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Role of the pharmacist


needs including diagnosis and screening for PsA, patient awareness and treatment options,7


and a consensus statement following the 2012 Psoriatic Arthritis Forum (which consisted of researchers, clinicians and patient representatives) identified poorly-defined treatment algorithms, definitions of response and remission, and low awareness of the disease burden of PsA as additional unmet needs.1


identified as a further unmet need by Leung et al, who found that patients expressed unmet needs in relation to education on their disease (68.3%), exercise advice (73.3%), psychological support (29.3%), and social support (41.6%).8


Diagnosis


As described above, PsA is commonly undiagnosed or misdiagnosed.1


patients develop psoriasis ten years before they develop PsA,3


and the


majority of patients with psoriasis are managed in primary care; for example, in Germany only 22% of patients are still under the care of a dermatologist two years after a diagnosis of psoriasis, and in the UK only 18% of patients with a diagnosis of psoriasis were referred to a specialist dermatology service.9


Patients Typically


Patient education was also


It is also likely that many patients will self-medicate with over-the-counter


with non-severe psoriasis can be managed in primary care using products such as vitamin D analogues, corticosteroids, and coal tar derivatives, and would obtain these products via prescription from a community pharmacy. These will frequently be repeat prescriptions issued without the patient seeing their general practitioner (GP); 45% of North American and European patients with psoriasis reported not seeing a physician within the last 12 months during a telephone survey.7


pharmacists could remind patients of the need to promptly report any symptoms such as swollen joint(s), fingers or toes (dactylitis), or heel pain as this could indicate the onset of PsA. Finally, most community pharmacies in England offer the Medicines Use Review service and could also use this as a more structured opportunity to educate patients with psoriasis on the symptoms that may indicate psoriatic arthritis.


Treatment and education Although existing treatments exist for


“There are opportunities for pharmacists working in both primary and secondary care to become involved in the care of patients with PsA”


analgesia or non-steroidal anti- inflammatory drugs (NSAIDs) if they begin to develop arthralgia and other symptoms associated with PsA. Raising awareness of PsA among community pharmacists will provide them with the opportunity to aid in the earlier recognition of PsA, potentially leading to earlier diagnosis and improved outcomes; for example, when counselling patients on the use of medicines for psoriasis,


PsA, including phototherapy, conventional DMARDs and biologics, not all patients respond to these and those that do may lose their response over time. There are a number of new therapies in the pipeline, including monoclonal antibodies, such as secukinumab, and small molecules, such as Janus kinase 3 or phosphodiesterase-4 inhibitors.3


This


broadening range of molecules with different mechanisms of action will


www.hospitalpharmacyeurope.com 27


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