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Complex rheumatology therapies require physicians, nurses to work together
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ORLANDO — As rheumatology treatments continue to advance and grow more complex, the need for teamwork among physicians, nurse practitioners, registered nurses and other health care professionals has never been more important, according to Adam J. Brown, MD, of the Cleveland Clinic.
“The use of infliximab opened up a huge new era in rheumatology, and ushered in the biologic era with targeted therapy,” Brown told attendees at the 2019 Rheumatology Nurses Society Annual Conference. “However, it also brings in more complications. We have these drugs that work extremely well, but they are very complicated, and everyone has to know what we’re dealing with in these medications and these diseases.”
Brown, who also hosts the Rheuminations podcast for Healio Rheumatology, added that the rheumatology field can be challenging, as it involves a wide variety of diseases and manifestations. Physicians faced with the same conditions can regularly encounter forms of the disease that were previously unknown to them, he said.
“Rheumatology is a particularly tough field, because we’re not dealing with a few diseases — we are dealing with a whole lot of them — and they can come in a lot of strange forms,” Brown said. “I deal with vasculitis for a living, and people will come up and ask me, ‘Is this vasculitis?’ And I say, “Oof, I don’t know.’ No matter how often you see a disease, it can still surprise you.”
According to Brown, physicians and nurses should work together to walk patients through taking their medications and the potential risks. In addition, patients require a team that can work together to assist with labs and frequent follow-up visits, as well as watch for signs of infections and appreciate the unique side effects of individual medications.
“These conditions are tough, and our drugs are becoming more and more specialized, and that’s why we need a team,” he said. “We need to work very closely with physician’s assistants, nurse practitioners, RNs, nursing assistants and pharmacists to take care of these patients who have very complex illnesses and very complex medications.”
Brown described rheumatology as a “black box for everyone else in medicine,” in that many of its conditions are mostly unfamiliar to physicians in other specialties.
“They say, ‘Is that lupus? I don’t know, talk to a rheumatologist.’ Or, ‘is that rheumatoid arthritis? I don’t know about that,’” he said. “Lots of physicians and health care workers know a little about cardiology, they know a little about gastrointestinal diseases, a little about endocrine, but rheumatology is such a black box.”
“We now have a better understanding of the diseases, and we have a better understanding of better use of drugs that will help patients,” he added. “It is critical that everyone works together, to sit down and talk to patients about these very complicated diseases, and about the potential risks of these medications, to have a better understanding and team approach to help these people.” – by Jason Laday
Reference:
Brown AJ. Keynote presentation. Presented at: Rheumatology Nurses Society Annual Conference; Aug. 7-10, 2019; Orlando, Florida.
Disclosure: Brown reports no relevant financial disclosures.