In addition to answering the questions above, rheumatology providers also typically address what happens if biologics are not used properly—for example, what happens if patients still use a biologic while they have an infection (whether knowingly or not).
Patients may form inaccurate opinions about biologics, because when the medications are advertised direct to consumers, they include an exhaustive list of possible side effects and adverse reactions out of context. Many patients also do research on the Internet and gather information from both reliable and unreliable sources, says Adena Batterman, LCSW, clinical social worker and senior manager for Inflammatory Arthritis Support and Education Programs, Hospital for Special Surgery, New York. “That makes it more challenging to put these treatments and risk profiles in context,” she says.
Among all the questions and concerns, rheumatologists must make patients the copilot in the decision-making process to improve compliance, Dr. Field emphasizes.
Misuse Issues
Although rheumatologists are well versed in discussing biologics and patients take them seriously, misuse issues sometimes can occur.
Dr. Field has found out about patients in her practice who have administered self-injections while sick, changed the frequency of their injections and neglected to get timely lab studies and office follow-ups.
“We address potential misuse issues, particularly with self-injectable biologics, during the patient’s appointment, but it could always be improved or supported by more patient education,” she said.
Although Ms. Batterman has not seen specific misuses of biologics, she has spoken with patients who were not well-informed about inflammatory arthritis as a systemic illness or the rationale for the use of biologics.
“I have worked with patients who did not understand that biologics treat a progressive systemic illness,” she says. “Instead, some patients can be under the assumption that if they can tolerate the joint pain and some other symptoms they experience, then they can delay or do without treatment with a disease-modifying anti-rheumatic drug [DMARD] or biologic.”
Dr. Troum has had patients tell him that they took their biologic when they had an infection because no one told them not to do so. Although the latter may not be true, it brings home the point of reinforcing the potential for misuse, he says.
A 2016 study of 677 French patients with inflammatory arthritis found that certain factors were associated with lower self-care skills associated with biologics.1 Led by Anne-Christine Rat, MD, Lorraine University, Nancy, France, patients who lived alone, had a lower educational level, lived in a large city, were unemployed and did not receive written information had lower safety skills associated with the use of biological DMARDs.