Medicine Optimisation

Medicine Optimisation

Mrs. Pam is a lone resident who was diagnosed with rheumatoid arthritis. She is under medication of 15 mg of oral methotrexate which she takes on every Mondays, 5mg of Folic acid on every Friday, and 1.5 g of Sulfasalazine twice each day, 400 mg of Hydroxychloroquine daily. She also takes 200 mg of ibuprofen, 200mg of Omeprazole, and 1g of paracetamol. The woman receives 40 mg of Humira injection which is supplied by Homecare Company and has an acute prescription of 200 mg of trimethoprim which is to be consumed twice each day for seven a week. This medicine is to cater for a certain infection in the urine. It is therefore important to have a professional approach towards ensuring that the patient is well taken care and the principles of medicine optimization are adhered to.

Rheumatoid arthritis is a condition of chronic inflammation characterised by the lack of control in the proliferation of the Synovial tissue (Kim 167). The disorder is also defined by wide range of Comorbidities in the multisystem. The disease prevalence is a percentage of 0.8 % in the world. Women are at a higher chance of developing the condition in the comparison with men. As a result of being untreated, a percentage ranging between 20 and 30 of people affected by the condition end up being disabled for two to three years after set diagnosis.

Major factors contributing to the pathogenesis are environment and genetics (Klein 254). As much as testing in the laboratory and studying of imaging may be of great assistance in confirming the diagnosis and observing the progress of the disease, there is no single lab test which is considered to be diagnostic. Complications accompanying the disease may appear several months after the disease is presented. Hence, it is important to make consultations early enough so that treatment is started. There are several drugs which have been availed in the market. There are inflammatory drugs being not steroidal, corticosteroids, and modalities which are not pharmacologic. Patients who may not be responsive to a single drug mostly result in combination therapy.

Rheumatoid arthritis is a disease which lasts for the whole life of a patient, but ill individuals can have remission. Doctors should be aware of common Comorbidities. The rate of the disease progress is monitored depending on the change in certain symptoms and findings of the laboratory (Kourilovitch 302). Very poor outcomes in the first stages of the disease are characterized by a functional score which is low, a poor socioeconomic status, too many joints being involved during early stages, too much sedimentation of erythrocyte, the presence of rheumatoid factor and changes in radiology.

Rheumatoid arthritis has a feature of persistent inflammation of the joint synovial tissue. With time, bones get eroded, cartilage is destroyed, and loss of integrity in joints is a possible occurrence (Bryun 265). At long last, most of the systems of organs may become affected. The disease is the very common inflammatory arthritis. The onset of the condition may come up at the ages of 30 to 50. In the United States, 25 people in 100,000 men and 54 people in 100,000 women are estimated to have contracted the disease. More than 250,000 people are hospitalized under visits of physicians amounting to 9 million.

Diagnosis

Rheumatoid arthritis is viewed as a clinical diagnosis. It is observed that patients feel the pain and stiffness in several joints. However, a third of those experiencing the sickness may face the symptoms in scattered locations within their body. Most of the sick have the symptoms detected from weeks to months. The disorder begins with a single joint, and in most cases, it is accompanied by anorexia symptoms which are prodromal (Sorensen 189). In more than 15 percent of patients, the signs start off days after having an event of illness.

Commonly affected joints are those with a large ratio of synovium cartilage when compared to articular cartilage. Wrists, interphalangeal and metacarpophalagenal joints have a high chance of being involved. Interphalagenal and sacroiliac joints are mostly not affected. Joints of a rheumatoid patient are often tender when touched, boggy, and have a sense of warmth (Singh 167). There are patients who make complaints of puffiness in their hands. The weakness of the patient is not in the same proportion as the pain experienced. There is stiffness experienced in the morning when the patient begins moving. People harmed by the illness hold their muscles while flexing to ensure that they reduce the pain in capsules which are joined. Once the patients visit a doctor at the beginning, they should be told to explain the extent to which they feel pain, how long stiffness and fatigue lasts, and what the disease limits them from doing.

Tests for Diagnosis

There is no existence of a single test that can confirm the diagnosis of the disease. There are, however, many tests which can provide data which is objective to increase the certainty of the diagnosis and ensure that the progression of the disease is followed. According to American College of Rheumatology Subcommittee on Rheumatoid Arthritis, basic evaluations of the lab involve and are inclusive of a complete count of blood cells which contain differential components of rheumatoid factor and sedimentation rate of erythrocyte (Sun 236). It also involves baseline evaluation of the renal and hepatic functions. These measures assist in coming up with appropriate medical solutions.

Optimizing Care for Patient Using Four Principles of Medicine Optimization

Patient Experience

Patients are often faced with the worry of having to take medicines which are toxic to their entire life. Most of them dislike injections not to mention self-injections. At the same time, ill people experience the need to have the courage to face pain. As a result, they end up telling the nurses, caregivers, and doctors that they feel much better than they do. At the point when the disease is in remission, the patients may stop taking their medication because they feel like they are cured. The sick are in the need of being helped to live a life which is considered as normal. They also have to be in a position to manage flares of pain on their own when they arise.

It is therefore important to remind the patient that the disease is easy to control as long as the one follows medical prescription (Lionta 212). The individual should also be assured that the cure is only toxic to the condition and not the person. The individual must be informed that the medicines have been proven to be safe for use. It is also necessary to advise the patient on acquiring the best means to relieve themselves of pain.

Evidence If the Medicine Is Appropriate

Rheumatoid arthritis is a disease which can be easily managed. Combination of early treatment procedures helps reduce symptoms and damage on joints caused by the illness. Methotrexate has been proven to provide a boost to other medications and can offer protection to the heart. As a health practitioner, it is important to assure the patient that experiencing the effect of medicine may take the duration of up to six months. One should also put emphasis that the patient should adhere to medication. If a person possesses other infections, one should avoid taking DMARD’s and biological drugs until being fully recovered.

Safe and Effectiveness

Medicines which are prescribed for the disease are often effective as long as one takes them due to the prescription. Patients should be in a position of monitoring their progress on assessing how the joints feel, the look of the latter, and the level of relief of pain the sick are in need of. Taking responsibility is part of ensuring that patients manage their condition. As a health practitioner, I should ensure that I have access to medication record of the ill individual. It is also important to ensure that patients make use of their doses for remission and to encourage them of the importance of being aware about their DAS28 and what it informs concerning the disease.

Medicine Optimization as Part of Routine Practice

Being in a position where one is conscious of the patient’s condition is helpful. It is essential for one to familiarize with the life of the sick and his or her needs. At the same time, it is important to practice skills of consultation since the patient is comes for advice. Therefore, the patient will be capable to understand the reason behind taking medicine. It is also necessary to ensure if patients acquire the desired effect from the treatment they take. Finally, one should signpost in the groups and websites of the disease as a means of offering assistance with various aspect of the disorder.

Recommendations

The European League against Rheumatism (EULAR) has guidelines aimed at ensuring that patients suffering from the disease are not over treated. One of their recommendations is that people with the disease should undergo an every three months monitoring process. An adjustment of the treatment should be performed if no improvement is experienced within six months. Also, Methotrexate should be used as the first line of therapy and be substituted by leflunomide if any contradictions for Methotrexate exist (Smolen, 226). The prescriptions also state that Tumor necrosis factor inhibitors are not the only existing biologics which are offered to those patients, who do not completely reflect to methotrexate. Any other biologic is equally functional and also has effects. Lastly, biologics should be taken in combination with disease-modifying antirheumatic drugs, also known as DMARD’s.

References

Bruyn, George AW, et al. Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of an OMERACT consensus-based ultrasound score focussing on the diagnostic reliability. Annals of the rheumatic diseases. 2014.

Kourilovitch, Maria, Claudio Galarza-Maldonado, and Esteban Ortiz-Prado. Diagnosis and classification of rheumatoid arthritis. Journal of Autoimmunity. 2014; 48: 26-30.

Lionta, Evanthia, et al. Structure-based virtual screening for drug discovery: principles, applications, and recent advances. Current topics in Medicinal Chemistry. 2014; 14(16): 1923-1938.

Smolen, Josef, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 Update. Rheumatology. 2014; 28(1): 1-25.

Sørensen, Jan, and Merete Lund Hetland. Diagnosis in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: results from the Danish nationwide DANBIO registry. Annals of the rheumatic diseases. 2014.

Singh, Jasvinder A., et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis.” Arthritis & rheumatology. 2016; 68.1: 1-26.

Kim, Sooah, et al. Global metabolite profiling of synovial fluid for the specific diagnosis of rheumatoid arthritis from other inflammatory arthritis. PLoS One. 2014; 9(6): e97501.

Sun, J., et al. Diagnostic accuracy of combined tests of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis: a meta-analysis. Clinical and experimental rheumatology. 2014; 32(1): 11-21.

Klein, Kerstin, and Steffen Gay. Epigenetics in rheumatoid arthritis. Current Opinion in Rheumatology. 2015; 27(1): 76-82.

Lee, Eun Bong, et al. Tofacitinib versus methotrexate in rheumatoid arthritis. New England Journal of Medicine. 2014; 370(25): 2377-2386.

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