RA treatment by injection

If your current arthritis medication is not easing your symptoms, including joint pain or swelling, your doctor may recommend that you use a newer biologic medication that is given by injection.

Initially when you are started on this treatment, your doctor or nurse may inject this medicine. However, where appropriate, self-injection may be recommended. This will mean that you will be able to take your medication yourself at home, thus avoiding regular trips in and out of hospital for appointments.

Who will teach me how to self-inject?

The idea of giving yourself an injection can be a little daunting at first, but you may be surprised to find you will become an expert in no time at all. Your nurse or doctor will take time to teach you about the medicine and how to give yourself an injection.

You may be shown in the hospital or a nurse may come to your home to demonstrate to you how to store and handle the medicine, administer the injection, and dispose of the used needle etc.

Ask for a demonstration of the injection technique as many times as it takes for you to feel comfortable and confident to do it yourself. Patient education information and videos are available in conjunction with self-injectable medicines, so ask about this type of support.

Can I ask a friend or family member to give me the injections instead?

It may be useful to bring a family member or friend with you to learn how to give the injection. However, it is recommended that if you are physically able, you should learn the procedure for yourself in case there are occasions when the other person is not available and you need to self inject.

Most patients who have initial fears regarding self-injection are usually able to overcome their concerns. After instruction, practice and support, it is straightforward and not painful.

What part of my body do I inject?

The medication is injected into the front of your thighs or abdomen. Injection sites should be rotated so that the same site is not used repeatedly. It can be useful to make note of the injection site you used on a calendar or in an injection diary to help you remember.

If a caregiver is giving you the injection, they can also use the outer area of the upper arms.

How often will I need to inject myself?

How often you need to inject the medicine will depend on the type of medicine you use and how severe your symptoms are. For example, frequency of injection can very between once or twice a week to once a month.

Where will I obtain supplies of my injectable medication?

Usually, your medicine will be delivered at regular intervals to your pharmacy or to your hospital, as prearranged by your doctor, for you to collect.

Will I have to fill the syringe myself?

No. The injectable biologic medicines are supplied in a single-use pre-filled syringe or ‘pen’.

How do I store my medicines?

Your medications should be stored in a refrigerator and warmed to room temperature prior to use – about 30 minutes after removing from the fridge should be fine. Remember to keep all medicines out of the reach of children

What are the basic instructions for self-injection?

While you are waiting for your medication to come to room temperature, you can get the rest of your equipment ready, including an alcohol swab, a cotton ball or gauze and a sharps container (the special box you will be given to dispose of used needles and syringes).

You should wash your hands thoroughly with soap and warm water before you begin. Wipe the injection site with an alcohol swab and allow the skin to dry before injecting. Do not fan or blow on the clean area and do not touch this area again before giving the injection.

Remove the cap from your pre-filled syringe, being careful not to touch the needle or let it touch any surface Some people find that using their free hand to pinch and hold the skin at the injection site during administration makes injecting easier. Holding the syringe comfortably in your hand and with one quick, short motion, push the needle all the way into skin. Push the plunger to inject the solution – it can take from 2-5 seconds to empty the syringe.

Using your thumb or a piece of gauze, apply pressure over the injection site for 10 seconds, but don’t rub it. Use a plaster if you prefer.

What do I do with the empty syringe?

You can only use the pre-filled syringe once. It’s important to remember that you should never recap the needle and you should never reuse the syringe and needle. Dispose of the needle and syringe in a sharps container that will be given to you by the hospital or at your local pharmacist before you start self-injecting at home. When the sharps bin is full, you can return it to your hospital or pharmacist, as prearranged, and collect an empty one.

You can return a full sharps bin and collect another one was given to you by as instructed by your doctor, nurse or pharmacist.

How quickly will the medicine work?

This will vary but you may notice a marked improvement after the first or second injection.

Are there any side effects?

The possibility of side effects will be discussed by your doctor. Also, if you notice any effects while on the medication, please talk you your health professional about these.

The most common side effects seen with the injectable medicines include skin reactions, which are called “injection site reactions” causing a rash or itching at the site of the injection, but this reaction is only likely to occur in less than a third of patients.

There may also be an increased risk of infections so talk to your doctor about any precaution you can take, including getting an annual flu vaccination.

Who pays for this medication?

Most biologic injectable medications for rheumatoid arthritis are available free-of-charge under the HSE High Tech Drug scheme, once they have been prescribed by a consultant rheumatologist.

For more information and to find out about arthritis support services, log on to Arthritis Ireland at www.arthritisireland.ie