evidence emerges, and includes:
- Dose Reduction and Discontinuation Strategies
- Opioids for Pain Management
- Glucocorticoid therapy as an adjunct to DMARD therapy in the treatment of rheumatoid arthritis
- Initial DMARD therapy for people with rheumatoid arthritis
- Perioperative use of DMARDs in people with inflammatory arthritis
Video: A new living guideline to provide direction for the pharmacological management of inflammatory arthritis
Dr Sam Whittle, Cochrane Musculoskeletal Alliance member and rheumatologist, introduces the living guideline, explaining how it is developed and the gaps in the evidence it will address.
For pharmacists
- Practice Audit Tool – MTX and bDMARDs: Optimising use in rheumatoid arthritis
- Online learning module: Optimising the use of biological and targeted synthetic disease modifying antirheumatic drugs - the key role of pharmacists
- Disease-modifying antirheumatic drugs and inflammatory arthritis: article from the Pharmaceutical Society of Australia (PSA)
- Webinars
Research and education
MedicineWise App
The MedicineWise app is a free health and medicines management app. Features have been developed to support people with inflammatory arthritis, including a dose tracker to manage complex dosing or stepping up or stepping down of medicines.
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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.
