Summary of fundamentals of care in Rheumatoid Disease

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Now and as needed:

  • Ask who is providing pain relief for your patient. Prescribe or refer as needed.
  • Discuss with patient what to do in case of emergency.
  • Be sure prescription list is correct and patient knows purpose of each prescription & what to expect from it.
  • Share all labs & clinic notes with patient. Allow patient to correct any errors.
  • Encourage patient to
      • Find support online or locally
      • Become educated about the disease
      • Learn coping strategies such as energy conservation, pacing activities, and recognizing limits[1]
      • Obtain occupational therapy, joint protection techniques and devices, hydrotherapy, or aerobic exercise without exacerbating disease activity or hastening joint destruction[1]

Every 3 months if disease is active

  • Employ a measure of disease activity (DA) that includes patient input
  • Skilled joint examination with inventory of all “involved joints” (joints which have been symptomatic or which have shown evidence of disease via imaging)
  • Adjust treatment plan with patient input, unless DA is low
  • Inquire specifically regarding extra-articular aspects of disease
  • Use imaging to confirm DA or damage. See EFFECTIVELY USING TOOLS FOR IMAGING.

Annually unless otherwise indicated:

  • Check immunizations
      • Flu
      • Pneumonia
      • Shingles (herpes zoster)
  • Identify and create summary of all systemic effects of disease.
  • Assess disease impact and prognosis, and share with patient.
  • Get baseline examination or update as recommended by specialist for heart, lungs, and eyes, or other areas where disease symptoms have developed such as gastrointestinal, peripheral vascular, or skin.
  • Important screenings
      • TB (tuberculosis)
      • Bone mineral density (DEXA)
      • Assessment of infection risk[2]
      • Chronic kidney disease (“Patients with rheumatic diseases must be routinely monitored by blood and urinary parameters for concomitant CKD, which can be either a manifestation of the same systemic disease, a side effect of DMARD therapy, or an unrelated renal disease”)[3]

Resources on rheumatoid disease management or patient engagement

Physician’s Guide to the Patient-Centered Interview, Michael Bednarski, PhD, 2009
Guidelines for management of rheumatoid disease by the British Society for Rheumatology and British Health Professionals in Rheumatology, Luqmani, et al., 2006
Quality indicators endorsed by American College of Rheumatology
RA Joint Count Tool, Starz, et al., 2011
Unmasking rheumatoid disease: the patient experience of rheumatoid arthritis: A white paper from the Rheumatoid Patient Foundation
American College of Rheumatology recommendations for the use of disease-modifying drugs, Singh, et al., 2012
American College of Rheumatology recommendations for disease activity measures, Anderson, et al, 2012
Journal of Participatory Medicine
E-Patients: how they can help us heal healthcare, Tom Ferguson, M.D., 2007

MORE INFORMATION

WHAT NOT TO DO WHILE TREATING PEOPLE WITH RHEUMATOID DISEASE (PRD)

SHARED DECISION-MAKING AND RHEUMATOID DISEASE

DRUG SIDE EFFECTS IN RHEUMATOID DISEASE: HOW TO HELP

LEVELS OF TREATMENT RESPONSE IN RHEUMATOID DISEASE

10 Fundamentals of Care for Rheumatoid Patients
Significant Numbers of RA Patients Don’t Receive Recommended Care
Issues in preventive care with rheumatoid disease
Imaging in rheumatoid disease
A Paradigm Shift in Rheumatoid Arthritis Disease Activity? Part 2
Facts on immunizations with rheumatoid disease
What about a Clinical Protocol for Rheumatoid Arthritis Disease?
Where the Rubber Meets the Road or What If Only the Cancer in Dave’s Kidneys Was Treated?

FOOTNOTES

1 Luqmani R, Hennell S, Estrach C, Birrell F, Bosworth A, Davenport G, Fokke C, Goodson N, Jeffreson P, Lamb E, et. al. British Society for Rheumatology and British Health Professionals in rheumatology guideline for the management of rheumatoid arthritis (the first two years). (Oxford) Rheumatology [Internet]. 2006 [cited 2013 Sep 22];45(9): 1167-1169. doi: 10.1093/rheumatology/kel215a. Available from: http://rheumatology.oxfordjournals.org/content/45/9/1167.full
2 Crowson CS, Hoganson DD, Fitz-Gibbon PD, Matteson EL. Development and validation of a risk score for serious infection in patients with rheumatoid arthritis. Arthritis Rheum [Internet]. 2012 Sep [cited 2013 Sep 22];64(9):2847–2855. Available from: http://onlinelibrary.wiley.com/doi/10.1002/art.34530/full
3 Anders HJ, Vielhauer V. Renal co-morbidity in patients with rheumatic diseases. Arthritis Res Ther [Internet]. 2011 [cited 2013 Sep 22];13:222. Available from: http://arthritis-research.com/content/pdf/ar3256.pdf

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