Why do I need IV infusions?

If your rheumatoid arthritis has been causing you a lot of pain and stiffness and it seems like your current medication is not helping, your doctor may consider another approach. An alternative to taking oral medicines when it is clear that your arthritis is not being controlled is one of the newer medications given by IV infusion. This involves the delivery of liquid medication into a vein. Special clinics have been set up all over the country for this. People with severe arthritis are now having their arthritis controlled more effectively.

Is the IV infusion medicine different?

Yes. The advent of a newer class of drugs known as biologics has advanced the treatment of rheumatoid arthritis (RA). While researchers are working on developing a tablet form, currently biologic medications can only be given by injection into a vein (intravenously, IV) or under the skin (subcutaneously, SC).

The experience of IV treatment

It is difficult to generalise about the experience of receiving IV treatments since the centres that provide the services vary so much from area to area.

However, there are some practical questions, which may be useful to ask your health professional so that you can be prepared for your treatment. The treatment may take a couple of hours.

The responses will vary depending on the centre to which you are being referred. Some centres are in hospitals while others are in the community. Writing out some

questions in advance of seeing your doctor and taking notes while you are there may prove very useful:

• How long does the IV treatment take?
• What facilities are in the centre? (Can you take a friend, is there a TV, should
  
  you bring something to read, are you allowed to have anything to drink?)
• Will you be with other patients with different illnesses?
• What is the situation regarding car parking?
• Are you likely to feel unwell after your IV treatment and what should you do?
• Is it advisable for you to drive yourself home?
• What side effects might you experience?
• How long will it take before you will feel the effects of the new medication?

Biologics given by IV infusion

With an IV infusion, the medication is delivered as a liquid, flowing slowly through a needle directly into a vein. One of the advantages of infusions is that they are required less frequently than oral medication or injection. The length of the infusion and how often you need an infusion will depend on the type of medication. Typically, you spend an hour or two in the infusion clinic while you’re having your treatment and you may not need to return for a month or in some cases, several months.

Where will I receive my infusion treatment?

If your doctor decides that you are a good candidate for IV infusion therapy, they will make arrangements for you to receive your infusion treatment in a special hospital or community-based clinic, where medical staff will be there to set up the infusion and to care for you throughout the process.

The infusion is usually given to you sitting in a comfortable chair. The nurse first takes your vital signs (pulse, blood pressure, temperature etc). These may be taken again during the process, which can last several hours. The intravenous needled is inserted into a vein in the forearm. This provides the access to the vein and the medication is fed in through a tube. Should you need to go to the bathroom, you can be disconnected and reconnected.

Can I receive my IV infusion treatment in the community?

Yes, there are several private healthcare companies offering specialised infusion services in health centres, nursing homes, and larger GP clinics around the country.

It is likely that you will probably have your initial infusions in the hospital, to monitor the use of the new medication. If your doctor is happy with your progress, you may be given the option of receiving your IV infusions in a more convenient location, if practical.

A specialist infusion nurse will then get in touch with you about your needs and treatment schedule. Although you will be receiving your treatment in the community, you will always remain under the care of your hospital consultant, who will receive constant feedback from the infusion nurse.

Who pays for IV infusion?

This treatment is free of charge in the hospital setting as a public patient. Private health insurers may cover the cost of specialty nursing and IV infusion therapy in the community or in your home. You need to check this.

Are there any side effects?

Yes, there may be side effects. Your doctor will discuss this with you.

What precautions can I take?

You may be more susceptible to infection so if you develop a sore throat or other new symptoms, you should let your doctor know. As a precaution, your doctor may recommend that should have an annual flu vaccination.

How do I know if my IV infusion treatment is working?

Biologic medications generally take a few weeks or months to show effects. If your symptoms improve, that’s a sign that the treatment is working. You may have less

pain in your joints or you may not feel so tired all the time. And you may notice that you’re able to move your joints more easily. Your rheumatologist will continue to perform tests and take x-rays to see how your RA is progressing. When your doctor prescribes a therapy, ask how long it is likely to take before you see effects. This will help to give realistic expectations.

Will IV infusion therapy cure my rheumatoid arthritis?

There is no cure for rheumatoid arthritis and the aim of treatment is to improve your symptoms, reduce pain and to improve your quality of life generally. Biologic

medications can often work where other medications have failed. They can successfully reduce symptoms and some people will go into remission from their arthritis. A clinical remission is defined as fewer than 15 minutes of morning stiffness, and no tender or swollen joints for at least three months.

Passing the time during an IV treatment

Here are some suggestions:

• Read a book, magazine or newspaper

• Bring a crossword puzzle or suduko game

• Hand held games are fine, once they are quiet or you have headphones

• Bring your own music and headphones (iPod or MP3 player)

• Bring your computer and get some work done or watch a movie.

• You can use your smartphone or computer to catch up with your friends on Facebook etc

• Plan a holiday/trip

• Bring a pen and paper and make your weekly shopping list, or a to-do list

• Study for that upcoming exam

• Catch up on paper work

• Knit or crochet

• Take a nap

• Meditate

• Bring a family member or a friend with you to the clinic. Check beforehand that it’s okay, but most clinics don’t mind.

For more information and to find out about arthritis support services, log on to

Arthritis Ireland at www.arthritisireland.ie