One challenge of treating rheumatoid arthritis (RA) is to go beyond what is typically discussed at an appointment and gain a deeper understanding of what a patient is feeling and experiencing. In order to maximize their chances for successful treatment, it’s important to have an honest and open discussion about their symptoms, their goals for treatment, and a case-by-case analysis of what progress means for them.
In this discussion with Grace Wright, MD, PhD, president of the Association of Women in Rheumatology and a consultant rheumatologist in New York City, Dr. Wright offers strategies to foster productive conversations with patients that can help identify the right treatment course to help manage their RA and lifestyle.
Q: What can physicians do to help empower their patients?
In my experience, empowerment comprises three key elements: hope, listening, and education. Maintaining hope helps patients to keep working towards their desired treatment, goal and outcomes. Similarly, listening to a patient describe their experiences, symptoms, and treatment journey lets them know that they are participating in an active conversation with their doctor to help improve their health – when a patient walks into my office, I want them to know they will be heard. Drawing from their personal story allows me to educate my patients by helping them understand what’s going on in their body, which ultimately helps them learn more about what they’re experiencing and why.
Q: What are the key aspects of patient communication?
This conversation starts with anchoring the metrics in their individual experiences, such as personal milestones or goals that patients can connect to, not just disease activity scores or lab measurements, so patients can see whether they are getting better or worse.
For example, one patient's goal may be to go on daily walks around their neighborhood, while another patient is looking for help just getting around their own house. Because these metrics vary from person-to-person, the conversation needs to be customized to each.
Q: How should physicians work with patients to ensure they are benefitting from a new treatment option?
To start, the patient’s life and condition need to be taken into consideration as a whole. What are their goals from treatment? Are they more comfortable with one type of treatment versus another? What symptoms are persisting?
In order to capture all of these considerations, it is critical to empower patients through hope, listening, and education. From there, if our conversations reveal that the patient is still experiencing symptoms or aren’t reaching their established goals, we will work together to determine if a switch to a new treatment is warranted.
Q: How can physicians and other professionals that treat RA, like nurses, best partner with patients to help them adhere to their treatment regimen?
It really comes down to how you can empower patients to take that next step. The physician’s job is to find the motivators that will help the patient do the work to reach that next step.
Q: What are the key factors to think through before considering a change in a patient’s treatment?
I start with a blood test to look at the biomarker indicators that will help me understand ongoing issues the patient may be experiencing. This includes inflammatory markers like C-Reactive Protein (CRP).1 Then I move on to quality of life metrics. How are they functioning in their world? How are they describing their everyday activities? It is also important to consider if a patient is wary of switching treatments because of fear of the unknown, often referred to as “loss aversion.” Is their fear of a new treatment outweighing their desire to change their treatment course?
If physicians see those things aren't allowing the patient to be where they want to be, then it’s time to start a conversation about new treatments.
Q: What are a few characteristics, beyond a medical degree and hard skills, that physicians should have when working with RA patients who are still experiencing painful symptoms with their current treatment?
The first characteristic is to be an intentional listener. This allows physicians to truly understand the patient’s narrative. The second piece is to be a non-judgmental listener. Physicians should facilitate open and honest conversations about everything their patients have done and everything they've taken. The final characteristic is vulnerability. Physicians need to be willing to admit that finding an answer will take work, but together you will come up with a strategy that’s right for them. This trait goes hand-in-hand with physicians being advocates for their patients, to ensure they receive the right treatment for their disease. Once those three conditions are met, then a physician can go on to share the information about the disease, therapies, targets, remissions, and outcomes.
This interview is based on Dr. Wright’s experience treating RA for nearly 30 years. Dr. Wright is a fellow and member of the American College of Rheumatology. She has authored or co-authored several articles and is deeply engaged in medical education in Rheumatology.
If your conversations with patients indicate that they are continuing to experience symptoms of uncontrolled RA, discuss other potential treatment options. One treatment option is Kevzara (sarilumab), an IL-6 inhibitor.
Indication Statement: KEVZARA is indicated for treatment of adult patients with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response or intolerance to one or more disease-modifying antirheumatic drugs (DMARDs).
Important Safety Information
Patients treated with KEVZARA are at increased risk for developing serious infections that may lead to hospitalization or death. Opportunistic infections have also been reported in patients receiving KEVZARA. Most patients who developed infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids.
Avoid use of KEVZARA in patients with an active infection.
Reported infections include:
Closely monitor patients for signs and symptoms of infection during treatment with KEVZARA. If a serious infection develops, interrupt KEVZARA until the infection is controlled.
Consider the risks and benefits of treatment with KEVZARA prior to initiating therapy in patients with chronic or recurrent infection.
Do not use KEVZARA in patients with known hypersensitivity to sarilumab or any of the inactive ingredients.
WARNINGS AND PRECAUTIONS
USE IN SPECIFIC POPULATIONS
Advise patients to read the FDA-approved patient labeling (Medication Guide and Instructions for Use).
Please click here to see full Prescribing Information, including Boxed WARNING.
Please click on Next tab to advance through activity.
Tell us what you think about Healio.com »
Get the latest news and education delivered to your inbox
©2021 Healio All Rights Reserved.