Injections for Treating Psoriasis and Psoriatic Arthritis

Tips for Self-Injection to Treat These Conditions

Man Injecting himself.
ballyscanlon / Getty Images

Psoriasis and psoriatic arthritis are often treated with self-injectable drugs such as methotrexate and newer biologic drugs. Psoriasis injections work to temper the autoimmune response, clearing up psoriasis plaques and slowing the progression of the disease.

Though self-injections with psoriasis shots may seem daunting at first, compliance is, of course, key when it comes to ensuring a medication's effectiveness. The self-injection process can quickly become second nature with a little insight and practice.

This article discusses the different psoriasis injections on the market and how they work. It also provides step-by-step instructions for giving yourself psoriasis shots.

Types of Biologics

Biologics are medicines derived from human or animal proteins rather than those created in the lab. These drugs suppress facets of the immune response, rather than the immune system as a whole.

Biologics are prescribed to people with moderate to severe plaque psoriasis or psoriatic arthritis who have not responded to other treatments or who have experienced intolerable side effects from them. 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 psoriasis injections are given in areas where the skin can be pinched, such as the abdomen or thigh. Your healthcare provider will discuss which option is best for you.

If you are able to inject yourself, psoriasis shots may come to you as either a single-use prefilled syringe or a pen-like disposable auto-injector. (There are also powdered formulations in single-use vials. Because these require reconstitution with sterile water, they are generally reserved for use in a medical setting.)

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

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

Biologic Administration
Cimzia Subcutaneous injections every other week (psoriatic arthritis only)
Cosentyx Subcutaneous injections every four 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 eight 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 four weeks thereafter
Tremfya Subcutaneous injections every eight weeks (psoriasis only)

How to Self-Inject

The injection procedure is essentially the same whether you are given a prefilled syringe or auto-injector. The only difference is that a syringe has a plunger that you depress after the needle is inserted. With an auto-injector, the unit is placed against the skin and the needle automatically lowers after you press a button. (You don't actually see the needle when using the latter option.)

Note: Pre-filled syringes and auto-injectors need to be refrigerated at temperatures between 36 and 46 degrees F until used.

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 bandage, 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 the are to air dry.
  5. Uncap the needle. Hold the syringe in one 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 healthcare provider.)
  8. 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.
  9. Depress the plunger. If there is no blood in the syringe, slowly depress the plunger all the way down.
  10. Remove the needle. Hold the alcohol pad over the injection site. Do not rub.
  11. Bandage the skin, if needed.
  12. 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 covered garbage can.

To inject yourself with a disposable auto-injector:

  1. Follow instructions 1 through 4 above.
  2. Twist off the auto-injector cap. There will usually be an arrow to show you which direction to twist.
  3. Place the base of the auto-injector 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 above.

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.

Frequently Asked Questions

  • Can you get a steroid shot for psoriasis?

    Yes, corticosteroid shots are often used to treat psoriasis when topical steroid treatments aren't enough. Your healthcare provider will carefully inject a corticosteroid directly under the skin of your rash.

  • Can steroid injections make psoriasis worse?

    Not typically. Corticosteroids can help to stop the itching and clear up psoriasis plaques. The effects of corticosteroids last anywhere from a few weeks to a few months. Once the shot wears off, however, the rash may return.

  • What are the side effects of psoriasis shots?

    Side effects of psoriasis injections like methotrexate and other disease-modifying anti-rheumatic drugs (DMARDs) range from mild skin irritation at the injection site to more severe systemic reactions.

    Some people experience flu-like symptoms for a few days after the psoriasis shot. Fatigue is a common side effect of biologics and may last throughout the treatment. 

    Talk to your healthcare provider if you experience uncomfortable side effects from psoriasis injections. There are often other drugs to try that may not affect you in the same way. 

Sources
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By Lia Tremblay
Lisa Tremblay is an award-winning writer and editor, writing for magazines, websites, brochures, annual reports, and more for over 15 years.