Self-Injection Tips for Psoriasis and Psoriatic Arthritis

Step-by-Step Guide to Injecting Biologic Drugs

Man Injecting himself.
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For mild cases of psoriasis, topical treatments like hydrocortisone cream may be all you need to control symptoms. Moderate to severe cases often require stronger drugs that temper the autoimmune response which drives the disease.

Some, like methotrexate and cyclosporine, are taken by mouth. Others require injections, namely the newer-generation biologic drugs that suppress facets of the immune response rather than the immune system as a whole. Because biologic drugs require injections or intravenous (IV) infusions, they are generally staged after methotrexate fails to provide relief.

If frequent injections are needed, you may need to learn how to inject yourself rather than going back and forth to the doctor. This may seem scary at first, but will a little insight and practice, the process will quickly become second nature.

Types of Biologics

Biologics are medicines derived from human or animal proteins rather than those created in the lab. Insulin used to treat diabetes is one such example.

Biologics are prescribed to people with moderate to severe plaque psoriasis or psoriatic arthritis who have not responded to other treatments or have experienced intolerable side effects. They can be used on their own or in combination with methotrexate or other drugs.

Among those most commonly used to treat psoriasis or psoriatic arthritis are:

Depending on the drug used, you may need an injection every one to 12 weeks.

Preparation

All of the biologics approved for the treatment of plaque psoriasis or psoriatic arthritis are delivered subcutaneously (under the skin). The one exception is Remicade which is delivered intravenously (into a vein) in an infusion center or similar medical facility.

Subcutaneous injections are given in areas where the skin can be pinched, such as the abdomen or thigh. Your doctor will discuss which option is best for you.

If you are able to inject yourself, the drug may come to you as either a single-use prefilled syringe or a pen-like disposable autoinjector. (There are also powdered formulations in single-use vials. Because these require reconstitution with sterile water, they are generally reserved for medical use rather than home use.)

Each biologic has different preparation and dosing instructions. Your rheumatologist will walk you through the steps, but you should read the packet instructions nevertheless to avoid mistakes or misunderstandings.

Here is an overview as to how each drug is delivered:

  • Cimzia: subcutaneous injections every other week (psoriatic arthritis only)
  • Cosentyx: subcutaneous injections every 4 weeks
  • Enbrel: subcutaneous injections twice weekly to start, once weekly thereafter
  • Humira: subcutaneous injections every other week (psoriasis only)
  • Ilumya: subcutaneous injections every 12 weeks (psoriasis only)
  • Orencia: subcutaneous injections once weekly (psoriatic arthritis only)
  • Remicade: IV infusions every 8 weeks
  • Simponi: subcutaneous injections once a month (psoriatic arthritis only)
  • Skyrizi: subcutaneous injections every 12 weeks (psoriatic arthritis only)
  • Stelara: subcutaneous injections every 12 weeks
  • Taltz: subcutaneous injections every other week to start, every 4 weeks thereafter
  • Tremfya: subcutaneous injections every 8 weeks (psoriasis only)

Prefilled syringes and autoinjectors need to be refrigerated at temperatures between 36ºF and 46ºF (2ºC to 8ºC) until used.

How to Self-Inject

The injection procedure is essentially the same whether you are given a prefilled syringe or autoinjector. The only difference is that a syringe had a plunger that you depress after the needle is inserted.

With an autoinjector, the unit is placed against the skin and the injection made with a button of the pen. As such, you don't actually see the needle.

To self-inject yourself with a prefilled syringe:

  1. Bring the drug to room temperature. Remove the syringe from the refrigerator 30 minutes beforehand. You can also warm it in your hand (but not the oven or microwave).
  2. Get your injection equipment ready. This includes an alcohol pad, some sterile gauze, an adhesive bandaid. and a child-proof trash container.
  3. Wash your hands. The injection must be aseptic, so use plenty of soap and warm water.
  4. Cleanse the skin with alcohol. Remove the alcohol pad from the packet and rub it over the injection site in a circular motion. Allow to air dry.
  5. Uncap the needle. Hold the syringe in the hand as would you would a pen and twist off the cap with your free hand.
  6. Pinch the skin at the injection site. Whether you choose your thigh or abdomen, pinch two inches of skin between your thumb and forefinger so that there is an ample target for the injection.
  7. Insert the needle. With a single quick thrust, insert the needle completely into the fold of skin at a 90-degree angle. If you do this quickly, you will feel little to no discomfort. (If you are overweight or obese, a 45-degree angle may be better. Speak with your doctor.)
  1. Pull back slightly on the syringe. If blood is drawn into the syringe, DO NOT proceed. You have accidentally hit a blood vessel and need to try again on another spot.
  2. Depress the plunger. If there is no blood in the syringe, slowly depress the plunger all the way down.
  3. Remove the needle. Hold the alcohol pad over the injection site. Do not rub.
  4. Bandage the skin, if needed.
  5. Dispose of the syringe and used injection equipment. Carefully cover the needle with the cap. For extra safety, place the syringe back into its original box or in a puncture-resistant container (like a milk carton) before disposing of it in a sealable garbage can.

To inject yourself with a disposable autoinjector:

  1. Follow instructions 1 through 4.
  2. Twist off the autoinjector cap. There will usually be an arrow to show you which direction to twist.
  3. Place the base of the autoinjector against your skin. The flattened base should be situated firmly and flatly against the injection site.
  4. Turn the lock ring to the unlock position. This may be clockwise or counterclockwise; check the arrows.
  5. Press the injection button. You should hear a loud click. This means the injection has begun.
  6. Listen for the second click. This means the injection is complete.
  7. Follow instructions 10 through 12.

To prevent fibrosis (scar tissue) at the injection site, change the location of each and every injection. It often helps to keep a log of your injections in a diary or calendar.

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