Methotrexate Injection

Methotrexate Injection

Methotrexate Injection

Why injection?                                                                                                                                            To avoid side effects or to have more of the medication absorbed by the body.

  • There is 25 mg/ml of medication
  • The syringe is either tuberculin or insulin
  • Both have a one ml capacity
  • Both have very thin needles

Have all your supplies ready

  • Vial of methotrexate, syringe, alcohol swab.
  • Also access to your upper belly or outer thigh.

It’s easy as this

  1. Wipe off top of vial with alcohol
  2. Remove covers on syringe
  3. Draw back on the syringe to add about .5 ml of air
  4. Insert needle of syringe into vial
  5. Push in the air(avoids med leaks)
  6. withdraw the correct dose of your medication( mine is 25 mg or 1 ml so I withdraw up to the 1 ml mark). Tap out the air bubbles.
  7. Pinch a bit of your skin, belly or outer leg
  8. Wipe with alcohol swab
  9. Insert the needle(think dart)
  10. Push plunger to empty
  11. withdraw needle
  12. Wipe skin if any leaks.
  • There are no blood vessels in these particular areas that you need to be concerned with.
  •  Put your vial back in its box to protect the medicine from the light.
  • Put your used supplies (syringe, DO NOT RECAP THE NEEDLE, and alcohol wipes) into the sharps container
  • This is awkward at first(new skill) but you will become expert after two or three administrations.

what website has the best RA info

RA Just sayin

 

Maneuvering the tangled jungle of internet information can be extremely frustrating. There is a lot of misleading information by reputable sites.  A lot of information is summarized and then vaguely  jumps to  faulty assumptions.  All this adds to our confusion.

 

Reputable resources may vaguely summarize information for patient information sheets.

The American College of Rheumatology is a good  resource for general information about  RA.  However, patient information sheets are generalized and vague.  I wonder if the science writers think we are too dumb to get the real stuff.  A lot of our confusion about RA stems from getting peace meal information that is vague.  Rheumatologists actually do use the 2010 Rheumatoid Arthritis Classification Criteria to assist diagnosis.  Why don’t they tell us about it?  It sounds pretty black and white to me.  PubMed comments on the criteria show how the new criteria is the game changer tool to diagnose RA. The classification tree of the 2010 Rheumatoid Arthritis Classification Criteria is worth checking out.

Johns Hopkins Arthritis Center is a respected source of Rheumatoid Arthritis information.  Check out their patient information site.  It is clear and helpful. The site’s explanation of what is happening to the body with RA is well thought out.

Be careful of pharmaceutical companies posing as RA info sites. Their information may be grossly slanted to support their company interests.

The Arthritis Foundation has some good information but it is a busy site and  may be misleading to someone new to RA.  Check out their site.

Here were just a few thoughts on why we can be left more confused than ever after cruising the web. It’s not because we are just too dumb to understand these things. It is because we are being fed vague information. The clear info is available.  We just have to be more discriminating on what information we are willing to accept.

 

Rheumatoid arthritis progression attitude

RA Just sayinRheumatoid arthritis sticks to me like glue.  Severe.  Persistent. Progressing.    OMG!    I have a tough one.  But then, so do many, many others.  I am alive.  I am grateful.

Life is good.  Every minute of life is a gift.  Believe it or not, the biggest joys in our life happen in our everyday life.  Stop and think about it.  What are the five best moments you have had this week?

Remember, this week your life is ticking by.  Life is now and a daily experience. Love it.

Life has changed dramatically for me.  My pace is about 20% of what it was.    Am I sad.    Not.     Probably  because I am spending  my time  managing my day.  I’m living today.

A lot of the maneuvering is  about energy and pain control.  So life is about balance.  A little of this and a little of that.  Breaking time into chunks. Working on re-potting plants. Then reading a good book or writing articles for a while.  Lucky for me I can do many of the things I love.

When I have lunch with a friend, I always have a great time.  I keep my adventures out of the house to a few hours to avoid severe fatigue.  It helps to set limits.

I love getting letters from friends, especially my granddaughter. I love a good cup of coffee first thing in the morning. I love to journal. I love to see the lovely blend of colors in my weekly flower bouquet. I am thrilled when Baldacci or Preston and Child come out with a new mystery. I love online jigsaw puzzles.  I love movie night with my son.  I love the New Mexico air.  Lots to keep me happy.

I could be mad, depressed and discouraged.  I am not.  Life is too short.  I am human. That means I am  resilient,  creative and joyful.  Just what I’m talkin about!

 

 

 

RA Drugs-Methotrexate

I take my 10 little pills of methotrexate on Sunday afternoon.  I put the ten 2.5 mg tablets in a little white bowl.  I take them over a 4-5 hour period.  My little ritual makes a major difference.  I have no nausea from the medication.

My first dose was 2/17/2013.  It was 10 mg.  My dose was increased gradually to 25 mg on 4/28/2013.  Nausea is the most common side effect.  I did have some initially  but as long as I followed my ritual,  I was fine.  Additionally,  for the first year I was  tired on the day following the dose.

Low dose methotrexate has been the drug of choice for the treatment of Rheumatoid Arthritis for 30 years.  It is safe and generally well tolerated.   It is a DMARD, disease-modifying anti-rheumatic drug.  It helps with pain and swelling.  It slows the progression of RA over time.

Methotrexate was one of the first products of ” intelligent drug design”.  It was introduced as a treatment for cancer in the 40’s.  It was introduced to treat RA in the 70’s and 80’s.  The treatment pathway of methotrexate is different for RA than it is for cancer.

Methotrexate is frequently used in combination with other DMARD’s and is quite effective when used with the biologics.

I take Folic Acid as a prescription dose daily.  Folic acid helps avoid side effects of methotrexate. I have regular labs that measure blood values, liver and kidney function.  I have normal function.  In the USA it is recommended that a person on methotrexate  abstain from alcoholic beverages. I do. It was tough giving up the glass of wine while cooking dinner. I am fine with it and I still enjoy cooking dinner.

Methotrexate is on the World Health Organization’s List of Essential Medicines, a list of the most important medications needed in a basic health system.

For further reading:                                                                                                                                         Methotrexate(Rheumatrex, Trexall), American College of Rheumatology

Old Drugs Can Learn New Tricks, Methotrexate and its mechanism of action,  Bruce N. Cronstein, MD, The Rheumatologist, November, 2011

How the docs diagnose RA

Going up- Going down RA at it's finest.

Going up- Going down
RA at it’s finest.

The course of RA is unique to each of us.  My RA announced itself  to me as  big and boisterous.  Initially, I had sharp pain in my left shoulder.  I thought it was from swimming as shoulders do get a workout in lap swimming.  Quickly hands, fingers, wrists, ankles, feet and toes joined in.  I was in total pain and largely incapacitated.  I sought salvation to my problem in the ER, the only solution at the time.

In 2010 the American College of Rheumatology(ACR) and the European League Against Rheumatism(EULAR) formed a working group to replace the 1987 ACR classification criteria for RA with up to date classification criteria.

RA is at its most destructive in the first 2 years.  It needs to be caught early and treated aggressively.  The 2010 Rheumatoid Arthritis Classification Criteria became a big diagnostic help.

The group came up with a 10 point system that covers four RA categories:  joint involvement, serology, acute-phase reactants, duration of symptoms.  The target population for this scoring must be patients who have at least 1 joint with definite clinical synovitis(swelling) that cannot be explained by another disease.

There could be a total of 10 points. 6 points would confirm the RA diagnosis.

A.    Joint involvement                                                                                  Points

1.  One large joint                                                                                       0                                                    2.  2-10 large joints                                                                                     1                                                   3.  1-3 small joints                                                                                       2                                                  4.  4-10 small joints                                                                                     3                                                  5.  > 10 joints( at least one small joint)                                                    5

B.  Serology

1.  Negative RF and negative  ACPA                                                            0                                               2.  Low positive RF or low positive ACPA                                                    2                                               3.  High positive RF or high positive ACPA                                                 3

C.  Acute-phase reactants

1. Normal CRP and normal ESR                                                                    0                                              2. Abnormal CRP or abnormal ESR                                                              1

D.  Duration of symptoms

1.     < 6 weeks                                                                                                  0                                             2.     > 6 weeks                                                                                                  1

My score

A   Many more than 10 small joints                                                                      5

B    Serology negative                                                                                               0

C.   Acute-phase reactants off the charts both ESR and CRP                             1

D.  Duration of symptoms > 6 weeks                                                                      1

 

My score is 7 and a firm diagnosis for RA.  I met the greatest rheumatologist in the world within two weeks of my ER visit.  In another month I would have started the drug methotrexate.  Presently, I have full blown and seriously progressing RA. This 2010 criteria was right on for me.

For more information on it, Google it. An article that I like is:

2010 Rheumatoid Arthritis Classification Criteria, ARTHRITIS AND RHEUMATISM, Vol.62, No 9, September 2010, pp2569-2581. There is a long list of authors starting with Daniel Aletaha and ending with Frederick Wolfe and Gillian Hawker.

 

Susan

Sometimes it's the small things that are the most important.

Sometimes it’s the small things that are the most important.

I said goodby to Susan today.  She has  had a very interesting time of it.  Her life was full.  No one can ask for more.  I knew her for a brief period.  I was glad of it.  It was an important period in her life as well as in mine.

I met her at a cancer support group.  She was angry as she had recently learned of a serious metastasis.  I had had a whirlwind bout  with a diagnosis of RA and sequentially two cancers.  I was trying to process as well as she.

I saw her as the chemo failed and as she was denied her favorites of swimming and yoga.  I saw her as the last chemo drug failed.  She lost her anger and frustration.  She seemed to mellow.  Then she moved on.  She became engaged in planning her exit.

The last day in our breast cancer group, we made bracelets.  She gave me her’s.  She used red beads as I was wearing red that day.  We had our final hug.

She has been on my mind since.  Today was her memorial service.  It was amazingly wonderful.  I loved her and will miss her.  Today as I said goodby, I still had her with me.  She has her own special place in my heart.

 

Our humanity

Mary  JoI was almost to Barnes and Nobles, one of my favorite hangouts. I stopped as a very old, bent woman in a blue print dress with a cream sweater was slowly moving across the street to    Toys- R-Us.  She inched along with her walker and I marveled at the effort and determination it had taken for her to go through all the motions to dress, to ease into her car after laying the walker in the back seat and to arrive at her mission. She was amazing.

I see the same scene almost every day of someone working very, very had just to get a very simple task accomplished. There is something fundamental in our humanity that keeps us going through all the variations of hardships in our lives. It is a great quality we possess and it is to be celebrated.