“Knowing all of these nuances as a clinician is the hardest part,” Dr. Farrell said. “There is so much for us to learn. Then to be able to put all of this information into simple terms for our patients is quite a challenge—it takes practice.” Her group has developed its own fact sheets and frequently asked questions (FAQs) specific to each treatment, drawing upon prescribing information and handouts and medication guides from groups such as the ACR, but then tailored to its setting and peer reviewed by its clinicians. Ideally, order sets with check boxes would be integrated into the electronic health record.
“If you don’t have tailored patient education handouts for your practice, I’d urge you to work on developing them. They are very helpful,” she said. “When highlighting side effects, try not to make them sound too scary. Tell patients that being educated about the risks helps them better manage their disease and potentially reduce their risk for adverse events,” she added. “We use a mix of resources here.”
Dr. Farrell also encouraged professionals to work with patients to address their questions and anxieties at every face-to-face encounter, before and after treatment is started. “I find that when patients know more about each treatment and how they work, they tend to have more confidence in their treatment plan.” Reducing patients’ anxieties also increases their compliance. It is important that patients have realistic expectations, she said. “Explain that these drugs are disease modifying, with their own methods of action and common side effects, although it can take multiple visits to reinforce this information.”
‘Knowing all of these nuances as a clinician is the hardest part,’ Dr. Farrell said. ‘There is so much for us to learn.’
Additional Challenges of Patient Education
Some DMARDs can’t be used during pregnancy. Talk to patients of child-bearing age about the different medication exposures and associated complications for each treatment—although overall risk to pregnant women is relatively low with most biologic treatments, Dr. Farrell said. Some biologics, specifically certolizumab pegol and etanercept, can be used as needed during the first trimester and then tapered or continued if disease activity remains high.
Injection-site and/or infusion reactions to some biologic treatments are common. Premedication treatment can help with those, for example, diphenhydramine and second-generation antihistamines or steroids. “We give these 30 minutes before starting some infusable biologics. Make sure you have the pre-med treatments on hand, and your protocols should absolutely include how to treat for infusion and injection-site reactions.”