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Overcoming the Fear of Self-Injections for Rheumatoid Arthritis

Posted on May 03, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Joan Grossman

  • Self-injection is a safe and convenient way to take some biologic drugs.
  • Understanding how to properly self-inject can help you overcome fears.
  • Your health care provider can train you to self-inject with confidence.

Many biologic drugs used in the treatment of rheumatoid arthritis (RA) can be conveniently self-injected at home. It’s common for people with RA to feel nervous about this method initially. Self-injection is a topic of discussion on myRAteam, where members share their experiences, along with their fears. Many members are eager to learn more about self-injection.

A fear of needles is a common reason people with RA are apprehensive about self-injection. “I am starting my biologic injection tonight. I’m very nervous!” a myRAteam member wrote. “I have a terrible fear of needles.” But after trying self-injections, she wrote, “I did great. It’s not scary at all 😊😊.”

“I’m changing from infusions to self-injections. I'll be giving myself the first one this Friday. I've got to be honest, I'm nervous. I've never given myself an injection,” one member said. “Any tips from anybody that gives themselves injections would be welcome.”

“I’m feeling anxious about biologics and self-injection. Positive experiences would be appreciated!!” another member wrote. “Self-injection was scary at first, but it was much easier than I thought,” replied a member. “A little pinch and done. Don't be surprised by a bruise or red mark where you do the injection.”

Not every biologic can be self-injected, but when appropriate, self-injection is a popular alternative to receiving injections in a clinical setting. While it’s common to be wary of self-injections, they can help reduce doctor visits and provide more self-sufficiency with managing treatment. Many people with rheumatoid arthritis prefer the flexibility and comfort of having a self-injection at home.

“Self-injection is the best. You feel absolutely nothing!!! Love it! All should be so easy,” a myRAteam member expressed.

Understanding how self-injection works may help you gain confidence and overcome fears you may have about trying it.

Why Do You Have To Inject?

Biologic drugs are taken by injection because they contain large molecules that cannot be properly absorbed in the digestive system if taken orally.

Biologics have transformed the treatment of autoimmune diseases like rheumatoid arthritis in recent decades, and can significantly reduce symptoms, slow the progress of the disease, and improve quality of life. These drugs target proteins in the immune system that tend to overreact in people with RA, causing painful swelling and stiffness in joints. Chronic inflammation in joints can lead to lasting damage and deformation.

Biologic drugs that are commonly used for the treatment of rheumatoid arthritis include Cimzia (certolizumab pegol), Enbrel (etanercept), Humira (adalimumab), and Remicade (infliximab). These are some of the many biologics that are a treatment option for at-home use.

Different Types of Self-Injection

There are three main types of self-injection for administering biologic drugs at home: prefilled syringes, self-injection pens, and e-devices. Depending on your particular condition, one method may be preferable to another. Talk to your doctor about the advantages or disadvantages of each self-injection method to find an option that works best for you.

Prefilled Syringe

A prefilled syringe is a syringe and needle that comes filled with the correct dose of a drug. The syringe is administered manually, in the way that many shots are typically taken. Prefilled syringes allow you to manually control the speed of the injection. However, self-injection with a prefilled syringe can be hard for people with rheumatoid arthritis, who may have reduced function and mobility in their hands.

Self-Injection Pen

A self-injection pen, also called an auto-injector, is prefilled with the appropriate dose of a drug. Auto-injectors have a hidden spring-loaded needle, which is released by pressing a button when the device is held against the skin. Some people find self-injection pens easier to use than manual prefilled syringes, but they may cause more swelling, bruising, or pain at the injection site.

E-Devices

E-devices are reusable auto-injectors with enhanced technology. E-devices can have a range of functions, such as control over the speed of injection, internal injection logging that maintains a record of treatment with the device, and sensors that prevent injection unless the device has proper contact with the skin. Some people may find e-devices too complicated and prefer a simpler form of injection.

Proper Training for Self-Injection

Talk to your health care provider about having your first self-injection at your doctor’s office, where you can be supervised by a clinician. With your first self-injection you may have questions about how to administer the injection properly. Your health care provider can also talk to you about how best to store syringes or self-injectors, which require refrigeration.

One study of 79 participants with autoimmune diseases, including RA, found that people who received training on the self-injection process with the drug Cimzia had improved confidence and treatment experiences. Training was found to build confidence among people with limited dexterity and help people reduce fears associated with the use of needles.

Tips for Self-Injection

Always follow medical advice from your health care providers on self-injections. The following tips can help make your injection experience easier.

Prepare

Before injecting, prepare a clean, uncluttered area. Wash your hands and have an alcohol wipe handy to clean the injection site. Some people like to have a family member or friend with them, especially when first using self-injection.

Cold, refrigerated medication may be uncomfortable when injected. Some syringes and auto-injectors can be removed from the refrigerator for an hour or two before using. Some syringes and auto-injectors can be warmed in your hands before use. Be sure to check with your doctor first about specific protocols for your particular medication.

Choose the Right Site for Injection

Self-injections are typically administered to the arms, abdomen, or thighs. Many people find the thigh to be a site that is both easy to reach and the least sensitive. Talk to your doctor about rotating through various injection sites to avoid any one site becoming sore over time or building up scar tissue.

One myRAteam member shared her tips. “A couple tricks I've learned just from experience: let the alcohol dry completely before injecting,” she said. “And jab that needle in really quickly. Also, location. Use the upper, outer thigh, the meatiest part of it.”

Ice the Injection Site

An ice pack or ice cube can be used to numb the injection site before and after self-injecting to reduce any pain or swelling. Pinching the skin around the injection site before and during the injection is also recommended.

“I've given myself injections both with syringes and with auto-injectors,” a member wrote. "If you ice the area first, it really isn't as bad as you think it's going to be. Sometimes it's easier if you have someone to help.”

Possible Self-Injection Side Effects

An injection may cause side effects at the site of the injection, whether it is administered by a clinician or self-injected. Common side effects include pain, redness, itching, or swelling, and these reactions may stop after a few injections. Discuss any injection site reactions you experience with your health care team.

Treatment with biologic drugs may also cause side effects from the medication itself. Nausea, flushing, or headaches are common side effects from biologics. Your health care team can explain potential side effects associated with self-injecting a biologic drug.

If you experience an allergic reaction to a self-injection with symptoms such as shortness of breath, itchy eyes, a full-body rash, fever, or chills, contact your doctor immediately.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 147,000 members come together to ask questions, give advice, and share their stories with those who understand life with rheumatoid arthritis.

Are you nervous about self-injection? Do you have questions about it? Share your thoughts in the comments below, or start a conversation with others on myRAteam.

References

  1. Biologics — Arthritis Foundation
  2. Recent Advances in the Oral Delivery of Biologics — The Pharmaceutical Journal
  3. The Use of Biologics in Rheumatoid Arthritis: Current and Emerging Paradigms of Care — Clinical Therapeutics
  4. Rheumatoid Arthritis Treatment — Johns Hopkins Arthritis Center
  5. A Portfolio of Biologic Self-injection Devices in Rheumatology: How Patient Involvement in Device Design Can Improve Treatment Experience — Drug Delivery
  6. Patient Satisfaction With CIMZIA ® (Certolizumab Pegol) AutoClicks ® in the UK — Advances in Therapy
  7. Correct Performance of Subcutaneous Injections in Plaque Psoriasis: Comparison of Trained and Untrained Patients With Different Application Systems in Routine Clinical Care — Journal of Dermatological Treatment
  8. Self-Injection Education Improves Patient Confidence, Satisfaction — Dermatology Times
  9. The Patient’s Guide to Psoriasis Treatment. Part 3: Biologic Injectables — Dermatology and Therapy
  10. How To Give Yourself Biologic Injections: Tips From Patients and Doctors — CreakyJoints
  11. Subcutaneous Injection of Drugs: Literature Review of Factors Influencing Pain Sensation at the Injection Site — Advances in Therapy
  12. Injection Site Reactions With the Use of Biological Agents — Dermatologic Therapy
  13. Side Effects of Biologic Medications — Johns Hopkins Arthritis Center
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

A myRAteam Member said:

I inject my own Methotrexate every week. No big deal.

posted 3 days ago

hug

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