Question 1

Why was I put on a biologic?

Accepted Answer

Your specialist has determined that a biologic is the most effective treatment for your condition. Unlike some treatments, biologics work to control symptoms and help to prevent long term damage as in the case of rheumatoid arthritis. Likely you have tried other treatments that have not controlled your symptoms well enough.

Question 2

What is a biologic medication?

Accepted Answer

Biologics are a category of drugs that genetically engineered proteins derived from human genes. They are designed to inhibit specific components of the immune system that play pivotal roles in fueling inflammation, which is a central feature of rheumatoid arthritis.

Question 3

How do biologics treat rheumatoid arthritis?

Accepted Answer

Biologics are used to treat moderate to severe rheumatoid arthritis that has not responded adequately to other treatments. They differ significantly from traditional drugs used to treat rheumatoid arthritis in that they target specific components of the immune system instead of broadly affecting many areas of the immune system. Biologics may be used alone but are commonly given along with other rheumatoid arthritis medications.Biologics have been shown to help slow progression of rheumatoid arthritis when all other treatments have failed to do so. Aggressive rheumatoid arthritis treatment is known to help prevent long-term disability from RA.

Question 4

What are the long-term effects of a biologic?

Accepted Answer

Some biologics such as the anti-TNF medications have been approved in Canada for 15 years and have been studied long term here and in many other countries. Fortunately, serious adverse effects have been rare. They do not appear to affect the liver or kidney long term with the exception of the more recent product Actemra, which requires liver testing.  There has been concern over the slight risk of lymphoma with the biologics. Many countries have monitored this risk for 10 years and longer and concluded that in adults, the autoimmune disease itself increases the lymphoma risk similar to the lymphoma risk while on a biologic. Still, patients should be aware of rare reports of lymphoma as well as lupus, seizures, MS, and recurring infections. Biologics have not been used in children for as long and there is less data on long term safety in children.

Question 5

How long will I be on this medication for?

Accepted Answer

Indefinitely. There are occasions, especially for those newly diagnosed, where these treatments can knock the disease into remission. Most patients require ongoing treatment to continue to feel the benefit. There have been patients on a biologic for 10 years or longer. Some patients who remain symptom free for long periods can discuss with their specialist if they can try without medication. Recognize that autoimmune diseases are chronic and stress, illness, and other factors can bring on a flare-up.

Question 6

What are the side effects of a biologic?

Accepted Answer

The most common side effect seen with biologics is pain and rash at the injection site. This occurs in less than 30% of patients. Patients taking biologics should seek immediate medical attention if they develop persistent fever or unexplained symptoms. Vaccinations that prevent infections should be considered prior to administration of biologics. Patients should not receive live vaccines while taking biologic medications.

Question 7

Why do I have both a nurse and a pharmacist involved in my medication?

Accepted Answer

We provide medication training and continued support.  The nurse is for injection training and the pharmacist is your direct link to training on the medication.  NKS Health differs from typical pharmacies. We focus on a few chronic disease states and highly train our pharmacists to provide the most current treatment information to our patients. Pharmacists and nurses have different skill sets and work together as part of your team with your physician in healthcare to give you the best information and follow up to improve your disease state. Our pharmacist pays a personal visit to biologic patients in their home.

Question 8

How will I know when to take this medication?

Accepted Answer

All medications are more effective if taken at the right time. We have you covered in this regard. NKS Health has an advanced compliance program that we manage for on behalf of the patient. We arrange to have your medication to you just before you are ready for the next dose. We personally call you to determine when and where you would like to have this medication arrivre.

Question 9

How will I pay for this medication and can NKS Health help me?

Accepted Answer

Biologics are expensive medications. We can help establish coverage through private insurance, ODB or trillium. Once your physician decides which medicine is best for you, NKS will contact the support agency from the manufacturer to assist in paperwork to have your drug plan cover this medication.

Question 10

What else can I do to improve my condition?

Accepted Answer

Compliance to your therapy, diet, exercise and lifestyle all play a part in treating your condition. Compliance with your medication is important. NKS Health is here to help ensure that you get your medication on-time. NKS Health offers nutritional guidance for its patients through our certified nutrition expert. We also work in conjunction with the Arthritis Society in providing patient education seminars at our NKS offices to help educate patients on their condition.

Question 11

Where can I get more information on my disease state?

Accepted Answer

There are some excellent resources online explaining disease states. At NKS, we keep current Arthritis Society brochures to distribute to our patients and have monthly arthritis society information sessions. Please ask for them with your next delivery. An NKS pharmacist or nurse can visit your home to review disease information if you like.   Some sites we recommend: 
For Arthritis: Arthritis.ca Arthritissociety.ca Rheuminfo.com Arthritis.org For Psoriasis: Livingwellwithpsoriasis.com Psoriasissociety.org Psoriasissupport.ca

Question 12

Are there interactions with my other medications?

Accepted Answer

There are very few drug interactions with the biologics. We avoid putting patients on two biologics simultaneously to avoid lowering the immune system too much.

Question 13

What if I can't self-inject?

Accepted Answer

We can arrange more than one injection training if you are not comfortable with the procedure. There are nursing services available for severe cases.

Question 14

Does this new drug replace my methotrexate?

Accepted Answer

Not necessarily, your doctor will decide on the proper combination of therapy but commonly your biologic medication is added to your existing therapy like methotrexate.

Question 15

What is the main concern being on a biologic medication?

Accepted Answer

The main concern while on a biologic is that the immune system is lowered slightly which may make it harder for you to fight off an infection. We advise you to hold off on your next dose if you have any sign of infection until it is resolved. Taking your biologic dose could make the infection last longer or even cause the chance of it becoming worse. The home injections can sometimes cause an itch or irritation at the injection site. Most patients on biologics tolerate without any trouble. We advise some blood tests as ordered by your doctor to monitor for  rare adverse effects such as low blood counts.

Question 16

Arthritis Resources

Accepted Answer

RheumInfo.com Injection Training Videos How to Self-Inject Methotrexate How to Inject using a Pre-filled Syringe How to Inject using an Autoinjector   Free 1 Hour Arthritis Consultation

Question 17

Dermatology Resources

Accepted Answer

Information to come

Question 18

Flu Vaccine Information

Accepted Answer

Flu Vaccine Brochure

Question 19

Hepatitis Information and Resources

Accepted Answer

Hepatitis is inflammation and swelling of the liver. It can be caused by alcohol, medications, chemicals or other medical conditions. Viral Hepatitis is caused by a virus.  There are several hepatitis viruses and they are identified as A. B, C, D and E.   Hepatitis A causes a relatively mild infection and does not cause chronic hepatitis.  When you are first infected with the virus it is called an acute infection. With Hepatitis A symptoms will appear. Common symptoms of acute viral hepatitis are: Decreased appetite Nausea Tiredness (fatigue)  Lack of energy (lethargy) Abdominal pain Dark urine Jaundice (yellowish eyes and skin) You get Hepatitis A from contaminated food due to poor hygienic practices. Hepatitis A is passed through the stool of an infected person often in food preparation. It is very important that people who prepare food wash their hands often and thoroughly.   Hepatitis A does not lead to chronic disease but is a serious infection in the elderly and those with a poor immune system.    There is no treatment for Hepatitis A. Recovery time varies by person but once you have been exposed to Hepatitis A and have recovered you develop a lifelong immunity to the Hepatitis A virus.   Hepatitis B is common in Asia and Africa where it is thought that 1 in 5 people are infected with the virus.   Many people (95%) recover completely from Hepatitis B. Some people (5%) may not clear the virus and become infected for life. Slowly over time the Hepatitis B virus causes liver damage. Symptoms of this liver damage will not appear until the liver is severely scarred.    Chronic Hepatitis B has no cure but there are effective treatments for the disease.  Once you have cleared the Hepatitis B virus from your body you have immunity for life. Hepatitis B is spread through contact with the blood, semen or vaginal fluids of an infected person. Sexual contact with an infected person is the most common route of transmission of Hepatitis B.   The good news is that there is an effective vaccine that can prevent Hepatitis B infection.  If you are travelling to countries where Hepatitis B virus is common it is advised that you get the Hepatitis B vaccine before your travel.   Hepatitis C like Hepatitis B is common world-wide. It is a silent disease as no symptoms of the infection occur until there is major scarring in the liver.   The acute infection phase of Hepatitis C may have no symptoms and may last up to 8 weeks. You may not know you have been infected as symptoms are usually mild and include fatigue, lethargy, abdominal pain, nausea and jaundice.   Approximately 25% of people infected with Hepatitis C clear the virus on their own. In 75% of those infected the virus stays active in the body for over 6 months. This is then called a chronic infection.   In 3 out of 4 people with chronic Hepatitis C the damage to the liver is moderate over time. But in 1 in 4 cases of chronic Hepatitis C more serious problems occur such as cirrhosis, liver failure and liver cancer. These very serious problems with chronic Hepatitis C are more likely to occur if you are male, obese, became infected over the age of 40 and drink alcohol. Chronic Infections like HIV add to the possibility of cirrhosis occurring with Hepatitis C infection.   You get infected with Hepatitis C through blood to blood contact during sex or through a contaminated needle injection or blood transfusion.   There is treatment for Hepatitis C but unlike Hepatitis A or B you do not become immune to the virus and can be re-infected if you share blood to blood exposure again. This is because the Hepatitis C virus changes so quickly that your body cannot create efficient antibodies to the virus. Unfortunately, there is no Hepatitis C vaccine currently available. Over 250,000 people are infected with Hepatitis C in Canada and 1 in 3 of them do not know they are infected. Blood tests and perhaps a liver biopsy are the best way to identify a Hepatitis C infection. Treatment then can be started by your doctor.   Who should get tested for Hepatitis C? Anyone who has done something to put them at risk (risky sex, IV drug use, sharing a crack pipe)  Anyone who has symptoms of hepatitis (fatigue, loss of appetite, nausea, lethargy, abdominal pain,  jaundice or dark urine) Anyone who has lived in India, Pakistan, Vietnam, Egypt or south Italy and has been exposed to blood products, medical procedures or vaccinations. For much more information on Hepatitis and how to live well with hepatitis please go to www.catie.ca or ask a question of the NKS Health pharmacist or nurse or nutritionist at HIV-Hepatitis@nkshealth.ca

Question 20

HIV Information and Resources

Accepted Answer

HIV or Human Immunodeficiency Virus is a virus that slowly weakens your body’s defences against infections and diseases. HIV weakens your immune system. If HIV is untreated over a long time your body cannot fight off serious or fatal illnesses. There is no cure for HIV but current treatments can help you stay healthy.

Drug therapy for HIV is known as antiretroviral therapy. There are numerous drugs for HIV. These drugs are taken in combination and work to suppress HIV. Taking HIV drugs will suppress the virus and allow your body to fight infections and diseases. With good suppression of HIV most people with HIV should live a normal lifespan.

Antiretrovirals are not the only way to stay healthy. You must also look after your general health through a good diet, exercise and sleep routine.

Drug treatment of any kind may cause side effects which can be minor or serious. Most people find they can deal with the challenges of HIV treatment with helpful advice from their doctor or our HIV pharmacist.

It is very important that you take your medications on a regular consistent schedule. Regular drug schedules put pressure on HIV so that the virus cannot replicate successfully. Talk with your doctor or our pharmacist about the best ways to incorporate a regular drug schedule in to your life.

A comprehensive guide to HIV treatment is available at www.catie.ca.        We welcome your questions to our HIV specialist pharmacist Dr. Alice Tseng, PharmD at HIV-Hepatitis@nkshealth.ca   HIV Diet - Wellness Report
Read more about HIV Diet - Wellness Report click here

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