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Autoimmune Disease

Autoimmune diseases are illnesses that occur when the immune system mistakenly attacks healthy cells in the body. Rheumatoid arthritis, multiple sclerosis and inflammatory bowel disease (IBD, including Crohn’s disease and ulcerative colitis) are all examples of autoimmune diseases.

Rheumatoid Arthritis Treatment

Rheumatoid arthritis (RA) is a chronic autoimmune disease in which the body’s immune system attacks the lining of the joints, causing pain, inflammation and swelling. Bone erosion and joint deformity can result over time if the disease is not treated. In RA, the immune system can also attack other parts of the body, leading to problems with the heart, respiratory system, nerves and eyes. The cause of rheumatoid arthritis is poorly understood. There is a strong genetic component, which is thought to contribute to 50 to 60% of the overall risk of developing the disease.

The 2017-18 National Health Survey (NHS) conducted by the Australian Bureau of Statistics reported approximately 456,000 Australians with rheumatoid arthritis. This equates to approximately 1.9% of the Australian population. RA accounted for 13% of all arthritic conditions in 2017-18.

Rheumatoid arthritis is most commonly reported in people over the age of 75, but the initial onset of the disease usually takes place between the ages of 35 and 64. It occurs more frequently in women, with an overall incidence of 2.3% of the female Australian population compared to 1.5% of the male Australian population.

There is no cure for rheumatoid arthritis. Instead, rheumatoid arthritis treatment in Australia focuses on stopping inflammation (putting the disease into ‘remission’), relieving symptoms and preventing future joint and organ damage. Medications are primarily used to treat the condition, however physical therapy and surgery can also be employed.

The range and efficacy of medications available to treat RA have improved dramatically over the past 20 years. The most commonly used medications are as follows:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – over the counter (e.g. ibuprofen) or prescription (e.g. meloxicam) to relieve pain and reduce inflammation;
  • Steroids (e.g. prednisolone) – to reduce inflammation, pain and slow joint damage; and
  • Disease-modifying antirheumatic drugs (DMARDs, e.g. methotrexate, leflunomide) – to slow the progression of the disease and save the joints and parts of the body from permanent damage.

Biological DMARDs are a form of advanced rheumatoid arthritis treatment in Australia. Due to their high cost (usually subsidised via Medicare’s Pharmaceutical Benefits Scheme), they are generally reserved for use when other forms of treatment have failed or are poorly tolerated.

Biological DMARDs (sometimes referred to as “immunotherapy”) act directly on the parts of the immune system that are responsible for triggering inflammation. They have been shown to stop or slow the disease process, reducing the joint destruction and disability associated with RA. The biological agents most commonly used for rheumatoid arthritis treatment in Australia include:

  • Actemra® (tocilizumab);
  • Orencia® (abatacept);
  • Remicade® (infliximab);
  • Mabthera® (rituximab); and
  • Simponi® (golimumab).

Many of these biological DMARDs must be given directly into the bloodstream by intravenous infusion, administered by a nurse specifically trained in their use. Many people attend a major hospital to have such doses administered, with 40% of all hospitalisations associated with RA being purely for the administration of medication.

In many cases, it is possible for these infusions to be administered in your own home by one of our highly trained nurses. Contact one of our friendly team members to see if home infusions with View Health – chemo@home might be suitable for you.

Multiple Sclerosis (MS) Treatment

Multiple sclerosis (MS) is a chronic disease affecting the central nervous system (the brain, spinal cord and optic nerves). MS is believed to be an autoimmune condition in which the body’s immune system attacks the myelin sheath (a fatty protective layer) of nerves. Scars (sometimes called ‘lesions’) eventually form on the nerves, interfering with the transmission of messages between the brain and spinal cord. This can result in symptoms such as:

  • Extreme fatigue;
  • Pain;
  • Tingling, numbness or pins and needles;
  • Muscle weakness, tremor, stiffness or spasms;
  • Difficulty with walking, balance and coordination;
  • Sensitivity to heat and/or cold;
  • Slurring or slowing of speech;
  • Visual disturbances, such as blurred or double vision; and
  • Changes in memory, concentration and/or reasoning.

The severity and specific symptoms experienced by people are difficult to predict. They vary from person to person and over time in the same person. The progress of the disease is similarly unpredictable. MS can be grouped into four broad classifications based on the way the disease progresses.

  1. Relapsing-Remitting Multiple Sclerosis (RRMS): the person has intermittent ‘attacks’ of MS (a ‘relapse’ or ‘flare’) followed by full or partial recovery. This is the most common form of MS.
  2. Progressive-Relapsing Multiple Sclerosis: symptoms gradually worsen over time, with distinct attacks along the way. The person may or may not recover to some degree after each attack.
  3. Secondary-Progressive Multiple Sclerosis (SPMS): occurs in approximately 50% of people with RRMS within 10 years of diagnosis; the attacks of RRMS cease and symptoms progressively worsen over time.
  4. Primary-Progressive Multiple Sclerosis: symptoms steadily progress without recovery or remission.

There are over 26,000 people living with multiple sclerosis in Australia, 85% with RRMS and 12% with PPMS. Most people are diagnosed with MS between the ages of 20 and 40 years old and is three times more likely to occur in women than in men.

The prevalence of multiple sclerosis both in Australia and overseas has increased over the last decade, which most likely reflects improvements in MS treatment and the resulting increase in survival of people with MS.

Multiple sclerosis treatment in Australia focuses on two distinct areas – controlling the symptoms of MS and reducing the risk of relapse and disease progression. Symptoms may be controlled by the use of medications such as:

  • Steroids (e.g. prednisolone) to reduce inflammation and control the severity of an attack;
  • Botox® to relieve muscle spasticity in a particular area of the body or to treat incontinence; and
  • Baclofen for muscle control and to alleviate muscle spasticity.

The risk of relapse and disease progression can be reduced using disease-modifying therapies (DMTs). The range and efficacy of medications available as DMTs has increased significantly in recent years. In 2017, 64% of all patients with MS were being treated with disease-modifying therapy, compared to 25% in 2010.

Examples of DMTs include interferon (Avonex®, Betaferon®), glatiramer acetate (Copaxone®) and fingolimod (Gilenya®). ‘Biological’ DMTs treat multiple sclerosis by targeting the parts of the immune system responsible for damaging the myelin around nerve cells. Examples include:

  • Lemtrada® (alemtuzumab);
  • Tysabri® (natalizumab); and
  • Ocrevus® (ocrelizumab).

Many of these biological DMTs must be given directly into the bloodstream by intravenous infusion, administered by a nurse specifically trained in their use. Many people regularly attend a major hospital to have such doses administered and appointments can take up a lot of time.

In many cases, it is possible for these infusions to be administered in your own home by one of our highly trained nurses. Contact one of our friendly team members to see if home infusions with View Health – chemo@home might be suitable for you.

Inflammatory Bowel Disease Treatment

Inflammatory bowel disease is a broad term that refers to any condition causing inflammation of the digestive tract. This can include the stomach, small intestine, large intestine (colon) and rectum. Crohn’s Disease and Ulcerative Colitis are chronic autoimmune diseases that cause the gut to become red, hot, swollen, tender and incapable of performing its normal function. This can lead to a range of symptoms, such as diarrhoea, pain, bleeding, severe fatigue, weight loss, anaemia and bowel obstruction. These symptoms can be extremely distressing and, if poorly controlled, can result in hospitalization and the need for surgery to remove the affected parts of the digestive tract.

Australia has one of the highest rates of inflammatory bowel disease in the world. In 2018, approximately 75,000 Australians suffered from ulcerative colitis and approximately 92,500 from Crohn’s disease. By 2022, these numbers are expected to rise to over 80,000 Australians with ulcerative colitis and nearly 100,000 with Crohn’s disease.

The exact cause of inflammatory bowel disease is unknown. Current research shows that there is a strong genetic link, but environmental and lifestyle factors are also thought to play a role. Infection with bacteria or viruses, the use of tobacco and the type of bacteria present in the ‘normal flora’ of the gut can all have an effect on the development of inflammatory bowel disease.

Crohn’s Disease Treatment

Crohn’s disease is a form of inflammatory bowel disease that can affect any part of the digestive tract, from the stomach to the anus. It causes inflammation of the full thickness of the gut wall. Treatment aims to control symptoms by reducing this inflammation, primarily through the use of medications, although lifestyle changes such as staying hydrated, exercising and limiting certain foods (such as spicy meals and caffeine) can also be useful.

Medications commonly used for Crohn’s disease include:

  • Analgesics (e.g. paracetamol), to control mild pain;
  • Loperamide (Imodium®, Gastro-Stop®), to slow or stop diarrhoea;
  • Aminosalicylates (e.g. sulfasalazine, mesalazine), to help control inflammation in mild to moderate disease;
  • Corticosteroids (e.g. prednisolone), to decrease inflammation and reduce the overactivity of the immune system in moderate to severe disease; and
  • Immunosuppressants (e.g. mercaptopurine, azathioprine, methotrexate), to reduce the overactivity of the immune system that is responsible for Crohn’s disease. These medications can take several weeks to start working.

Biological therapies (sometimes referred to as ‘immunotherapy’) are a newer class of medication that has been used with great success for Crohn’s disease treatment. These treatments work by targeting the parts of the immune system that are responsible for triggering inflammation. Examples of biologic therapies include:

  • Remicade® (infliximab);
  • Entyvio® (vedolizumab);
  • Stelara® (ustekinumab); and
  • Humira® (adalimumab).

Many of these biological therapies must be given directly into the bloodstream by intravenous infusion, administered by a nurse specifically trained in their use. Many people regularly attend a major hospital or associated outpatient centres to have such doses administered and appointments can take up a large part of the day.

In many cases, it is possible for these infusions to be administered in your own home by one of our highly trained nurses. Contact one of our friendly team members to see if home infusions with View Health – chemo@home might be suitable for you.

Ulcerative Colitis Treatment

Ulcerative colitis is a form of inflammatory bowel disease that only affects the large bowel (colon and/or rectum). It causes inflammation of the surface layers of the lining of the bowel only. Symptoms usually occur as intermittent attacks between periods of no symptoms (‘remission’), although 5 to 10% of people can experience symptoms all the time. The treatment options for ulcerative colitis depend on the severity of the symptoms.

Medications are commonly used to provide symptomatic control, reduce inflammation and prevent ongoing damage to the gut. Symptoms may be controlled by taking medications that help relieve pain, diarrhoea, abdominal cramping and supplement your diet (e.g. iron, calcium and vitamin D supplements).

Other medications used to treat ulcerative colitis may include:

  • Aminosalicylates (e.g. sulfasalazine, balsalazide, olsalazine, mesalazine), to help control inflammation in mild to moderate disease;
  • Corticosteroids (e.g. prednisolone, budesonide), to decrease inflammation and reduce the overactivity of the immune system in moderate to severe disease; and
  • Immunosuppressants (e.g. mercaptopurine, azathioprine, methotrexate), to reduce the overactivity of the immune system that is responsible for ulcerative colitis. These medications can take several weeks to start working.

If these medications don’t provide sufficient control of the disease, biologic agents (sometimes referred to as ‘immunotherapy’) may be an option. This class of medication target the parts of the immune system responsible for triggering inflammation. The most common biologic therapies used for ulcerative colitis treatment are:

  • Remicade® (infliximab);
  • Entyvio® (vedolizumab); and
  • Humira® (adalimumab).

Many of these biological therapies must be given directly into the bloodstream by intravenous infusion, administered by a nurse specifically trained in their use. Many people regularly attend a major hospital or associated outpatient centres to have such doses administered and appointments can take up a large part of the day.

In many cases, it is possible for these infusions to be administered in your own home by one of our highly trained nurses. Contact one of our friendly team members to see if home infusions with View Health – chemo@home might be suitable for you or your patients.

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