Rheumatology conditions

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.

Rheumatology conditions

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 algorithm

Date published : 2 November 2020

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.

Find the Australian living guideline for the pharmacological management of inflammatory arthritis here

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.

Find out more about the PBS Practice Review here

 

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.

Find the article here

Online learning module

Optimising the use of biological and targeted synthetic disease-modifying antirheumatic drugs – the key role of pharmacists – COMING SOON

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: 

Find the NPS MedicineWise Opioids program here

 

For your patients

Your roadmap for rheumatoid arthritis

Date published : 2 November 2020

Low-dose methotrexate patient action plan

Date published : 2 November 2020

Down-titration factsheet

Date published : 2 November 2020

Flares patient action plan – COMING SOON

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.

Find the Australian living guideline for the pharmacological management of inflammatory arthritis here


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

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.

Find the article here

Optimising the use of biological and targeted synthetic disease modifying antirheumatic drugs – the key role of pharmacists – COMING SOON

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: 

    Find the NPS MedicineWise Opioids program here

     

    For your patients

    Your roadmap for psoriatic arthritis

    Date published : 2 November 2020

    Low-dose methotrexate patient action plan

    Date published : 2 November 2020

    Flares patient action plan – COMING SOON

    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.

    Find the Australian living guideline for the pharmacological management of inflammatory arthritis here

    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.

    Find article here

    Optimising the use of biological and targeted synthetic disease-modifying antirheumatic drugs – the key role of pharmacists – COMING SOON

    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

    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:

      Find the NPS MedicineWise Opioids program here

       

      For your patients

      Your roadmap for ankylosing spondylitis

      Date published : 2 November 2020

      Flares patient action plan – COMING SOON