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Role of the pharmacist

Patient education and unmet needs

It is clear that patients with PsA have a number of unmet needs; however, there are opportunities for pharmacists to contribute directly to specialist care by providing medicines counselling in clinics, monitoring response to treatment and educating patients

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

The introduction of biologics during the past decade has resulted in a wider choice of treatment options for patients with auto-immune conditions such as psoriatic arthritis (PsA). However, despite the introduction and increased uptake of new and more effective treatments for psoriatic arthritis, many patients still have unmet needs; PsA is frequently undiagnosed or misdiagnosed, leading to delays in treatment, and many patients consider their treatment options to be equally as burdensome as the disease. This can result in poor long-term outcomes, marked by disease progression, poor health-related quality of life, increased disability and comorbidities, including cardiovascular disease, hypertension and type 2 diabetes, and high direct and indirect costs.1 The observational RAPSODIA study investigated quality of life, unmet needs and involvement in medical care among Italian patients with inflammatory arthropathies. Although patients on biologics had better disease activity and self-efficacy scores than those on conventional treatments, joint issues and generalised symptoms, such as fatigue, were common.2

However, not all patients

respond to or tolerate treatment with biologics, and others may lose their initial response over time.3

Additionally, the use 26 of biologics may be restricted to ensure

“It is recognised that patients with psoriatic arthritis have a number of unmet needs other than just a lack of treatment options”

the best use is made of limited resources; the UK National Institute for Health and Care Excellence (NICE) currently only recommends the anti-tumour necrosis factor (TNF) agents etanercept, infliximab, adalimumab4

effective by NICE.6 An obvious unmet and golimumab5

for the treatment of PsA, if patients have more than three tender and three swollen joints, and have failed to respond to at least two conventional DMARDS.4,5


biologic ustekinumab, an antibody to IL-12/23, is not currently recommended for use in the National Health Service (NHS) as it was not considered cost-

need is the lack of treatment options for patients from whom an anti-TNF is contraindicated or ineffective, or for those patients who are not controlled with conventional DMARDs but do not have severe enough disease to meet the criteria for commencing treatment with an anti-TNF.

However, it is recognised that people with PsA may have other unmet needs other than a lack of treatment options. A multinational survey of patients with psoriasis or PsA identified several unmet

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