Methotrexate Injections for Rheumatoid Arthritis, part 2: Needles

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Why methotrexate injections?

Methotrexate is the most widely used treatment for Rheumatoid Arthritis. Almost every Rheumatoid Arthritis patient will be prescribed methotrexate at some point. Doctors are thankful to have something they can prescribe that works well for most patients with fewer serious or irreversible side effects than the older disease treatments. Methotrexate is a big topic and there is much more about it on the Methotrexate and RA section of this website.

Methotrexate can be administered by tablets, but injections are the first choice of many doctors. When methotrexate is injected, it bypasses the digestive system. There are two simple benefits to that: First, the patient may be spared some annoying intestinal side effects of methotrexate tablets. Second, the methotrexate dose is more potent since none of it is lost during digestion. All of the medicine is more directly available, so it can be more effective.

Does size matter with methotrexate injection needles?

If a patient is prescribed injectable methotrexate, she will eventually face the needle question. What is the “right” needle for injecting methotrexate? It’s more confusing than which topping to pick at Cold Stone Creamery. And a lot less fun.

Last year, I was watching a video from Johns Hopkins Universityabout methotrexate injections. What a surprise when I heard the nurse describe the tiny needle used to inject methotrexate subcutaneously (into the fat layer under the skin). All of the rheumatologists that I had met had advocated an intramuscular injection (into the thigh or hip muscle) with a larger needle for better absorption. This is pretty confusing for patients.

Determined to find an answer, I pressed my new doctor and a couple of pharmacists for their best recommendations. They agreed that injecting into the muscle is slightly better, but not critically important. It seemed like the most important thing is that the patient is comfortable enough that the injection actually gets done.

My needle solution for methotrexate injections

I had an idea for making the injection process more comfortable and I found a pharmacist who helped me put together a new best-of-both-worlds plan. Here is my new method for injecting methotrexate.

I got smaller needle tips that will fit onto the larger syringe since they are the same brand. First, I use the larger 3 mL syringe with a 25 gauge tip to draw the methotrexate out of the bottle. Then, I replace the cap on the needle. Next, I twist off the “sharp” and drop it into my used sharps disposal container. That tip is now dulled from piercing the bottle top. Finally, I attach the smaller fresh tip and do my injection.

For me, this has made a significant difference in comfort. The larger 3mL syringe is easier for my RA hands to manipulate. I can easily inject into a relaxed thigh muscle and not even feel it with the smaller fresh tip. I dread my injection less.

Note: This workaround helps me. It is always good to ask your personal doctor or nurse what is recommended for you. Click here to read Methotrexate Injections for Rheumatoid Arthritis, part 1.

Postblog: One small study comparing subcutaneous injections with intramuscular injections of methotrexate found no difference in serum levels.

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Kelly Young. All rights reserved.

This entry was posted on Tuesday, May 11th, 2010 at 7:09 am and is filed under RA Education. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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