(BPT) - Dr. Sharma and Ashley were compensated for their participation.
Content sponsored and provided by Pfizer. Ashley and Allegheny Health Network (AHN) rheumatologist Dr. Tarun Sharma partnered with Pfizer to share their different experiences with moderate to severe rheumatoid arthritis (RA).
Note: The image is not the actual patient and physician
Ashley grew up watching her grandmother struggle with rheumatoid arthritis (RA), a chronic inflammatory disease of the joints, and saw first-hand the effects RA could have on a person. When she was diagnosed with moderate to severe RA as an adult, managing her condition became a priority.
'I had concerns about the impacts of living with RA, and I knew that I needed to find a way to help manage my condition,' Ashley explains.
Ashley sought the opinion of several rheumatologists to help manage her RA before establishing an ongoing relationship with Tarun Sharma, MD, a rheumatologist at Pittsburgh-based Allegheny Health Network (AHN). When she met Dr. Sharma, she felt that his approach to care fit her needs and that he listened to her concerns and partnered with her to find a treatment that worked best for her.
Patients with RA, like Ashley, may find it difficult at first to establish a trusting relationship and discuss treatment goals with their rheumatologist. It can sometimes be challenging for patients to articulate the RA symptoms that they are experiencing to their doctor.
Dr. Sharma says he finds that patients may not initially share everything about their RA experiences with their physician but may open up once asked specific questions about how RA impacts their daily activities. 'It is important for the patient to feel comfortable being honest about their condition, during an appointment,' says Dr. Sharma. 'This helps physicians conduct a comprehensive evaluation and treat the patient's RA.'
To that end, Dr. Sharma and Ashley work together to manage Ashley's RA symptoms through ongoing communication. Ashley is now proactive about asking Dr. Sharma questions and is comfortable communicating clearly with him about her RA symptoms. She works closely with Dr. Sharma when making a treatment plan decision or change to her care with the goal of finding a plan suitable for her.
Throughout her disease management journey, Ashley has gone through a lot of trial and error with different treatments for her RA, including trying medicines called tumor necrosis factor (TNF) blockers, but none worked well enough for her. As a result, she did some research online and learned about XELJANZ® (tofacitinib), an oral medication for moderately to severely active rheumatoid arthritis when one or more TNF blockers have been used and did not work well or cannot be tolerated.
Ashley asked Dr. Sharma about XELJANZ. Dr. Sharma reviewed the potential serious side effects of the medication with her and discussed the type of laboratory monitoring that would be needed before and during treatment. Dr. Sharma also explained that XELJANZ has a BOXED WARNING.
XELJANZ can cause serious side effects and can lower your ability to fight infections; don't start XELJANZ if you have an infection. Before and during treatment, your doctor should check for infections like tuberculosis (TB), and do blood tests. Serious, sometimes fatal infections, cancers including lymphoma, and lung cancer, blood clots and serious heart-related events have happened. People 50 or older with heart disease risk factors had an increased risk of death. Tell your doctor if you had a heart attack, other heart problems, stroke, or a history of blood clots.
Read more Important Safety Information and Indication below.
When Dr. Sharma and Ashley identified XELJANZ as a potential treatment option, they had an open conversation about Ashley's treatment history and how her symptoms were impacting her at the time, which allowed Dr. Sharma to gather the appropriate data needed. According to Dr. Sharma, 'It is important for rheumatologists to have a candid discussion about a patient's disease management goals to help find a treatment plan that works best for them.'
From a patient perspective, Ashley's advice to those navigating their own journey with RA is to focus on how you communicate with your doctor and look for ways to enhance active listening and two-way communication. For example, make a list of items you'd like to discuss with your rheumatologist in advance of your appointment and take notes during the conversation so you can refer to them in the future.
'You can't be afraid to speak up when communicating with your doctor. Your rheumatologist is not going to know what's going on with your RA symptoms or what your specific concerns are unless you address them directly. If something is on your mind related to your RA management, don't be shy about addressing it with your doctor,' says Ashley.
Dr. Sharma agrees with Ashley's tips and emphasizes the importance of proactively communicating developments related to your health and RA treatment plan. 'If you have questions or concerns, it's okay to reach out to your doctor in between visits. Your doctors are there for you, which sometimes requires an additional office visit or conversation,' says Dr. Sharma.
'In my experience, I've learned that managing my RA is about finding a balance - between me as an empowered patient and my doctor as the expert guiding me through my medical journey,' says Ashley. 'My relationship with Dr. Sharma is an ongoing partnership, with the common goal of ensuring the best care for my RA.'
To learn more about XELJANZ, visit XELJANZ.com/RA.
IMPORTANT SAFETY INFORMATION AND INDICATION
The safety information below applies to all marketed formulations of XELJANZ. Specific risks associated with certain dosing are noted.
Serious infections. XELJANZ can lower the ability of your immune system to fight infections. Do not start taking XELJANZ if you have any kind of infection unless your healthcare provider tells you it is okay. Serious infections have happened in people taking XELJANZ. These serious infections include tuberculosis (TB) and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting and during treatment with XELJANZ. You should not start taking XELJANZ if you have any kind of infection unless your healthcare professional tells you it is okay.
Before and after starting XELJANZ, tell your doctor if you are being treated for an infection,
have infections that keep coming back, or have symptoms of an infection, including:
- fever, sweating, or chills
- blood in phlegm
- warm, red, or painful skin or sores on your body
- burning when you urinate
- urinating more often than normal
- muscle aches
- shortness of breath
- weight loss
- diarrhea or stomach pain
- feeling very tired
Increased risk of death in people 50 years of age and older who have at least 1 heart disease (cardiovascular) risk factor and are taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily.
Cancer. XELJANZ may increase your risk of certain cancers by changing the way your immune system works. Lymphoma and other cancers, including skin cancers, can happen. People taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily have a higher risk of certain cancers including lymphoma and lung cancer, especially if you are a current or past smoker. Tell your healthcare provider if you have ever had any type of cancer.
Higher dose. People with rheumatoid arthritis taking the higher dose of XELJANZ (10 mg twice daily) or XELJANZ XR (22 mg one time each day) have a higher risk of serious infections, shingles, or skin cancers.
Immune system problem. Some people who have taken XELJANZ with certain other medicines to prevent kidney transplant rejection have had a problem with certain white blood cells growing out of control (Epstein Barr Virus-associated post-transplant lymphoproliferative disorder).
Increased risk of major cardiovascular events such as heart attack, stroke or death in people 50 years of age and older who have at least 1 heart disease (cardiovascular) risk factor and are taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily, especially if you are a current or past smoker.
Get emergency help right away if you have any symptoms of a heart attack or stroke while taking XELJANZ, including:
- discomfort in the center of your chest that lasts for more than a few minutes, or that goes away and comes back
- severe tightness, pain, pressure, or heaviness in your chest, throat, neck, or jaw
- pain or discomfort in your arms, back, neck, jaw, or stomach
- shortness of breath with or without chest discomfort
- breaking out in a cold sweat
- nausea or vomiting
- feeling lightheaded
- weakness in one part or on one side of your body
- slurred speech
Blood clots in the lungs (pulmonary embolism, PE), veins of the legs (deep vein thrombosis, DVT), and arteries (arterial thrombosis) have happened more often in people who are 50 years of age and older and with at least 1 heart disease (cardiovascular) risk factor taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily. Blood clots in the lungs have also happened in people with rheumatoid arthritis. Some people have died from these blood clots.
- Stop taking XELJANZ and tell your healthcare provider right away if you have any signs and symptoms of blood clots such as sudden shortness of breath, difficulty breathing, chest pain, swelling of a leg or arm, leg pain or tenderness, or red or discolored skin in the leg or arm.
Tears (perforation) in the stomach or intestines. Tell your healthcare provider if you have had diverticulitis (inflammation in parts of the large intestine) or ulcers in your stomach or intestines. Some people taking XELJANZ can get tears in their stomach or intestine. This happens most often in people who also take nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or methotrexate. Tell your healthcare provider right away if you have fever, stomach-area pain that does not go away, and a change in your bowel habits.
Serious allergic reactions can occur. Stop using XELJANZ and call your healthcare provider right away if you have swelling of your lips, tongue, throat, or get hives.
Changes in certain lab test results. Your doctor should do blood tests to check your white and red blood cells before starting and while you are taking XELJANZ. Your doctor should also check certain liver tests. You should not take XELJANZ if your lymphocyte count, neutrophil count, or red blood cell count is too low or your liver function test levels are too high. Changes in lab test results may cause your healthcare provider to stop your XELJANZ treatment for a time. Your cholesterol levels should be checked 4 to 8 weeks after you start receiving XELJANZ.
Before you use XELJANZ, tell your healthcare provider if you:
- Are being treated for an infection, have an infection that won't go away or keeps coming back, or think you have symptoms of an infection
- Have TB, or have been in close contact with someone with TB, or were born in, lived in, or traveled where there is more risk for getting TB
- Have diabetes, chronic lung disease, HIV, or a weak immune system. People with these conditions have a higher chance for infections
- Live or have lived in certain areas (such as Ohio and Mississippi River Valleys and the Southwest) where there is an increased chance for getting certain kinds of fungal infections
- Have or have had Hepatitis B or C
- Are a current or past smoker
- Have had any type of cancer
- Have had a heart attack, other heart problems or stroke
- Have had blood clots
- Have liver or kidney problems
- Have any stomach area (abdominal) pain or been diagnosed with diverticulitis or ulcers in your stomach or intestines
- Have recently received or plan to receive a vaccine. People taking XELJANZ should not receive live vaccines but can receive non-live vaccines
- Are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed. You should not take XELJANZ and breastfeed
- Have had a reaction to tofacitinib or any of the ingredients
- Are taking other medicines, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take any of the following medicines while taking XELJANZ since this may increase your risk of infection:
- tocilizumab (Actemra®)
- etanercept (Enbrel®)
- adalimumab (Humira®)
- infliximab (Remicade®)
- rituximab (Rituxan®)
- abatacept (Orencia®)
- anakinra (Kineret®)
- certolizumab (Cimzia®)
- golimumab (Simponi®)
- ustekinumab (Stelara®)
- secukinumab (Cosentyx®)
- vedolizumab (Entyvio®)
- ixekizumab (Taltz®)
- sarilumab (Kevzara®)
- azathioprine, cyclosporine, or other immunosuppressive drug
- Tell your healthcare provider if you are taking medicines that affect the way certain liver enzymes work. Ask your healthcare provider if you are not sure if your medicine is one of these.
What are other possible side effects of XELJANZ/XELJANZ XR?
If you are a carrier of the Hepatitis B or C virus (viruses that affect the liver), the virus may become active while you use XELJANZ. Your healthcare provider may do blood tests before starting and while using treatment with XELJANZ. Tell your healthcare provider if you have any signs of these symptoms: feel very tired, little or no appetite, clay-colored bowel movements, chills, muscle aches, skin rash, skin or eyes look yellow, vomiting, fevers, stomach discomfort, or dark urine.
Common side effects in people with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis include upper respiratory tract infections (common cold, sinus infections), headache, diarrhea, nasal congestion, sore throat, runny nose (nasopharyngitis), and high blood pressure (hypertension).
Common side effects in people with ulcerative colitis include nasal congestion, sore throat, runny nose (nasopharyngitis), increased cholesterol levels, headache, upper respiratory tract infections (common cold, sinus infections), increased muscle enzyme levels, rash, diarrhea, and shingles (herpes zoster).
Common side effects in children (2 & older) with polyarticular course juvenile arthritis include upper respiratory tract infections (common cold, sinus infections), nasal congestion, sore throat, and runny nose (nasopharyngitis), headache, fever, nausea, and vomiting.
XELJANZ & Pregnancy
XELJANZ may affect the ability of females to get pregnant. It is not known if this will change after stopping XELJANZ. It is not known if XELJANZ will harm an unborn baby.
- Pregnancy Registry: Pfizer has a registry for pregnant women who take XELJANZ. The purpose of this registry is to check the health of the pregnant mother and her baby. If you are pregnant or become pregnant while taking XELJANZ, talk to your healthcare provider about how you can join this pregnancy registry, or you may contact the registry at 1-877-311-8972 to enroll.
You and your healthcare provider should decide if you will take XELJANZ or breastfeed. You should not do both. After you stop your treatment with XELJANZ do not start breastfeeding again until 18 hours after your last dose of XELJANZ or 36 hours after your last dose of XELJANZ XR.
What is XELJANZ/XELJANZ XR?
XELJANZ/XELJANZ XR (tofacitinib) is used to treat adults with:
- Moderately to severely active rheumatoid arthritis when 1 or more medicines called tumor necrosis factor (TNF) blockers have been used, and did not work well or cannot be tolerated
- Active psoriatic arthritis when 1 or more tumor necrosis factor (TNF) blocker medicines have been used, and did not work well or cannot be tolerated
- Moderately to severely active ulcerative colitis when 1 or more tumor necrosis factor (TNF) blocker medicines have been used, and did not work well or cannot be tolerated
- Active ankylosing spondylitis when 1 or more tumor necrosis factor (TNF) blocker medicines have bene used, and did not work well or cannot be tolerated
It is not known if XELJANZ/XELJANZ XR is safe and effective in people with Hepatitis B or C.
XELJANZ/XELJANZ XR/XELJANZ Oral Solution is not recommended for people with severe liver problems.
It is not known if XELJANZ/XELJANZ Oral Solution is safe and effective in children for treatment other than active polyarticular course juvenile arthritis.
It is not known if XELJANZ XR is safe and effective in children.
August 2022; PP-XEL-USA-7764