Rheumatoid arthritis

• Timely diagnosis of rheumatoid arthritis (RA) and early initiation of treatment (specifically methotrexate) can beneficially impact outcomes by improving physical function, as well as delaying or preventing irreversible joint damage.
  
• Low-dose methotrexate – as monotherapy and in combination with other DMARDS (disease-modifying anti-rheumatic drugs) – remains the cornerstone of RA therapy.
  
• Collaboration and communication between the patient and all their healthcare providers can contribute to an integrated management plan, provide consistent messaging about appropriate medicines, support adherence and optimise outcomes.

Thanks to everyone who joined our live webinar – Rheumatoid arthritis: getting the facts straight about methotrexate. Watch a recording on demand here.

The webinar presents a clinical scenario in case-study format to help facilitate the discussion and prompt participants to reflect on their individual practice and counselling of patients with rheumatoid arthritis. Download webinar slides PDF. 

We also provide further reading to support the topics discussed during the webinar, including shared care and prescribing and information for your patients.

Rheumatoid arthritis (RA) is a relatively common condition, reported to affect about 456,000 Australians (2%). It has a major impact on quality of life, is an important cause of disability and psychological distress, and is associated with increased mortality due to related comorbidities and complications.¹

Clinical presentation can vary, but typically this chronic autoimmune condition causes joint pain, swelling, and stiffness. If untreated, the condition can be progressive and lead to joint destruction and deformity.

The aim of treatment for RA is to achieve clinical remission or low disease activity. People with suspected RA should be referred to a rheumatologist as quickly as possible to allow early diagnosis and initiation of DMARD therapy within the therapeutic ‘window of opportunity’.

DMARD treatment can alter the course of disease by improving physical function, and also delay or prevent irreversible joint damage.^2,3,4 Early treatment with conventional synthetic DMARDs (csDMARDs) is associated with higher rates of disease remission and reductions in long-term complications, including disability.^2,3,4

The csDMARD methotrexate given at a low dose once weekly is the gold standard and first-line therapy for RA. It should be initiated and continued wherever tolerated.

A definitive diagnosis of RA can be difficult to make,² leading to delays in the initiation of treatment. To address this delay, NPS MedicineWise has worked closely together with the Australian Rheumatology Association to develop a national educational program that will improve the quality use of medicines in the management of rheumatoid arthritis by Australian health professionals.

The program also recognises that health professionals have a central role to play in delivering consistent messaging to their patients about the place of once-weekly low-dose methotrexate for RA therapy. It is reported that adherence to methotrexate therapy is variable – due partly to misconceptions about the medicine.⁵  

For pharmacists

Case study: optimising rheumatoid arthritis treatment

Pharmacists play an important role in counselling patients with rheumatoid arthritis who are starting treatment. This case study focuses on strategies for pharmacists to help their patients optimise the use of once-weekly low-dose methotrexate. 

Up-to-date information, tools and resources 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 RA.

• Interventions for health professionals
• Practical tools for your patients

Inadvertent overdose of oral methotrexate – usually from accidental daily administration of a weekly dose – can lead to serious and potentially fatal toxicity.

Read the full report 

Medicines for rheumatoid arthritis

• Arthritis Australia fact sheet: Medicines and arthritis
  
• The Australian Rheumatology Association and Arthritis Australia fact sheet: Methotrexate
  

Management of RA

• Arthritis Australia fact sheet: Blood tests for arthritis
  
• Arthritis Australia brochure: At home with arthritis
  

Self-injection

• The Australian Rheumatology Association and Arthritis Australia fact sheet: Self-injecting methotrexate for the treatment of RA
• The Australian Rheumatology Association video: How to inject yourself with methotrexate just under the skin