Saundra Jain, MA, PsyD, LPC, and Andrew Laster, MD, on Wellness for Patients With RMDs: Part 1

In this part 1 of this 4-part podcast, Saundra Jain, PsyD, LPC, and Andrew Laster, MD, review the importance and application of wellness practices among patients with rheumatic diseases.

Saundra Jain, MA, PsyD, LPC, is adjunct clinical affiliate at the University of Texas at Austin with the School of Nursing, and a psychotherapist in private practice in Austin, Texas. Andrew Laster, MD, is a rheumatologist in private practice in Charlotte, North Carolina.

Listen to part 2 of this podcast here.

TRANSCRIPT:

Welcome to this podcast from the Rheumatology and Arthritis Learning Network. I'm Rebecca Mashaw, your moderator. And I'm very pleased to have here today Dr. Saundra Jain, who is an adjunct clinical affiliate at the University of Texas at Austin with the School of Nursing there and a psychotherapist in private practice. And we also have Dr. Andrew Laster, who is a rheumatologist in private practice with a group in Charlotte, North Carolina. What we're going to talk about today is the concept and the importance of wellness across disease states in rheumatology, Dr. Jain, I know your research over the years has focused strongly on wellness. So would you share your definition of wellness with us?

Dr Saundra Jain: Of course, Rebecca, I'd be happy to. But before we start, I'd love to begin by saying how excited we are to be having this really important conversation, bringing together two specialties like rheumatology and psychiatry, it really is... I mean, honestly, it's a unique opportunity to come together so we can talk about our shared learnings in hopes of what I know we all want to do, which is to take better care of our patients. So back to your question, Rebecca, and that is how do we go about defining wellness? And I have to be honest, it's a little bit of a challenge. It's an overused term. It has a lot of varieties of meaning, lots of definitions. It kind of depends upon your set and setting as to how you define the word wellness. So I'm going to do this for our conversation today. I'm just going to offer a definition that comes straight from World Health Organization.

And I want you to know this, the definition dates back to the mid-'40s. So it's tried and true and has been around for a very long time. And WHO defines health this way: as a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity. And I just love this. Andy, you and I have talked about this many times, that we as patients, we all have kind of our own things, whether we're clinicians or actual patients, we are more than just our disease.

And again, as clinicians, we're always interested in the reduction of symptoms and improvement in functionality, regardless of disease state. But what we don't want to do is overlook how our patients are doing in terms of their overall wellbeing. So if you leave our conversation today with that in your back pocket, I think we've been hugely successful in achieving our goals.

Andy, if I could, I'd love to turn to you. I'm so curious, from your perspective as a rheumatologist, how important do you think wellness is in the lives of patients who are suffering and dealing with RA?

Dr Andrew Laster: I'll use the word huge again. That really is hugely important. We think it's really not just rheumatoid arthritis, but a variety of diseases, and rheumatologists certainly have expertise in number of immune mediated diseases. But we'll kind of focus on RA here a bit, because I think there's some information here that's more tried and true. But I think patients really want to retain some control over their arthritis and how it's managed. And this concept of wellness, I think, really helps to empower the patient. If you've been diagnosed with an autoimmune disease, I'm sure it's incredibly intimidating that your immune system has gone awry, and you're going to need to take drugs to go ahead and modify it. But wellness acknowledges that the patient really has some control.

I mean, we know that the brain is hardwired to the immune system and that the behaviors that we're going to be talking about in a few minutes really are complimentary. It's not an alternative to traditional drug therapy. So I think that when we sit down and talk to patients and we acknowledge the importance of wellness, their eyes often light up. Finally, I found somebody who I can talk to, not just about allopathic medicine and the drugs, but also, this concept of wellness, which more and more individuals are coming to understand.

RALN: Dr. Laster, you and Dr. Jain were coauthors, with others, on an article recently published in Rheumatic and Musculoskeletal Diseases, titled “Call for action: incorporating wellness practices into a holistic management plan for rheumatoid arthritis - going beyond treat to target.” Can you explain what is meant by going beyond treat to target?

Dr Laster: Sure. Rebecca, so treat to target is really an essential aspect of caring for patients with rheumatoid arthritis. And I think understood by rheumatologists, but just to kind of give you a definition. So basically you determine the metrics that you're going to use to measure disease activity over time, and then you adjust the treatment accordingly if the metrics—it's usually low disease activity or remission—if the metrics are not met at that fixed time point. But the challenge here is that all the metrics we use, whether it's a RAPID3 or a CDAI or a DAS28, all of them include a patient global. And the patient global can be driven by more than just the number of tender and swollen joints.

So the dilemma is that if you simply follow the metrics, and you have a patient with moderate and high disease activity, but they don't have corresponding tender and swollen joints, then you'd be led to go ahead and make a change in their conventional DMARD therapy or biologic. When really what you need to do is to focus on other aspects, such as the patient's sense of wellbeing. This is what we'll be talking about and really how we can improve the patient overall. If we can incorporate that, I think the patient global will improve and will be further along in terms of caring for our patients.

RALN: Be sure to join us for the continuation of this conversation with Drs Saundra Jain and Andrew Laster on wellness among patients with rheumatic diseases.