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Role of the pharmacist

Patient adherence and compliance

Pharmacists can potentially improve the outcomes for their patients with PsA by applying the principles of medicines optimisation to the specific needs of this patient group

Andrew Pothecary MSc MRPharmS Specialist Pharmacist, Rheumatology & Biologics UK National Health Service

Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy affecting up to 40% of patients with skin or nail psoriasis. It can cause arthritis, enthesitis, dactylitis and axial inflammation. British Society for Rheumatology guidelines recommend that patients are initially treated with non-steroidal anti- inflammatory drugs (NSAIDs) and/or local intra-articular steroids, followed by at least two disease-modifying anti- rheumatic drugs (DMARDs) before finally moving on to anti-tumour necrosis factor (TNF) therapies if conventional treatments have been ineffective.1 The management of PsA aims to suppress inflammation in all domains of the disease, including joints, tendons, entheses and skin involvement. This should improve the pain and functioning of the patient, and should reduce the likelihood of joint damage.

Adherence to therapy

Limited data are available on adherence rates in patients with PsA. However, there is evidence that patient compliance with, and adherence to, treatment is generally poor in patients with rheumatic diseases; for example, adherence rates as low as 30% are reported for rheumatoid arthritis and systemic lupus erythematosus.2,3 Furthermore, a recent study by Bluett et al found that 27% of patients prescribed

anti-TNF therapy for rheumatoid arthritis reported non-adherence to treatment within the first six months, and that this was significantly associated with a poor response to treatment when assessed at six months.4

When one considers that

anti-TNFs typically cost just over £9000 per patient per year, it is clear that non-adherence to these treatments, and the ensuing sub-optimal outcomes (compared to adherent patients) represent a substantial waste of scarce healthcare resources.

Assuming that adherence to treatment in psoriatic arthritis is similar to that reported in other rheumatic diseases, there is an opportunity for pharmacists to become involved in supporting these patients, particularly with the current emphasis on medicines optimisation

(MO) in the National Health Service (NHS). MO focuses on patients and their experiences to improve outcomes, reduce wastage and improve the safety of medicines use. Although MO should become embedded into the practice of all front-line healthcare professionals, pharmacists can provide the leadership and support to make this happen.5

Pharmacist intervention With conventional DMARD therapy, there are many potential opportunities for pharmacists to intervene. Although patients are likely to be counselled on their drug treatment by members of the specialist rheumatology team, patients may have questions about their new therapies, and may seek further advice from their usual community pharmacy or


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