Injecting Skyrizi at Home: A Simple Step-by-Step Guide

January 4, 2024

Skyrizi, an injectable biologic, blocks interleukin-23 to ease psoriasis and Crohn's. Master injection, storage, and dosing tips.Skyrizi, an injectable biologic, blocks interleukin-23 to ease psoriasis and Crohn's. Master injection, storage, and dosing tips.

Introduction to Skyrizi

Skyrizi (risankizumab-rzaa) is an injectable prescription medication used to treat certain chronic inflammatory conditions, including moderate-to-severe plaque psoriasis, active psoriatic arthritis, and moderately to severely active Crohn’s disease in adults (FDA Label).

Skyrizi works by selectively blocking IL-23, a naturally occurring protein in the body that drives inflammatory responses. By inhibiting IL-23, Skyrizi helps reduce inflammation that contributes to symptoms of the conditions it treats.

For plaque psoriasis, Skyrizi helps treat adults with moderate-to-severe symptoms involving large portions of the body or face/hands that have not responded adequately to other treatments or phototherapy. For psoriatic arthritis, Skyrizi can reduce signs/symptoms of active arthritis and improve physical function in adults with active disease. Lastly, for Crohn’s disease, Skyrizi is used to achieve and maintain clinical remission in patients who have not responded well enough to conventional Crohn’s disease therapies or have lost their response to other biologic treatments.

How Skyrizi Works

Skyrizi is a biologic medicine that works by targeting a specific protein called interleukin-23 (IL-23), which contributes to the development of inflammatory diseases like psoriasis, psoriatic arthritis, and Crohn’s disease. Skyrizi is designed to prevent IL-23 from binding to its receptor on the surface of immune cells, disrupting the inflammatory pathway that can lead to symptoms of these diseases ¹.

Skryizi contains a substance called risankizumab, which attaches to the p19 part of IL-23, stopping it from activating the immune system. By doing this, Skryizi decreases inflammation and the number of certain immune cells, which can help with psoriasis, psoriatic arthritis, and Crohn’s symptoms.

In clinical trials, Skyrizi demonstrated the ability to significantly clear skin and improve symptoms in patients with moderate to severe plaque psoriasis. Reductions in disease activity have also been observed in studies of psoriatic arthritis and Crohn’s disease. Overall, by neutralizing IL-23, Skyrizi helps restore balanced immune system function and reduce harmful inflammation.

Before the Injection

Before administering a Skyrizi injection at home, it’s important to choose an appropriate injection site, gather and prepare all necessary supplies, and follow proper hygiene practices. It’s also important to make sure the medication isn’t expired and that it looks clear, not cloudy.

Recommended injection sites for Skyrizi include the front of the thighs, the abdomen, and the back of the upper arms. Avoid injecting within 2 inches of the navel or any scars or stretch marks. Rotate injection sites each time to avoid skin reactions.¹

Gather all supplies needed for the injection including alcohol wipes, cotton balls, the Skyrizi injector pen and sharps container. Allow the Skyrizi pen to come to room temperature for 30 minutes before injecting. Make sure to wash your hands thoroughly with soap and water.

Before injecting, wipe the chosen site with an alcohol wipe and allow it to dry fully to sanitize the skin. Do not touch the site again before inserting the needle. Having everything prepared ahead of time helps ensure proper hygiene.²

Step-by-Step Injection

The following are the step-by-step instructions for injecting Skyrizi at home:

Remove the Skyrizi pen from the refrigerator and allow it to reach room temperature for 30 minutes before injecting. Cold Skyrizi can be more painful to inject.
Wash your hands with soap and water and assemble the injection components on a clean surface. You will need the Skyrizi pen, alcohol wipes, a cotton ball or gauze, and a sharps disposal container.
Hold the Skyrizi pen with the orange cap pointing down. Gently rock the pen back and forth 5 times. DO NOT shake the pen as this can damage the medicine. Inspect the medicine in the pen to make sure it is evenly distributed and not cloudy or discolored before injecting [1].
Remove the orange cap from the pen. The medicine should look clear to slightly yellow. Do not inject if the medicine appears cloudy, discolored, or contains large particles.
Attach the needle by securely twisting it onto the pen. Pull off the needle cap but do not throw it away yet.
Use an alcohol wipe to sanitize the injection site, either your abdomen, thighs, or upper arms. Allow the skin to air dry.
Using your thumb and forefinger, gently pinch at least 1 inch of skin around the injection site. Hold firmly.
With your other hand, insert the needle into the pinched skin at a 90 degree angle using a quick dart-like motion. Skyrizi is injected just under the skin, not into the muscle.
After the needle is fully inserted, release the pinched skin. With your thumb, slowly press the green activation button until you hear a click. Hold in place and count slowly for 5-10 seconds to deliver the full dose.
When the injection is complete, pull the needle straight out. Do not rub or recap the needle. Properly dispose of the used pen components in a sharps container.

Be sure to follow the instructions included with your Skyrizi pen. A nurse or doctor can also demonstrate proper injection technique.

After the Injection

After injecting Skyrizi, it’s important to follow proper aftercare procedures at the injection site.

First, apply firm pressure to the injection site with a cotton ball or gauze for 10-15 seconds after removing the needle. This helps prevent bruising or bleeding.

The injection site may be slightly red, swollen, itchy, or bruised after injection. This is fairly common and should go away within a few days. Call your doctor if the reaction increases in severity over time (see https://www.skyrizi.com/skyrizi-complete/side-effects).

Some patients experience side effects like headache, joint pain, tiredness, or redness/rash after starting Skyrizi. These are usually mild and tend to resolve within a week or two as your body adjusts. Taking an over-the-counter pain reliever can help manage discomfort. Let your doctor know if any side effects concern you or don’t go away.

With proper aftercare and monitoring, Skyrizi injections at home can be simple and comfortable. Reach out to your healthcare provider if you have any persistent or worsening reactions so they can provide guidance and support.

Tips for Painless Injections

There are several techniques you can use to make your Skyrizi injections as comfortable and painless as possible:

Apply an ice pack or cold compress to the injection site for 5-10 minutes beforehand. This will numb the area so you feel less pain. You can also use an over-the-counter numbing cream or gel, like lidocaine, and apply it 30-60 minutes before injecting.
Stay relaxed during the injection process. Take slow, deep breaths and try to clear your mind. Tensing up can make the injection feel worse.
Distract yourself while injecting by watching TV, listening to music, or talking to someone. Focus your attention elsewhere instead of on the injection.
Rotate injection sites each time you administer Skyrizi. Switch between your stomach, thighs, and upper arms to give one area a break before injecting it again.

By using these simple tips, you can make your Skyrizi injections significantly more comfortable. The goal is to relax both your body and mind as much as possible during the process. With practice, self-injecting will become second nature and much less intimidating.

Ongoing Use of Skyrizi

Skyrizi is injected 4 times per year after the initial dosing schedule. The recommended dosing is 150 mg (one prefilled syringe) administered subcutaneously at week 0, week 4, and every 12 weeks thereafter. Patients will need to continue getting injections every 3 months to maintain treatment. Consult your doctor for your specific dosing regimen.

Skyrizi should be stored in the refrigerator between 2°C to 8°C (36°F to 46°F) in the original carton to protect it from light until ready to use. Do not freeze Skyrizi. Do not shake the prefilled syringe or pen. If needed, the medicine can be kept at room temperature up to 30°C (86°F) for a maximum of 30 days in the original carton to protect from light. Throw away Skyrizi if it has been out of the refrigerator for more than 30 days.

If you have any questions about using Skyrizi, contact your healthcare provider. You can also call the manufacturer’s support line at 1-866-4Skyrizi (1-866-475-9742) or visit the Skyrizi website at www.skyrizi.com for additional resources and assistance.

Conclusion

Self-administering Skyrizi injections properly at home is crucial for receiving the full benefits of this medication. When injected correctly following the steps outlined above, Skyrizi can help control inflammation and symptoms of conditions like psoriasis, psoriatic arthritis, and Crohn’s disease. Many patients find Skyrizi helps them achieve clear skin, improved joint mobility, and even remission of Crohn’s disease. By learning to inject Skyrizi comfortably at home on your own schedule, you can take control of managing your condition while avoiding unnecessary trips to the doctor’s office. With some practice and patience, most patients are able to master self-injecting this medication in a safe and effective way. Remember to follow the instructions carefully and don’t hesitate to ask your healthcare provider questions. Proper self-injection technique will help ensure you get the most out of Skyrizi’s benefits.

Additional Resources

Here are some helpful resources with further information and assistance for those taking Skyrizi:

Skyrizi Complete offers comprehensive personalized support, including injection training and financial assistance. Patients can call 1-877-266-7538 to speak with an Access Specialist.

The SKYRIZI® Complete Savings Card and Patient Support page on the Skyrizi healthcare provider website also has details on financial assistance options.

The Patient & Practice Resources page for gastroenterology has educational materials, FAQs, and injection guides that may be helpful references.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

Self-Injection Videos

Enbrel SureClick: What to Know About Taking the Autoinjector Pen

December 27, 2023

What is Enbrel?

Enbrel is a prescription biologic medication used to treat certain autoimmune diseases like rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, and plaque psoriasis. It comes as an autoinjector called Enbrel Sureclick, a syringe, and delivered with a machine (i.e., Enbrel Mini).

It contains the active ingredient etanercept, which is a tumor necrosis factor (TNF) blocker that targets overactive immune system cells to reduce inflammation and manage disease symptoms. Enbrel works by binding to TNF and blocking its function, which interrupts the inflammatory cascade that leads to joint swelling, pain, and damage in inflammatory forms of arthritis.

Enbrel comes in an autoinjector pen called the Enbrel SureClick that allows patients to self-administer the medication subcutaneously. The autoinjector contains a pre-filled cartridge with a single dose of Enbrel and spring-activated needle for injection. Using the autoinjector allows for a simple, convenient way to take the medication at home.

Understanding the Enbrel SureClick Autoinjector

The Enbrel SureClick autoinjector is a prefilled, single-dose disposable device designed to make self-injection straightforward and convenient. Here are the main parts to understand:

Cap – Covers the needle before injection to keep it sterile. Remove the cap just before injecting.
Viewing window – Allows you to see the Enbrel solution inside the device. Make sure the liquid looks clear to slightly yellowish and does not contain particles.
Expiration date – Check that the date has not passed before using. Do not use if expired.
Medicine – Each SureClick contains 50 mg of Enbrel in a prefilled syringe. No reconstitution is required.
Needle guard – Covers the needle after injection to prevent injury. The needle guard will deploy and lock automatically after the full dose is given.
Start button – Pressing this blue button starts the injection after the autoinjector is positioned on skin.
Injection complete indicator – Orange part that is visible when injection is done.

Familiarize yourself with these parts before using the Enbrel SureClick to ensure proper administration. With some preparation and by following all instructions, the autoinjector allows you to easily and comfortably deliver your Enbrel dose subcutaneously.

Before the Injection

Before injecting Enbrel, take the autoinjector out of the refrigerator and allow it to reach room temperature. This is an important step, as injecting cold medication can be uncomfortable. Leaving Enbrel at room temperature for about 30 minutes before injection allows the medication to warm up.

Some tips for allowing Enbrel to reach room temperature:

Take Enbrel out of the refrigerator about 30 minutes before your scheduled injection time.
Do not try to warm the medication by heating it in a microwave or placing it in hot water, as this can damage the medication.
Lay the autoinjector on a flat surface like a tabletop or counter while you wait for it to warm up.
Avoid leaving Enbrel out of the refrigerator for longer than 30 minutes before injecting. The medication can be safely kept at room temperature for up to 30 days if needed, but it’s best to inject it as soon as it reaches room temperature. You also should not put it back in the refrigerator.
Check the solution in the autoinjector window periodically. When ready to inject, the solution should be clear and colorless, with no lumps or particles.

Allowing Enbrel to warm to room temperature helps make the injection process smooth and comfortable. Once the medication has reached room temperature, you are ready for the next steps of preparing the injection site and injecting Enbrel.

Choosing the Injection Site

The recommended injection sites for Enbrel SureClick are the abdomen, thighs, and upper arms. These areas generally have more padding between the skin and muscle which makes injections easier and more comfortable.

When choosing a site, avoid injecting within 2 inches of the navel or any scar tissue or bruises. Also avoid areas that are tender, red, hard or have psoriasis plaques.

Rotate injection sites with each use. Do not inject into the exact same spot each time. Recommended rotation patterns include:

Abdomen: Divide the abdomen into quadrants using the navel as the center. Inject in a different quadrant each time.
Thighs: Alternate between left and right thigh.
Upper arms: Alternate between left and right upper arm.

Properly rotating sites allows one area to fully heal between injections. This helps minimize skin reactions or buildup of scar tissue.

Preparing the Injection Site

Before administering your Enbrel injection, you will need to properly prepare the injection site. This helps ensure the medication is delivered safely and effectively.

The first step in preparing the injection site is to wash your hands thoroughly with soap and warm water. Be sure to scrub for at least 20 seconds. This helps remove dirt and bacteria from your hands before handling the injection components.

Once your hands are clean, use an alcohol wipe to clean the skin at the injection site you have chosen. Be sure to let the alcohol fully dry before proceeding. Cleaning the skin with an alcohol wipe kills bacteria on the surface of the skin and prevents infection.

Only inject Enbrel into areas with no signs of skin problems like redness, swelling, scarring, or irritation. Avoid injecting into areas that are bruised, scarred, or feel hard. Also do not inject into moles, scars, bruises, or areas where the skin is tender, damaged, red, or hard.

Properly cleaning the injection site with an alcohol wipe before each use of Enbrel helps minimize skin reactions and ensure proper delivery of the medication.

Removing the Cap

To remove the cap from the Enbrel SureClick autoinjector, first inspect the cap to make sure it is intact and has not been previously removed. Grasp the cap and gently pull it straight off the autoinjector. Do not twist or bend the cap, as this could damage the internal needle.

Once you have removed the cap, set it aside on a clean surface. Be careful not to touch the exposed needle under the cap with your fingers, as this could contaminate the needle. The autoinjector is now ready for positioning and injection. Avoid removing the cap until you are ready to inject, as this helps keep the needle sterile.

If the cap is loose, damaged, or missing, do not use that autoinjector. Call your healthcare provider for a replacement. Never try to recap a used autoinjector or you may risk accidental needlestick injury.

Positioning the Autoinjector

Hold the autoinjector at a 90 degree angle against the injection site you have cleaned. You want to position it straight up and down, perpendicular to the skin, not at an angle. This allows the needle to properly insert into the skin.

Gently press the autoinjector firmly against the skin to start the injection. You will hear a click which signals the start of the injection, but continue holding it firmly in place. It is important to keep holding it securely against the skin throughout the entire injection process.

Do not try to inject at an angle as this can affect how well the medication is delivered. Keep the autoinjector straight up and down. Apply enough pressure so that it remains firmly in contact with the skin.

Starting the Injection

Once you have positioned the autoinjector against your skin at the injection site, you are ready to start the injection. To do this, you simply need to:

Firmly push the autoinjector all the way down against your skin until it stops moving. This will trigger the start button.
Listen for the click. The click signals that the injection has started and the medicine is being delivered.
Keep pushing down on the autoinjector. It is important to hold the autoinjector in place against your skin after the click for about 10 seconds to allow the full dose to be delivered.
You may hear a second click during this time – this is just an indicator that the injection is nearly complete.
After 10 seconds, you can then lift the autoinjector straight off of the injection site. The purple indicator will be visible to confirm the dose has been fully given.

Pushing the autoinjector all the way down until it stops moving is the action that starts the injection process. Keep the autoinjector firmly in place for 10 seconds after the click to allow the full dose to be properly injected.

Completing the Injection

After the loud click, continue holding the Enbrel SureClick autoinjector firmly against your skin for 10 seconds to ensure the full dose is delivered. Do not remove it sooner than 10 seconds, even if you think the injection is complete.

Holding the device in place allows time for all of the medication to be injected under the skin. If you remove it too soon, some medication may stay in the autoinjector and you will not get your full dose.

Keep holding the autoinjector firmly against the injection site for a slow count of 10 seconds. Count slowly in your head or out loud. After counting to 10, you can then lift the autoinjector straight up from your skin to complete the injection.

The blue indicator will now be visible to confirm the injection is complete. You may see a few drops of liquid on your skin, which is normal. Press a cotton ball or gauze pad over the injection site and hold for 10 seconds. Do not rub the site.

After the Injection

After you have completed the injection, you can remove the autoinjector from your skin. Check the viewing window to ensure the purple indicator is visible, confirming the full dose has been delivered. There may be a small amount of blood at the injection site – you can press a cotton ball or gauze over the injection site for 10 seconds to stop any bleeding. Do not rub the injection site.

It is important to properly dispose of the used autoinjector right away. Place the used SureClick autoinjector into an FDA-cleared sharps disposal container right away after use. Do not throw away (dispose of) loose needles and syringes in your household trash. Do not recycle your used sharps disposal container.

If you do not have an FDA-cleared sharps disposal container, you may use a household container that is:

Made of a heavy-duty plastic
Can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out
Upright and stable during use
Leak-resistant
Properly labeled to warn of hazardous waste inside the container

When your sharps disposal container is almost full, follow your community guidelines for the right way to dispose of your sharps disposal container. There may be state or local laws about how to throw away used needles and syringes.

Medical Disclaimer

Tips and Tricks

How to Get Rid of Your Injections Properly

December 14, 2023

Introduction

Proper injections disposal is a critical aspect of healthcare and public safety. Improper disposal of used needles and other injectable medications can pose serious health risks, including the spread of infectious diseases such as HIV and hepatitis. It is essential to ensure that needles are safely and properly disposed of to protect healthcare workers, waste handlers, and the general public. In this step-by-step guide, we will walk you through the process of safe needle disposal, providing valuable information on how to properly dispose of injection needles and other injections. By following these guidelines, you can help prevent needlestick injuries and promote a safer healthcare environment.

The importance of proper injection disposal

Proper injections disposal is not just a matter of convenience; it is a critical step in ensuring the safety of individuals who may come into contact with used needles and other injectable medications. The risks associated with improper disposal cannot be overstated. Healthcare workers, waste handlers, and even the general public are at risk of needlestick injuries and the potential transmission of infectious diseases when needles are not disposed of correctly.

One of the key reasons for proper injection disposal is to prevent needlestick injuries. These injuries can have severe consequences, including the transmission of bloodborne pathogens such as HIV, hepatitis B, and hepatitis C. By safely disposing of needles, we can significantly reduce the risk of accidental needle pricks and subsequent infections.

Additionally, proper injection disposal also helps protect waste handlers who come into contact with medical waste. These individuals can be exposed to contaminated needles and other sharp objects if they are not disposed of safely. By following the appropriate disposal methods, we can minimize the risk of injury to these workers and prevent the spread of infections.

In the next section of this guide, we will delve into the specific steps involved in proper injection disposal at home. By following these steps, you can play an active role in ensuring the safety and well-being of everyone involved in the disposal process.

Step 1: Prepare the container

Now that you have gathered all the necessary supplies, it’s time to prepare the container for safe disposal. Follow these steps to ensure proper containment and storage:

1. Ensure the container is puncture-proof and leak-resistant: Check the integrity of the container to make sure that it is sturdy and won’t be easily pierced by needles. Look for containers specifically designed for needle disposal, as they are made to withstand punctures and leaks.

2. Place the container on a stable and sturdy surface: Find a location in your home or facility where the container can be easily accessed but out of reach of children and pets. Make sure it is on a stable and sturdy surface to prevent any accidental tipping or spills.

3. Keep the container upright: It is important to maintain the correct orientation of the container. Always keep it upright to prevent any potential leakage or spills.

4. Do not overfill the container: Follow the manufacturer’s instructions on the container capacity and do not exceed the fill line. Overfilling the container can increase the risk of needle sticks and may compromise the integrity of the container.

By properly preparing the container, you are taking the necessary precautions to ensure safe disposal. In the next section, we will discuss Step 2, which involves the actual disposal of your injectable medications. Stay tuned for more information on how to safely discard your used needles and syringes.

Step 2: Dispose of the injections safely

Now that you have properly prepared your container, it’s time to safely dispose of the needles and syringes. Follow these steps to ensure safe and proper injection disposal:

1. Carefully insert the used needles or syringes into the container: Make sure to place the needles in the container with the utmost caution. Do not recap the needles, as this poses a risk of needlestick injuries. Simply drop the them into the container.

2. Securely close the container: Once the injections are inside the container, seal it tightly. Follow the manufacturer’s instructions on how to securely close and seal the container to prevent any accidental spills or openings.

3. Store the sealed container in a safe location: Keep the sealed container in a place that is out of reach of children and pets. Store it in a secure location away from any potential hazards or areas of high traffic.

By following these guidelines, you can ensure the safe and proper disposal of your used needles and syringes. In the next section, we will discuss the importance of considering alternative disposal methods and the environmental impact of improper needle disposal. Stay tuned for valuable insights on how to minimize the impact on our surroundings.

Step 3: Secure the container

Now that you have properly disposed of your injection, it is crucial to take extra precautions to ensure the container is securely stored. This step is essential to prevent any accidental spills or needlestick injuries. Follow these guidelines to secure your container properly:

1. Double-check the seal: Before storing the container, inspect the seal to ensure it is completely closed and intact. Look for any signs of damage or potential leaks.

2. Store in a designated area: Choose a designated area for storing your container. It should be a secure location that is easily accessible, yet out of reach of children and pets.

3. Avoid extreme temperatures: Do not expose the container to extreme temperatures, such as direct sunlight or freezing conditions. These can compromise the integrity of the container and increase the risk of spillage.

4. Keep records: It is a good practice to keep a record of when you dispose of each container. This record can serve as a useful reference if ever needed.

By following these steps, you can ensure the containers are properly secured until they are ready for disposal. In the next section, we will discuss the importance of education and awareness in injectable medication disposal and how to spread the message effectively. Stay tuned for valuable insights on promoting safe disposal practices in your community.

Step 4: Properly label and store the container

Properly labeling and storing the container is another crucial step in ensuring safe needle disposal. It not only helps you identify the contents of the container but also prevents any confusion or accidents. Follow these guidelines to label and store your container effectively:

1. Clear and visible labeling: Use a permanent marker to clearly label the container as “Sharps” or “Biohazard.” This can help others identify the potential danger and handle the container with caution.

2. Store in an upright position: Always store the container in an upright position. This prevents any accidental spills or leaks that may occur if the container is knocked over.

3. Keep out of reach: Store the container in a location that is inaccessible to children and pets. Consider using a lockable cabinet or a high shelf to ensure their safety.

4. Do not overfill: Avoid overfilling the container to prevent protrusion of needles. Once the container is around three-quarters full, it is time to seal and dispose of it properly.

Taking these necessary steps in labeling and storing your container can greatly reduce the risks associated with needle disposal. In the next section, we will delve into the importance of community involvement in proper needle disposal practices. Stay tuned for valuable insights on how to engage your community and create a safer environment for all.

Step 5: Disposal options for containers

Proper disposal of needle containers is an essential part of safe needle disposal. You should never toss a needle container in the regular trash or recycling bin as it poses a serious risk to waste management workers and the environment. Instead, consider the following disposal options:

1. Local drop-off locations: Many communities have designated drop-off locations, such as hospitals, pharmacies, or local recycling centers, where you can safely dispose of containers. Contact your local health department or waste management agency to find out the nearest drop-off point.

2. Mail-back programs: Some companies offer mail-back programs where you can safely return your injection container through the mail. These programs provide pre-paid shipping containers that meet all safety regulations.

Here are a few links to mail back programs.

SafeNeedleDisposal .org

MedSharps.com

Stericycle.com

3. Hospital or Nursing Home: Check if your local hospital or nursing home accepts injection containers for proper disposal. In some states like New York State it is mandated by law.

Remember, always research local regulations and guidelines for needle disposal in your area. By utilizing these proper disposal options, you are taking an active role in protecting public health and maintaining a clean environment.

In the next section, we will discuss the importance of raising awareness about safe needle disposal within your community. Stay tuned for valuable tips on how to educate and engage others in this important topic.

Additional tips for safe injections disposal

While proper injeciton container disposal is crucial, there are also some additional tips to keep in mind for safe needle disposal. By following these guidelines, you can further minimize the risk of accidental needlestick injuries and ensure the safety of yourself and others.

a) Never recap needles: Once a needle is used, do not attempt to recap it. Recapping can increase the chances of accidental needlestick injuries. Instead, immediately place the needle in a container.

b) Do not overfill containers: They should only be filled up to the indicated fill line. Overfilling can lead to spills and potential injuries. If your container is full, seal it and dispose of it using one of the previously mentioned methods.

c) Avoid injection disposal in glass or plastic bottles: Using glass or plastic bottles for disposal is not safe nor recommended. These containers may break, can be easily penetrated, and do not provide the same level of protection as proper injection containers.

d) Educate others: Spread awareness about the importance of safe needle disposal to your friends, family, and community. By educating and engaging others, you can help prevent needlestick injuries and promote responsible needle disposal practices.

Remember, safe needle disposal is a collective responsibility. By taking these extra precautions, you play a vital role in ensuring a safer environment for everyone. In the following section, we will discuss the environmental impact of improper needle disposal. Stay tuned to learn more about the consequences and how we can work together to mitigate them.

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Self-Injection Videos

How to inject Tremfya at home

May 12, 2022

It’s been a while since I’ve posted on RheumDoctor.com but here goes! Today I’ll be demonstrating how to inject Tremfya at home. Tremfya recently received FDA approval for the treatment of psoriatic arthritis and already has approval for the treatment of plaque psorisais. It comes as a prefilled syringe as well as a pen. I’ll be demonstrating its use with a pen.

Preparing for your injection

· Keep your medication stored in the refrigerator until use

Before injecting medication, take the autoinjector or prefilled syringe out of the refrigerator.
Allow it to warm up to room temperature.

· Pick a place in your house that is clean and has room for your materials (such as the kitchen table).

· Wash your hands thoroughly with either:

Soap & water
Hand sanitizer

· Choose an area to inject – Thigh or Stomach.

Choose an area that is intact and clear.
It should not have any of the following:
- Cuts
- Scrapes
- Bruises
- Psoriasis patches
- If you have extensive psoriasis, inject between patches
- Moles
- Scars
Please rotate area each time you inject (shown in picture below).

Cleanse chosen area

Cleanse chosen area with either of the following:
- Alcohol swab
- Alcohol and a cotton ball
Use the chosen alcohol material to “swipe” area
- Can either use a circular motion or wipe in “strips”
- Allow the area to dry

How to inject Tremfya with an autoinjector pen

Observe the medication in the window to be sure that it is clear (no cloudiness or crystals)

You will see a small air bubble within the window, this is normal and will not cause harm when injecting

· Remove the cap

· Press the tip of the auto-injector down in the skin at a 90 degree angle until it is flush with the skin

· Press button and hold for 15 seconds

· Viewing window will turn yellow, but continue to hold the button for the full 15 seconds · Lift the auto-injector straight up

Injecting Tremfya with a prefilled syringe

· Pull off the cap and observe the syringe to be sure that it is clear (no cloudiness or crystals)

· Pinch the skin around the injection site and enter at a 45-degree angle

· Press the plunger (slowly) to administer the medication

· Once the medication is fully administered, the plunger will reach the bottom and a spring will place a cover over the needle

After the injection

Properly dispose of the entire autoinjector/pen or prefilled syringe
- Sharps Container
  - Can be purchased at your local pharmacy
  - Disposal
  - Hospitals may take full sharps containers, ask first.
  - Pharmacies and Doctors’ offices are not allowed to take used syringes or needle
Discard remaining materials in the trash (cap, alcohol swabs, etc.)

For more information regarding Tremfya, please follow this link.

Credits

Injection site image: By British Columbia Institute of Technology (BCIT).
Download this book for free at http://open.bccampus.ca [CC BY 4.0
(http://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons

Medical Disclaimer

This information is offered to educate the general public. The
information posted on this website does not replace professional medical
advice, but for general information purposes only. There is no Doctor – Patient
relationship established. We strongly advised you to speak with your medical
professional if you have questions concerning your symptoms, diagnosis and
treatment.

Self-Injection Videos

How to give yourself Enbrel with the Enbrel Mini

October 30, 2018

Enbrel now comes as a new autoinjector, which can help you decrease medical waste. Today we’re going to learn how to give ourselves Enbrel with the Enbrel Mini. This medication is indicated for the treatment of rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis (JIA).

How to give yourself Enbrel with the Enbrel Mini

Preparing for your injection

Keep your medication stored in the refrigerator until use
- Before injecting medication, take the cartridge out of the refrigerator.
- Allow it to warm up to room temperature.
Pick a place in your house that is clean and has room for your materials (such as the kitchen table).
Wash your hands thoroughly with either:
- Soap & water
- Hand sanitizer
Chose an area to inject – Thigh or Stomach.
- Chose an area that is intact and clear.
- It should not have any of the following:
  - Cuts
  - Scrapes
  - Bruises
  - Psoriasis patches
  - If you have extensive psoriasis, inject between patches
  - Moles
  - Scars
- Please rotate area each time you inject (shown in picture below).

By British Columbia Institute of Technology (BCIT). Download this book for free at http://open.bccampus.ca [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons

Cleanse chosen area
- Cleanse chosen area with either of the following:
  - Alcohol swab
  - Alcohol and a cotton ball
- Use the chosen alcohol material to “swipe” area
  - Can either use a circular motion or wipe in “strips”
  - Allow the area to dry

How to give yourself the injection

Prepare the autoinjector.
Choose how fast you want the medicine to be delivered: fast, medium, or slow.
Press the tab on the autoinjector to open the cartridge site.
With the blue facing down and with the sticker facing you, insert the yellow cartridge into the autoinjector. It should slip in very easily.
Close and remove the blue cap.
Hold the autoinjector like a joystick and press it firmly onto your skin at a 90 degree angle. The autoinjector will chime when ready.
Press the button. The time it takes to deliver the medication will differ. The injection is complete when you hear the second chime.

What to do after the injection

Lift the autoinjector up from skin.
The autoinjector will open and release the cartridge.
Place the cartridge into a sharps container
- If you do not have a sharps container available, contact your pharmacy/doctor’s office about obtaining one
  - In the meantime, you may use an old coffee container with a lid
- Some hospitals take full Sharps Containers for disposal. Here at the office we do not. Contact your pharmacy for more information about the disposing of your Sharps Container.
Discard remaining materials in the trash (cap, alcohol swabs, etc.)

Need more information?

Please follow the link to connect with the manufacturer’s website.

If you have any concerns about your medication (e.g., excessive pain, swelling, redness bruising, bleeding, fever, breathing problems), please contact your rheumatologist.

Medical Disclaimer

Diseases and Conditions When to see a rheumatologist

I have a positive HLA-B27 what does it mean?

June 5, 2018

During the course of a workup for possible autoimmune arthritis or autoimmune back disease, your rheumatologist may order something called a HLA-B27 test. So what does a positive HLA-B27 mean?

HLA-B27 antigen

HLA-B27 is a genetic test. The majority of people who have a positive HLA-B27 are perfectly healthy. HOWEVER, having a positive HLA-B7 can put you at increased risk of developing what we call spondyloarthritis-associated diseases. This is a family of autoimmune diseases.

Spondyloarthritis-associated diseases

Ankylosing spondylitis (AS), now called axial spondylitis
Peripheral spondyloarthritis
Reactive arthritis
Psoriasis
Psoriatic arthritis
Uveitis
Crohn’s disease
Ulcerative colitis

I have a positive HLA-B27, what does it mean?

The answer to this question highly depends on your situation. As I mentioned earlier, many people who have a positive HLA-B27 are perfectly healthy. More specifically, the majority of these people do NOT have an autoimmune disease. Here are a few stats to put things into perspective.

About 6 to 9 % of Caucasians and 3 % of African-Americans have a positive HLA-B27.
However, having a positive HLA-B27 increases a person’s risk of ankylosing spondylitis by 50 to 100 times.
But only 2 % of people who have a positive HLA-B27 go on to develop ankylosing spondylitis.
About 50% of people with psoriatic arthritis that involves the spine have a positive HLA-B27.
60% of people diagnosed with reactive arthritis have a positive HLA-B27. These people tend to have more severe symptoms, non-joint symptoms (e.g., uveitis), and it tends to last longer.
In the West, 50% of cases of anterior uveitis is associated with a positive HLA-B27 and about half of these people will develop spondyloarthritis.

I was diagnosed with AS, should I have my kids tested?

Technically not unless a family member is experiencing symptoms suggestive of ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, or any other spondyloarthritis-associated disease. Remember, only 2% of people with a positive HLA-B27 go on to develop ankylosing spondylitis, which is the main autoimmune disease associated with this test.

However, people who have a positive HLA-B27 AND have a first-degree relative with ankylosing spondylitis have a 15% to 20% risk of developing the disease at some point during their lifetime.

I guess the answer whether to or whether not to test your kids really is a matter of choice. My opinion is, if it’s going to happen it’s going to happen. All we really can do is try to make healthy life choices like eating clean, staying active, reduce stress, and making sure we sleep enough. Remember the Blue Zones Principles?

For some people, knowing they tested positive for HLA-B27 may increase their stress level and for others not knowing whether they test positive or not may be more harmful. Whatever decision you make is highly personal.

In summary

Why having a HLA-B27 increases risk of having ankylosing spondylitis as well as a host of different autoimmune diseases is still uncertain: arthrogenic peptide hypothesis, molecular mimicry, free heavy chain hypothesis, and unfolded protein hypothesis. These are very complex concepts, which I will hold off on discussing further.

If you want to learn more about HLA-B27 and spondyloarthritis, I invite you to read the following articles: What is autoimmune back pain? Guide to living with psoriatic arthritis: part 1, and What is autoimmune joint pain?

If you think you may be suffering from a spondyloarthritis-associated condition, I encourage you to get in touch with your local rheumatologist. Here is a link to the American College of Rheumatology physician directory.

Medical Disclaimer

References

Rheumatology Secrets, 3^rd edition

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