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

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.

Recipes

Anti-Inflammatory Pistachio and Date Oatmeal

December 20, 2023

Living with autoimmune diseases such as lupus and rheumatoid arthritis can be challenging, especially when it comes to managing inflammation in the body. While medication plays a crucial role in treatment, diet can also have a significant impact on reducing inflammation. In this blog, we will share a recipe for an anti-inflammatory pistachio date oatmeal that is not only delicious but also packed with nutrients that can help alleviate symptoms and promote overall wellness. Whether you have an autoimmune disease or simply want to incorporate more anti-inflammatory foods into your diet, this recipe is a must-try! So, let’s dive in and discover the healing power of food.

Understanding the role of diet in managing autoimmune diseases

When it comes to managing autoimmune diseases like lupus and rheumatoid arthritis, it’s essential to understand the role that diet plays in promoting overall wellness and reducing inflammation in the body. While medication is crucial for controlling symptoms, incorporating a healthy and balanced diet can significantly support your body’s healing process.

Certain foods have been found to have anti-inflammatory properties, which can help alleviate symptoms and prevent flare-ups. By including these foods in your diet, you can support your immune system and reduce inflammation.

In addition to our recipe for an anti-inflammatory pistachio date oatmeal, here are some other foods that are beneficial for individuals with autoimmune diseases:

1. Fatty Fish: Salmon, mackerel, and sardines are rich in omega-3 fatty acids, which have been shown to reduce inflammation.

2. Leafy Greens: Spinach, kale, and Swiss chard are packed with antioxidants that help fight inflammation.

3. Turmeric: This spice contains curcumin, a compound known for its anti-inflammatory properties.

4. Berries: Blueberries, strawberries, and raspberries are high in antioxidants, which help reduce inflammation.

By incorporating these foods into your diet, you can support your body’s natural healing process and manage your autoimmune disease more effectively. Now, let’s move on to the recipe for our delicious and nutritious anti-inflammatory pistachio date oatmeal!

The power of pistachios and dates in reducing inflammation

Pistachios and dates are two powerful ingredients that can play a crucial role in reducing inflammation and managing autoimmune diseases like lupus and rheumatoid arthritis. Both of these ingredients are rich in nutrients and compounds that have been shown to have anti-inflammatory properties.

Pistachios, for example, are loaded with antioxidants, fiber, and healthy fats, which can help combat inflammation in the body. These nuts are particularly rich in a type of antioxidant called polyphenols, which have been linked to a lower risk of chronic diseases and reduced inflammation. Additionally, pistachios are a great source of magnesium, a mineral that has been shown to have anti-inflammatory effects.

Dates, on the other hand, are not only delicious but also incredibly nutritious. They are packed with vitamins, minerals, and fiber, all of which contribute to their anti-inflammatory benefits. Dates also contain antioxidants, such as flavonoids, which can help reduce inflammation and oxidative stress in the body.

When combined, pistachios and dates create a powerful duo that can enhance the anti-inflammatory properties of any recipe. In our next section, we will guide you through the simple and easy steps of creating a mouthwatering and nutritious anti-inflammatory pistachio date oatmeal that you can incorporate into your daily routine to support your overall well-being. Stay tuned!

Incorporating oats for added nutritional value

Incorporating oats into your anti-inflammatory pistachio date oatmeal not only adds a comforting and hearty element to your dish but also provides numerous nutritional benefits. Oats are a great source of soluble fiber, which has been shown to have anti-inflammatory effects and promote a healthy gut. This is especially important for those living with autoimmune diseases like lupus and rheumatoid arthritis, as gut health has been linked to the regulation of immune responses.

Oats also contain beta-glucan, a type of fiber that has been shown to help regulate inflammation in the body. Additionally, they are packed with vitamins, minerals, and antioxidants, further enhancing the nutritional profile of your oatmeal.

To incorporate oats into your pistachio date oatmeal, simply cook them according to the package instructions and then mix in the chopped pistachios and dates. This combination of nutrient-rich ingredients will not only make your breakfast delicious but also provide you with the nourishment your body needs to support its overall function.

In the next section, we will walk you through the final steps of preparing and enjoying your anti-inflammatory pistachio date oatmeal. Get ready to start your day off on a healthy and delicious note!

Stay tuned for the next section of our blog, where we will walk you through the step-by-step process of creating this delectable breakfast option that will leave you feeling satisfied and energized.

Step-by-step recipe for an anti-inflammatory pistachio date oatmeal

Now that you understand the benefits of incorporating oats into your anti-inflammatory pistachio date oatmeal, let’s move on to the final steps of preparing this nutritious and delicious dish.

Step 1: Gather your ingredients – For this recipe, you will need:

– 1 cup of oats

– 1 3/4 cups of almond milk

– 1/4 cup of chopped pistachios

– 1/2 cup of chopped dates

– 1/2 sliver of cinnamon ground to a powder consistency

– 1/4 cup of blueberries

– 1 Tbsp of honey

– Pinch of salt

Step 2: Cook the oats – In a saucepan, bring the almond milk to a boil. Add in the oats and reduce the heat to medium-low. Let the oats simmer for about 5 minutes, stirring occasionally, until they reach your desired consistency.

Step 3: Add the pistachios and dates – Once the oats are cooked, remove the saucepan from the heat. Stir in the chopped pistachios, dates, cinnamon, and blueberries ensuring they are evenly distributed throughout the oatmeal.

Step 4: Serve and enjoy – Spoon the pistachio date oatmeal into bowls and add your optional toppings, if desired. Take a moment to appreciate the comforting aroma and vibrant colors of your creation before diving in. With every spoonful, savor the delicious combination of flavors and textures that will nourish your body and support your overall health.

By incorporating this anti-inflammatory pistachio date oatmeal into your morning routine, you are not only starting your day off on a healthy note but also providing your body with the essential nutrients it needs to thrive. Stay tuned for more recipes and lifestyle tips to support your journey towards managing autoimmune diseases like lupus and rheumatoid arthritis.

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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When to see a rheumatologist

What Are The Early Signs Of Rheumatoid Arthritis?

October 30, 2019

What are the early signs of rheumatoid arthritis? Rheumatoid arthritis is one of the more common forms of autoimmune arthritis, affecting about 1% of the adult population. This may not seem quite common, but in the world of rheumatology this is actually quite common. Women tend to be affected more than men 2-3:1 and the disease tend to manifest between the ages of 40 – 60. However, it can also happen in young adults and older individuals. When it happens in children, we call it juvenile idiopathic arthritis.

Early Signs of Rheumatoid Arthritis

The following are some of the early signs of rheumatoid arthritis.

#1 Inflammatory joint pain

Most of us experience joint pain at some point in our lives. This is simply a part of being human. However, most of us experience non-inflammatory joint pain NOT inflammatory joint pain. Non-inflammatory joint pain typically worsens as the day progresses. There typically is no swelling, redness, or warmth. There can be stiffness but typically this last just a few minutes and certainly less than 30 min. Basically, things quickly get better as you get going.

People that suffer from rheumatoid arthritis present with inflammatory joint pain, which presents very differently.

Joint pain that is worse in the morning and improves as the day goes by.
There is joint swelling and usually they feel warm. At times they can look red.

People suffering from rheumatoid arthritis experience stiffness that usually lasts more than one hour.

#2 Involvement of knuckles, wrists, ankles, and toes

Although rheumatoid arthritis certainly affects larger joints, like the knees, hips, and shoulders, it tends to affect smaller joints like the knuckles, wrists, ankles, and toes.

#3 Symmetrical joint distribution

This is pretty self-explanatory. Rheumatoid arthritis inflames joints symmetrically. If the second knuckle on the right hand is inflamed, the second knuckle on the left hand most likely will be too. Maybe not as much, but inflamed nonetheless. However, it’s important to take this with a grain of salt, particularly early in disease.

#4 Fatigue

People often feel very tired, when they suffer from rheumatoid arthritis. I’m talking can’t make it through the day tired.

#5 Fevers

This often depends on how quickly symptoms emerge. Symptoms of rheumatoid arthritis usually develop over the course of months (55 – 65% of cases), but at times can develop over a few weeks (15 – 20%), and even days (10%). The quicker the onset, the more likely someone will experience low grade fevers. Some people, particularly those aged greater than 65 years, can present like polymyalgia rheumatica. These people often present with fevers as well.

What Are Some Other Symptoms of Rheumatoid Arthritis?

Rheumatoid arthritis is a very complex autoimmune disease that can affect many different organs. We discussed the 5 common early signs of the disease but the following are some other less common manifestations.

Cardiac

Pericarditis
Myocarditis
Coronary vasculitis

Dermatologic

Nodules
Skin vasculitis

Ocular

Scleritis
Episcleritis
Retinal nodules

Pulmonary

Pleuritis
Interstitial lung disease
Bronchiolitis obliterans
Lung nodules

Neuromuscular

Nerve entrapment – e.g., carpal tunnel syndrome
Neuropathy

Other

Severe dry eyes and dry mouth
Felty’s syndrome

What Are Some Of The Mimickers Of Rheumatoid Arthritis?

When faced with symptoms that look and sound like rheumatoid arthritis, it’s important to take a step back and consider alternative diagnoses. Some of these include:

Osteoarthritis
Psoriatic arthritis
Lupus
Gout and pseudogout
Polymyalgia rheumatica
Lyme arthritis
Sarcoidosis
Hepatitis C
Etc..

Next Steps

If you think you or one of your loved ones may be suffering from rheumatoid arthritis, I highly suggest you discuss your symptoms with your general practitioner or schedule as appointment with your local rheumatologist. Although, signs and symptoms are very important, a good history and physical examination in conjunction with specialized bloodwork and x-rays, are essential to either rule in rheumatoid arthritis and rule out other possibilities.

References

Rheumatology Secrets 3^rd edition

Medical Disclaimer

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

Journal Club Overcoming Inflammation

Does eating fish help treat rheumatoid arthritis?

March 27, 2018

Does eating fish help treat rheumatoid arthritis? This is the question we will try to answer in this edition of RheumDoctor Journal Club. Rheumatoid arthritis is a common autoimmune condition that affects about 1% of the population. This disease can cause joint pain, swelling, and stiffness, as well as inflammation throughout the body. Disease modifying antirheumatic agents (DMARDs) are the standard of care for the treatment of rheumatoid arthritis. These medications help slow and stop the progression of the disease. Some of these medications include methotrexate, hydroxychloroquine, sulfasalazine, as well as biologic medications such as etanercept, tofacitinib, tocilizumab, etc.

We know from research from the 80s, that omega-3 fatty acids also help to decrease rheumatoid arthritis inflammation. We learned from the studies that supplementation with 3 g of omega-3 fatty acids is effective in decreasing inflammation. However, the studies focused on supplementation, not the consumption of whole natural fish.[1] [2]

Relationship between fish consumption and disease activity in rheumatoid arthritis[3]

The objective of the study was to determine whether people who ate fish frequently tend to have lower rheumatoid arthritis disease activity. The researchers conducted a cross-sectional analysis from a large group of patients evaluating cardiovascular disease. Their outcome was the disease activity score known as the DAS28, as well as C-reactive protein (CRP). CRP measures inflammation throughout the body.

Patients completed a 120 item food questionnaire. Because we think long-chain fatty acids degrade when exposed to high heat, fried fish, non-fried shellfish, and fish in mixed dishes, the research did not count them. It could be boiled, steamed, baked, or eaten raw.

Results

176 people were included in the analysis. The majority of these people were middle-aged, college-educated white women, who are taking DMARDs and who were seropositive, and had rheumatoid arthritis for a long time.

19.9% of the people reported infrequent fish consumption (never to <1/month), 17.6% were frequent consumers (≥ 2 times/week). People who supplemented with fish oil were more likely to eat fish infrequently (20%). Interestingly, people who smoked cigarettes, were more likely to eat more fish

After adjusting for age and sex, people who consumed fish more than two times per week compared to those who ate fish infrequently, had lower disease activity scores and had lower CRP levels. Moreover, each additional serving of fish per week decreased both the disease activity score and the CRP. In a sensitivity analysis, the researchers found similar results after adjustments for biologic DMARDs and fish oil supplements. Further adjustment for smoking produced similar results.

What does this mean?

Simply put, eating fish two or more times per week may decrease rheumatoid arthritis activity as well as systemic inflammation. Although supplementing with fish oil also decreases inflammation in rheumatoid arthritis, there is something about eating fish as a whole natural food. One serving of fish almost certainly includes less than 5.5 g of omega-3 fatty acids given that an 8 ounce serving of fatty fish generally provides 2 to 4 g of omega-3 fatty acids. Whole natural fish has various macronutrients and micronutrients including omega-3 fatty acids that could be beneficial.

Then again, maybe people who regularly eat fish tend to have a healthier lifestyle. This could be the case, however, in this particular group, people who ate fish more regularly tended to smoke more. I think we can all agree that this isn’t the healthiest of lifestyle choices!

What we learned today

People who eat fish two more times per week compared to those who never eat fish or those who eat fish less than one time per month, tend to have lower rheumatoid arthritis, disease activity as well as systemic inflammation.

Eating non-fried fish on a regular basis is an important part of eating to beat rheumatoid arthritis.

Medical Disclaimer

References

[1] Kremer JM, Bigauoette J, Michalek AV, Timchalk MA, Linenger L, Rynes RI, Huyck C, Zieminski J, Bartholomew LE. effects of manipulation of dietary fatty acids on clinical manifestations of rheumatoid arthritis. Lancet. 1985 Jan 26;1(8422):184-7.

[2] Kremer JM, Lawrence DA, Petrillo GF, Litts LL, Mullaly PM, Rynes RI, Stocker RP, Parhami N, Greenstein NS, Fuchs BR, et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal anti-inflammatory drugs. Clinical and immune correlates. Arthritis Rheum. 1995 Aug;38(8):1107-14.

[3] Tedeschi SK, Bathon JM, Giles JT, Lin TC Yoshida K, Solomon DH. Relationship between fish consumption and disease activity in rheumatoid arthritis. Arthritis Care Res (Hoboken). 2018 Mar;70(3):327-332.

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