Diseases and Conditions Self-Injection Videos

How to inject Humira, Enbrel, Simponi, and Cimzia

August 28, 2017

Humira®, Enbrel ®, Simponi ®, and Cimzia ® are medications commonly prescribed for rheumatoid arthritis, psoriatic arthritis, psoriasis, and ankylosing spondylitis. All of these come in self-injectable pens or pre-filled syringes. You will be asked to inject these yourself or by a love one, in the comfort of your home. Today, we’re going to go over how to inject these self-injectable medications.

Preparing for your injection

Keep your medication stored in the refrigerator until use
- Before injecting medication, take the autoinjector 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

The injection

Take off the white cap, 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
Press down firmly on the clean area of skin, so that the pen is flush with the skin (90-degree angle).
- The pen needle will not eject unless pressed firmly to skin

For Cimzia® and other medications that come in prefilled syringes

Pinch the skin around the injection site and insert the needle at a 45-degree angle

Press in the plunger slowly

You may notice the plunger is hard to press this is due to the size of the medication, be sure to continue to inject slowly to administer all medication

Press button to inject the medication.
- You may feel a slight pinch as the needle enters your skin, and tingling as the medication is administered
- If you have trouble pressing the button try lifting the pen off your skin, and repressing the pen firmly to the area
Hold for 15 seconds.
- Window will become colored (yellow) but continue to hold dose for at least 15 seconds to ensure that all medication is administered

What to do after the injection

Lift the pen up from skin and place the whole pen into the 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.)

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

For more information

Jessica Farrell, PharmD. Clinical Pharmacist, The Center for Rheumatology/Associate Professor, Albany College of Pharmacy and Health Sciences

With the help of Autumn Koniowka. Doctor of Pharmacy Candidate Class of 2018, Albany College of Pharmacy and Health Sciences, and Megan Phillips. Doctor of Pharmacy Candidate Class of 2018, Albany College of Pharmacy and Health Sciences.

A special thanks to Tammy Garren, PhD. Instructional Designer, Center for Innovative Learning, Albany College of Pharmacy and Health Sciences.

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.

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Diseases and Conditions When to see a rheumatologist

What is autoimmune back pain?

December 26, 2016

Let’s face it, back pain is terrible and unfortunately for us, very common. According to the 2016 Global Burden of Disease Study, low back pain is the number one cause for disability globally.

So we know back pain is common and debilitating, but the question is, what is the difference between regular and autoimmune back pain?

There are two broad categories: mechanical back pain and inflammatory or autoimmune back pain. Many but not all autoimmune diseases cause back pain. For example, rheumatoid arthritis usually does not cause back pain. Sometimes these disease are very difficult to diagnosis because they progress very slowly. Often times it takes years to decades to diagnose. Yes you heard me, DECADES. Unfortunately, if left untreated, it can cause irreversible spinal damage: joint erosions and spinal fusion also known as ankylosis. Prompt treatment with a disease modifying anti-rheumatic agent (DMARD) often can slowdown or prevent joint damage.

Autoimmune back pain

As I was mentioning before, mechanical and autoimmune back pain are completely different. Mechanical back usually improves with rest, worsens with strenuous activity, and usually begins later in life. People that have autoimmune back pain experience the opposite. Here are some of the key features.

Usually pain starts during the 2^nd or 3^rd decade of life. People usually experience symptoms before the age of 45
Onset is gradual for the most part
Symptoms have been ongoing for more than 3 months
Exercise improves the pain
Rest really doesn’t help. The pain usually worsens with rest
Anti-inflammatory medications like naproxen or ibuprofen helps the pain
Pain wakes you up during the second half of the night
Pain and prolonged stiffness in the morning. Typically, stiffness lasts more than one hour
Alternating deep buttock pain

Risk factors

Autoimmune disease rarely occur in isolation. The following are some of the risk factors pointing towards a diagnosis of autoimmune back pain.

Personal history of uveitis. This is a type of inflammatory condition that affects the eye.
A personal history of psoriasis.
Having a history of dactylitis in your finger or your toes, aka “sausage digitis”.
History of inflammatory arthritis: redness, swelling, and stiffness in any joint
Any first degree relative with any spondyloarthritis (SpA)-associated condition? This means mom, dad, siblings, or your children. SpA-associated conditions include:
- Axial spondylitis also known as ankylosing spondylitis
- Psoriasis
- Psoriatic arthritis
- Reactive arthritis
- Crohn’s disease
- Ulcerative colitis

If you think you could be suffering from autoimmune back pain, please seek your local rheumatologist. But do not jump to conclusions. There are many other diseases that can mimic inflammatory back pain that are not autoimmune in nature.

References

Vos T, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1545-1602.

Sieper J, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009 Jun; Suppl 2:ii1-44.

http://www.asas-group.org/publications/ASAS-handbook.pdf

Medical Disclaimer

Diseases and Conditions When to see a rheumatologist

Signs you may be suffering from autoimmune joint pain

December 5, 2016

Pretty much everyone at some point in their lives is going to experience some form of joint pain. But when does joint pain become more than just your typical, “I over did it” joint pain? When does it become, “I think there is something really wrong” type of joint pain? Is this joint pain caused by an autoimmune disease?

Here are a few typical scenarios.

Scenario #1

Mr. B is a 65-year-old man who presents to clinic with bilateral knee pain. He first noticed the pain a few years ago. He used to take some over-the-counter ibuprofen when it got real bad and that used to relieve the pain. Over the past few months he has noticed worsening. His left knee sometimes swells up. The ibuprofen isn’t really cutting it anymore. He tells me that the pain is worse after particularly active days. When he sits down he feels pretty good but when he stands up, he feels pretty stiff but generally loosens up after a few steps. He used to work construction and played football in college.

Scenario #2

Mrs. M is a 53-year-old woman who comes to the clinic for joint pain. About 3 months ago, she noticed that she was having a lot of difficulty removing her rings. She really didn’t pay much attention to it. She told herself, “I must be eating too much salt”, “I must be getting old”. Over the course of the next few weeks she began developing pain and swelling involving her knuckles. The pain is particularly worse first thing in the morning and sometimes wakes her up in the middle of night at times. She also states, “My hands feel like a claw in the morning”. The stiffness last well over one hour in the morning and typically, by noon she’s as good as she is going to be for the rest of the day. She’s tried ibuprofen, naproxen, and acetaminophen but nothing seems to work. She also remarks that her hot flashes have gone completely out of control recently.

Sounds familiar?

Inflammatory vs. Non-inflammatory joint pain

In scenario #1, we have a man presenting with non-inflammatory joint pain. This is your common wear and tear arthritis or osteoarthritis. It can involve pretty much any joint you can think of. What is important to note, is that it tends to progress slowly over time. The joint pain tends to worsen with increasing activity and it typically responds, although maybe not completely, to over-the-counter anti-inflammatory medications. Usually there is no joint swelling, but when it comes to the knees, swelling often does occur. A phenomenon called “gelling” can also occur with osteoarthritis. This occurs when the joint has been in a resting position for a while and then becomes active. The joint stiffens up or gels, but then loosens up pretty quickly.

In scenario #2, we have a woman presenting with joint pain that develops over the course of 3 months, or what we call a subacute presentation. She’s experiencing joint swelling involving small joints and it’s associated with prolonged morning stiffness. What I mean by prolonged is over one hour. Her symptoms also are worse in the morning. She also experiences constitutional symptoms, i.e., hot flashes. These are all hallmarks of inflammatory joint pain. There are MANY different autoimmune diseases that present with inflammatory joint pain and they all have their own particular flavor. Some like the knuckles, some like the ankles, some like the knees, some have a symmetrical distribution, and some are simply just random. But they all share these specific key characteristics. Rheumatoid arthritis and psoriatic arthritis are two common types. Please follow the links to learn more about these.

Another important note about autoimmune joint pain. It doesn’t go away. This is very important. There are A LOT of different things that can cause a joint to swell, but most of them get better with time. When it doesn’t, then you have to start wondering.

Summary

Why is this important?

So why should you care? Well, first, walking around with swollen joints isn’t exactly the most pleasant thing in the world. It turns out that it isn’t exactly healthy for your joints either. Autoimmune joint disease at times can cause permanent joint damage and it can happen in as little as 3 months.