Expert perspectives on the importance of establishing good patient-provider relationships while managing psoriatic arthritis.
Michele M. Cerra, MSN, FNP-C: How about patient-provider relationships and the importance of patients remaining compliant and staying on drugs? It’s important for me to have the patient a part of the decision process when it comes to drugs. Some of our patients will say, “Tell me what you think.” Then we have our other patients who tell me tell me the bad things that are going to happen to me when I start this medication. They see all these commercials on TV that it gives them all these adverse effects. If I had to go on some of them, I’d question the need for it and the importance of it. But having the patients in that decision process, they want to know how your other patients are doing on that medication. It gives them reassurance for compliance. Look at that patient as a whole and ask them, “What are your goals? What would you like to get out of this visit? Where would you like to be?” Most patients want to be who they were before they were diagnosed with psoriatic arthritis. Let the patients who want it to be part of that decision-making as far as their drugs and PTOT [physical therapy and occupational therapy]. Encourage anti-inflammatory diets—if it’s white it’s not right: sugars, potatoes, carbohydrates. We know that a lot of inflammation in the gut is driving our autoimmune diseases. Do you do anything different in your practice? I wish we had a dietitian on our team who we could send our patients to because we know they end up with obesity and have nonalcoholic fatty liver disease.
Nancy Eisenberger, MSN, FNP-C: Yes, I encourage the Mediterranean diet because it’s an easy diet. I tell my patients about that.
Michele M. Cerra, MSN, FNP-C: Do you have a dietitian on your team?
Nancy Eisenberger, MSN, FNP-C: I use handouts with my patients, and then I refer them. The interesting thing is that a lot of insurance companies will cover a dietitian visit. Some patients don’t know that. It’s helpful to get our patients to a dietitian, especially if they’re obese or have poor eating habits like some of our younger people do.
Michele M. Cerra, MSN, FNP-C: I didn’t experience any pushback from many patients during the pandemic as far as changing mechanism of action with my biologic or therapy. For our patients with psoriatic arthritis, we have long-term relationships with these patients; they trust us. I didn’t experience much pushback when I needed to add on therapy or change therapy. How about you?
Nancy Eisenberger, MSN, FNP-C: I had the same experience. If patients were hurting, then most of them would do whatever I recommended for them to do because we did have that trust relationship. There were a couple of patients who did stop their medications and did poorly. I could count them on my hands. I see 100 patients a week, so there weren’t many patients who didn’t do what we needed them to do to keep them in good control.
Michele M. Cerra, MSN, FNP-C: I found that the patients who didn’t want to or were low resistance to change therapies were the ones emailing all the time or calling for prednisone. We had to get into that discussion about prednisone also being an immunosuppressant, so it’s not good to take it during the pandemic if you did get COVID-19.
Nancy Eisenberger, MSN, FNP-C: With my patients, I’d give them an analogy: think of prednisone as affecting your entire immune system and suppressing it. Our other medications are very targeted and suppress only a portion of our immune system. It’s a rudimentary way to explain it, but once I did that a lot of them understood that their medications were safer than taking prednisone. They understood that concept. But otherwise, every 6 weeks, people who weren’t taking their medicines were calling for a Medrol dose pack.
Michele M. Cerra, MSN, FNP-C: That’s an excellent analogy. I’ll need to use that: prednisone suppresses your whole body, whereas we have targeted therapies toward different cytokines and proteins. Thank you for that.
Transcript edited for clarity.