Click on the concerns below to learn more.
Infection Risk
People with inflammatory arthritis have a greater risk of serious infections than the general public due to multiple factors.1 When inflammation is high, the body is exhausted and less able to fight infection. The risk of infection is greatest in an untreated person who has active disease. This risk should decrease within 3-6 months of starting advanced therapy, which is when we hope to achieve low disease activity, if not remission. This means that although an advanced therapy can increase infection risk, once well treated, a person’s overall infection risk could be lower compared to when their disease was active.2 People with active inflammatory arthritis who are treated with prednisone have a greater infection risk than being treated with an advanced therapy.1 2 3 Corticosteroids also have many more adverse effects than advanced therapies as mentioned in a separate section and are not suggested as a routine treatment.4
One of the best strategies to reduce infection risk is updating recommended adult vaccines such as the annual flu shot, pneumococcal (pneumonia)5 and herpes zoster (shingles) vaccines.
After reading the information above are you concerned about infection risk?
Out of pocket expense
Costs Associated with Advanced Therapies:
People with active inflammatory arthritis can access advanced therapies at minimal or no cost, through a combination of programs. Financial assistance through private insurance/government assistance and manufacturer support programs are often used in combination.
Costs associated with flared/untreated disease can be significant:
- Out-of-pocket expenses can accumulate for missed work
- Need for outside resources for daily living activities
- Transportation
- Cost to other family members and friends for their assistance
After reading the information above are you concerned about out of pocket expense?
Additional information and resources
Intro to Public and Private Reimbursement
Inflammation Beyond the Joints – Heart, Eye and Lung Disease
Certain types of inflammatory arthritis can also lead to disease in areas beyond joints or skin.
Some examples include:
- Heart Disease Risk, where excessive inflammation in the blood vessels can result in a greater risk of stroke or heart attack than the general public.5
- When choosing an advanced therapy, your specialist will consider your age, smoking history, medical history (e.g. stokes and heart disease) to pick a treatment which has the least risk to you.6
- Uveitis, where inflammation of the eye could lead to vision loss
- Symptoms of uveitis often come on suddenly and get worse quickly. They include eye redness, pain and blurred vision. It is important to seek immediate medical attention.
- Interstitial lung disease, where excess inflammation can lead to progressive scarring of the lungs
Advanced therapies that control inflammatory arthritis can play an important role in preventing such conditions.8 9
After reading the information above are you concerned about eye and lung disease?
Additional information and resources
Heart Disease
Uveitis/Iritis
Lymphoma
Some types of inflammatory arthritis have an increased risk of lymphoma as compared to the general public. Advanced therapies do not significantly change that risk.10 11 12 13 14 15 16 Health Canada approved patient handouts generated by drug companies may include this risk for advanced therapies, however, as we gather more information from regular use of these treatments, we realize that this risk may not be as common as previously thought. However, it is still a good idea to discuss this risk with your specialist based on your individual medical history.
After reading the information above are you concerned about lymphoma?
Skin Cancer
There is a slight increased risk in melanoma in patients treated with some advanced therapies. 17 18 19 20 21 However, as recommended for the general population, it is advised to have a skin assessment done during an annual physical checkup and report any changes in moles or skin lesions to your physician.
After reading the information above are you concerned about skin cancer?
Missed work/Loss of employment
People with active inflammatory arthritis who are not receiving the benefit of effective advanced therapies, have a 21% chance of missing work or being unable to work due to ill-health.22
Missed work can affect a person’s emotional and financial well-being. After achieving low disease activity with appropriate treatment, the average number of missed workdays per year decreases by about 3 days.23
After reading the information above are you concerned about missed work/loss of employment?
Additional information and resources
Disability Webinar (2022)
Spondyloarthritis and the Workplace
Fear of injection/Infusions (Applies to Biologic Therapies)
A common myth is that injected or infused medications are more dangerous. However, given that biologic treatments are made from protein, they cannot be swallowed as they would be digested and become ineffective.
Injectable medications are often available as “pen-like” auto-injectors where the person does not need to see the needle or push it through the skin by themselves. All injections are called subcutaneous, where the needle is very short and thin, going just under the skin. It is not long enough to enter a muscle or any major blood vessel.
While injections can be given at home, intravenous medications are only available at infusion clinics where nurses offer the treatment in a home-like environment outside the hospital. Most clinics provide reclining chairs, Wi-Fi, TV, and refreshments.
After reading the information above are you concerned about fear of injection?
Effectiveness: Morning Stiffness and Preventing Joint Damage
Morning stiffness is one of the biggest complaints from patients with inflammatory arthritis. Advanced therapies can significantly reduce morning stiffness and in many cases, it can be eliminated.24
One of the biggest risks of not achieving low disease activity or remission of inflammatory arthritis conditions is damage to joints which cannot be reversed. Joint damage can begin within the first year of being diagnosed and therefore treating early is crucial to prevent this damage. If damage progresses, it can lead to decreased function. By helping achieve low disease activity or remission, advanced therapies can reduce joint damage progression over time.25
After reading the information above are you concerned about morning stiffness and preventing joint damage?
Corticosteroid Use (ie. Prednisone)
While corticosteroids can be very helpful at reducing inflammation quickly, they are not intended to be a maintenance treatment to control inflammatory arthritis due to their many adverse effects. Examples of these adverse effects include:
- an increased risk of infection which is greater than advanced therapies1
- increased fracture risk26
- weight gain26
- increased risk of diabetes4 26
The use of advanced therapies can lower disease activity while also greatly reducing or eliminating the need for prednisone.24
After reading the information above are you concerned about corticosteroid use?
Additional information and resources
Corticosteroids
Weight Gain
Some studies show that advanced therapies may be associated with moderate weight gain. In people with active inflammatory arthritis, these inflammatory substances reduce appetite and increase muscle breakdown.27 When inflammatory substances are reduced by advanced therapies and disease state improves, appetite can return to a normal level and muscle breakdown can be reduced. (Keep in mind, muscle weighs more than fat and maintaining muscle decreases fall risk). Therefore, these reported weight gain changes are considered positive changes.27
After reading the information above are you concerned about weight gain?
Gastrointestinal Effects
Gastrointestinal (GI) adverse effects (e.g. abdominal pain, nausea, bleeding) due to advanced therapies are less common as opposed to anti-inflammatory medications referred to as NSAIDs (ibuprofen, naproxen, diclofenac, meloxicam) or conventional treatments such as methotrexate, leflunomide, sulfasalazine and corticosteroids.28
One of the categories of advanced therapies are called biologics. They are injected just under the skin (subcutaneous injection) or infused intravenously. By avoiding gut digestion, GI adverse effects are uncommon. Advanced therapies which are swallowed such as the JAK inhibitors can be swallowed after food to reduce GI effects.
After reading the information above are you concerned about gastrointestinal effects?
Additional information and resources
Crohn's and Colitis
Liver Function
As a safety measure, advanced therapies require ongoing monitoring to ensure there are no changes in liver or kidney function. By doing regular blood tests changes can be spotted early, and treatment stopped to allow these levels to return to their previous level. Although a low risk, some therapies have less risk regarding liver function than others. Your specialist will select an advanced therapy knowing your current health concerns.
After reading the information above are you concerned about liver function?
Pregnancy and Lactation
It is very important that family planning be discussed with your specialist. Several conventional disease modifying treatments are not recommended during pregnancy (methotrexate, leflunomide) and need to be stopped before becoming pregnant.29 New data suggest that NSAIDs (ibuprofen, naproxen, diclofenac, meloxicam etc.) should not be used after 20 weeks' gestation.30
What is important is that expectant moms remain in low disease activity. Hence the common statement: “Healthy mom, healthy baby.” In terms of advanced therapies, and in consultation with your specialist, some biologics can be an option during pregnancy. As biologics are made of protein, they cannot cross the placenta until late in the second trimester. One particular biologic (certolizumab) does not cross the placenta at any point in pregnancy.31
Biologic therapies have a low level of cross into breast milk. However, any biologic that is ingested by a newborn through breast milk will be digested in their stomach and rendered ineffective. This is why biologics are commonly continued while nursing.
Advanced therapies that are swallowed such as JAK inhibitors (tofacitinib, baricitinib, upadacitinib) are not to be taken during pregnancy or lactation.32 33 34
A great up-to-date and reliable resource is: www.mothertobaby.org
After reading the information above are you concerned about pregnancy and lactation?
Additional information and resources
Pregnancy and Parenting
Baring it All Project - baringitall.ca
Biosimilars
Biosimilars are as they sound – a class of medications similar to an originator biologic. After patents of an originator medication expire, manufacturers can produce a biosimilar which has strict guidelines for Health Canada approval. These protein-based substances are researched in patients to ensure they are as safe and effective as the originator biologic. It can take 7-8 years of research before a biosimilar can submit an application to Health Canada. Biosimilars may have miniscule differences in their protein structure compared to the originator, which is why studies are conducted to ensure they are safe and effective.35
Biosimilars offer significant cost savings over the originator biologic and have been used throughout the world.35
After reading the information above are you concerned about biosimilars?
Additional information and resources
Biosimilar Medications
Biologics Webinar (2022)
Pharmacological Treatments in Canada
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