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Tini from Edmonton asks: I am a lupus patient and the pharmacist and my insurance company said that my prescription drug Mycophenolate, which is quite expensive, may not be covered. What should I do?
Mycophenolate is a commonly used medication in the treatment of lupus and other connective tissue diseases. In rheumatology, many medications are used “off label”, meaning they do not have formal Health Canada (or FDA, etc.) approval for a particular use. However, through many studies and years of experience, we know these medications bring significant benefit to the management of rheumatic conditions and are appropriate to use. Despite this, companies have not asked health authorities for more formal approval and without it, insurance companies may not always reimburse the cost. If this is the case, we strongly encourage you to discuss this with your rheumatologist. This is not an unusual situation for your rheumatologist and they often have access to other means of ensuring you can take the best medication for your condition.
Glenda from Fort Saskatchewan asks: Where can I make a donation for Sjogren’s syndrome and its complications?
There are many great organizations that are doing excellent research, including locally in Alberta. Currently there is a growing research program examining connective tissue diseases, including Sjogren’s syndrome, at the University of Alberta. In fact, both the University of Calgary and University of Alberta are well known for the overall quality of research that is produced when it comes to rheumatic conditions.
To consider a donation, you can visit our donation page here or contact the University of Alberta’s Division of Rheumatology division director and administrator, using this link, to make arrangements. Supporting arthritis and rheumatology research will make a significant difference for tens of thousands who are fighting these conditions every day!
Stella from Medicine Hat asks: Can you use Tocilizumab (Actemra) for Giant Cell Arteritis?
Giant Cell Arteritis (GCA) is a form of autoimmune vasculitis (inflammation of blood vessels) that affects large blood vessels in the body, but most commonly arteries in the head area, particularly around the temples. Among other symptoms, it can cause headaches, scalp tenderness, and difficulty chewing your food. Some individuals may also have pain around their shoulders or hips. If not treated, GCA can cause sudden vision problems which in some cases, can be irreversible. This makes quick recognition and treatment of GCA important. GCA is most often first treated with prednisone. For some patients, if they are having difficulty getting off Prednisone, other disease modifying agents may be used. One of the newest treatment options for GCA is tocilizumab (Actemra). While some rheumatologists will use it at the start of treatment with Prednisone, others may wait to see if it is needed depending on how beneficial the Prednisone was. In individual cases, there may be reasons to use it earlier or later.
Jeanine from Sylvan Lake asks: Are cataracts associated with rheumatoid arthritis?
Rheumatoid arthritis can have a number of manifestations within the eyes, including scleritis, sicca symptoms (dryness), or even vasculitis. While not as common, cataracts can occur, although this may be more due to steroid use (e.g. prednisone) than the arthritis itself. Cataracts itself is also relatively common in the general population: those aged between 40-50 have a 5% rate of developing cataracts, so it is possible to coincidently have both. The most important thing to do from an arthritis point of view is to ensure your arthritis is under good control. If you have no inflammation, the chance the arthritis is affecting your eyes is low.
Jamie from Alberta asks: I am under 50 and having trouble getting a DEXA scan. I have secondary osteoporosis.
While osteoporosis is most common as we get older (>50 years old), it can occur for numerous reasons at a younger age. One tool used to identify osteoporosis is a DEXA scan. However, interpretation of the results is difficult for healthcare provider for those under 50. That is why it can sometimes be a challenge to arrange a DEXA scan if you are younger. An osteoporosis specialist can often arrange a DEXA scan for younger patients more successfully, as they can explain its value and how it will be interpreted. In Alberta, there is not one particular specialty that focuses on osteoporosis. Rather, there are osteoporosis specialists who are rheumatologists, endocrinologists and internal medicine specialists.
Ammar from Alberta asks: Biologics are expensive! How do I make sure the cost is covered?
Biologics are expensive! They can range from $10,000 to $25,000 per year. No one can afford that, which is why having insurance coverage for these medications is important. Most insurance plans have rules which must be followed to have these medications covered. Most of these rules are reasonable. For instance, for rheumatology problems, biologics must be prescribed by a rheumatologist. You must have a disease that we know is treatable by a biologic. You must have tried other medications first which we know may work as well (e.g. methotrexate) before trying a biologic. And finally, we must show that the condition has improved on a biologic. Working with your rheumatologist, there is nearly always a solution to finding funding for biologics. If you are having troubles, make sure your rheumatologist knows.
Brenda from Edmonton asks: Can I get the MMR vaccine while on methotrexate?
In most cases, we feel getting MMR on methotrexate is ok, even though it is an attenuated live vaccine. MMR should not be given to those on biologics however. For a full list of our vaccination recommendations, please visit our vaccine webpage!
Ahmed from Alberta asks: Where are rheumatologists located in Alberta? Is there a difference between Calgary and Edmonton?
Most rheumatologists in Alberta are located in Edmonton and Calgary, with the split currently about even between the two sites. This is also true of pediatric rheumatologists. Some rheumatologists will do outreach clinics in smaller centres. They have access to very similar resources across the province, so regardless of which rheumatologist you see, you will receive world class care. To find rheumatologists in Alberta, please visit our webpage listing clinic locations. To see a rheumatologist, you must have a referral from your own doctor.
Mona from Calgary asks: I don’t see anything about Rinvoq. My rheumatologist has suggested that one for me.
Rinvoq, otherwise known as Upadacitinib, is part of a newer class of advanced disease modifying medications for inflammatory arthritis called JAK Kinase inhibitors. To learn more about it and the other JAK Kinase inhibitors that are currently available, visit our webpage here.
Shawna from Edmonton asks: Do you recommend the anti-viral treatments for COVID?
The available treatments for COVID are ever changing. We try to keep our recommendations up to date on this site here. As a general statement, most patients under care of a rheumatologist are eligible for anti-viral treatment for acute COVID infections, and most rheumatologists would support this. If there is ever any doubt, contact your rheumatologist ASAP if you believe you have a COVID infection. A PCR test is also highly recommended in this case, not just the at home Rapid tests. Most patients with rheumatic disease remain eligible for PCR testing.