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For many people, injectable medications are a good option for treating psoriatic arthritis (PsA). These types of medications can help ease the symptoms of PsA and help prevent further disease progression and joint damage. Injection technology has improved a lot in the past few years, and there are now several different options to make injection easier.
Medications used for PsA include methotrexate, corticosteroids, and different types of biologic drugs.
Methotrexate — sold as Otrexup, Rasuvo, and Trexall — is a disease-modifying antirheumatic drug (DMARD) used to treat PsA and slow disease progression. Methotrexate is available in tablet form, but the injectable form may be more efficient and may prevent certain side effects from developing, such as nausea.
Methotrexate is available in vials, prefilled syringes, and autoinjectors.
Corticosteroids may be injected directly into an achy joint to help provide fast-acting but short-term relief from joint pain, swelling, and stiffness. Your health care provider will typically administer this injection.
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Many PsA flare-ups can be caused by excess levels of certain types of proteins called cytokines. These inflammatory cytokines include tumor necrosis factor-alpha (TNF-alpha) and the interleukins (ILs) IL-12, IL-17, and IL-23. Injectable biologic medications for PsA reduce inflammation by blocking the effects of these cytokines. Once injected, each of these medications targets a certain cytokine.
Another type of biologic medication for PsA is a T-cell inhibitor, which inhibits the formation of certain immune system cells that promote cytokine production.
The following TNF-alpha inhibitors are approved to treat PsA and are administered through subcutaneous injections:
The following IL inhibitors are approved to treat PsA and are administered through subcutaneous injections:
Orencia (abatacept), available in prefilled syringes and autofilled injectors, is approved to treat PsA and is administered through subcutaneous injection.
Many PsA medications are administered through subcutaneous injection. These medications are injected through a needle and into a layer of fat underneath the skin that is called subcutaneous fat. Injecting the medication into this layer of fat allows the body to absorb the medication slowly and gently.
Subcutaneous injections are usually administered into areas of the body that have wide layers of fat, such as the upper arm, the thigh, or the abdomen. You may be able to perform subcutaneous injections at home, or you can book an appointment with your health care provider to receive an in-office injection.
Most PsA medications have different dosing options such as prefilled syringes and autoinjectors, for giving yourself PsA injections. The prefilled syringe allows you to control the speed of the injection, while the autoinjector (which usually looks like a large pen) hides the needle and works with the click of a button. A few PsA medications are available in freestanding vials. Using vials allows you to fill your syringe but also requires more injection expertise.
PsA medication injections are different from infusions, which are administered directly into the veins (intravenously). Unlike injections, infusions require an IV bag and a visit to a doctor’s office or infusion center. PsA medications administered by infusion include Inflectra (infliximab-dyyb), Remicade (infliximab), and Simponi Aria (golimumab).
Your health care provider can train you how to use a prefilled syringe or autoinjector. In addition, many pharmaceutical companies provide detailed guides on how to self-administer injections for their PsA medications, including written instructions, online videos, or telehealth training sessions.
The injection technique depends on whether you use a syringe or an autoinjector. For either option, make sure to have everything you need before starting the injection process. These materials include:
Sharps containers are specially designed to keep used needles from injuring others. These containers are inexpensive and available from online sellers. Some pharmaceutical companies will provide a free sharps container along with your prescription. You can typically get rid of full sharps containers through your local pharmacy, doctor’s office, hospital, or your local hazardous waste site. Some sharps containers can be mailed to a collection site for a fee.
Avoid injecting medication into areas of the skin that are tender, bruised, red, hard or that are affected by psoriatic symptoms. Also, avoid injecting into scarred areas or stretch marks. The best areas of the body for subcutaneous injection are often the outer thighs (sometimes called the saddlebags), the abdomen, or the arm.
The abdomen can be a good option unless you’re very thin. For the abdomen, inject below your ribs and above your hips, and stay at least two inches away from your belly button.
If someone else is administering your injection, you may prefer the upper arm. Your helper should inject 3 inches above the elbow and three inches below the shoulder on the side or back of the arm. Don’t try to inject your own arm.
Before you inject, make sure the area that you need is sterile. Wash your hands and clean the area that you are going to inject with rubbing alcohol. Let the alcohol dry.
Avoid using the same area of the body every time. Inject at least 1.5 inches away from your last injection site. Keep a diary of injection sites so you can remember where your last injection was.
MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis. On MyPsoriasisTeam, more than 101,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and psoriatic arthritis.
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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.
Jessica Wolpert earned a B.A. in English from the University of Virginia and an MA in Literature and Medicine from King's College. Learn more about her here.
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