Most disease-modifying medications (DMARDs) like methotrexate, sulfasalazine and hydroxchloroquine take 8-12 weeks to be effective, particularly if they require a gradual dose increase. Some people notice an improvement earlier than this.
- I’m running low on my biologic medication; please can you tell me how to order more?
- I have not had my biologic drug delivery, who do I need to contact?
- Can I change the delivery address?
Please contact your homecare company:
Healthnet – 08000 833060
Alcura – 01064 433500
Sciensus (HC@H) – 03331 039499
If you have ongoing delivery problems and cannot solve this yourself with the company, please contact our advice line service.
All of your biologic drugs have use by dates on them and it is essential that you do not hold a stock of drug that goes out of date. It is not uncommon for patients to have to stop their planned dose of biologic drug ie: if you are taking antibiotics and we have found that patients were often building large quantities of drug in their fridge that would either go out of date or that they would be unable to use if we stopped their medication for health reasons. Once a drug is delivered to you, even if it is unopened it cannot be returned to the NHS for use elsewhere. Our monthly delivery therefore helps us limit drug and financial wastage
Your prescription is managed by the rheumatology team in conjunction with pharmacy and delivery company. The rheumatology nurses will renew your repeat prescription if you have attended your scheduled clinic appointments (face-face or virtual) and had any relevant bloods or tests that have been asked for.
If you do not attend your appointments, your prescription for biologic drugs will be stopped. You may need to phone the rheumatology team to discuss your repeat prescription.
If you get your prescription from your GP, please get in touch with them in good time to request extra medication for when you are on holiday if needed.
If we supply your medication, please contact us on our advice line for a travel letter if you are taking injections with you on a plane.
Keep your medication in your hand luggage if you are flying.
Ideally your medication schedule should not be interrupted as this increases the risk of your condition flaring.
People who regularly self-inject biologics drugs may continue while away, but ensure that refrigeration facilities are available.
Before you go, make sure you have sufficient supplies of your medication and 'sharps' bins for disposal of used syringes. Request a holiday letter from the delivery company or Rheumatology team to have with you when taking injectable medication through customs.
Currently research and patient presentation shows that you need to continue to take your biologic medication long term to maintain a good response.
If you are doing well on your biologic drug in some cases we can look at extending the gap between the doses of medication that you take ie: instead of taking it every 2 weeks you would take your medication every 3 weeks. The decision to do this though must be in discussion with your rheumatology team and will only be advised with certain patients. Generally, we would not look to do this within the 1st year of you taking your biologic drug.
Even if you think you did not receive all of the drug from the autoinjector DO NOT inject a 2nd dose of drug. Stick to your scheduled dosing and wait to take another dose of your drug at the time frame you are meant ie: in 2 weeks time.
We also advise patients to contact the healthcare team and they may ask for the “batch number” which can be found on the side of the autoinjector.
Some medicines used to treat your arthritis are processed by your liver, and when taken with alcohol can increase the risk of liver side-effects.
We recommend that you have no more than 10 units of alcohol a week
Complementary or herbal medicines may interact with prescribed drugs. If you wish to use these therapies, please discuss this with us at your appointment. For more information please visit https://
If you are vomiting and unable to keep food down, it is sensible to omit your rheumatology medication while symptoms persist. When things have settled, start taking your medication again: however, if symptoms come back, then the symptoms may be due to the treatment, please contact our advice line service.
If you are taking Methotrexate in tablet form, it may be possible to change this to the injectable preparation. This is given under the skin, bypassing the gastrointestinal system, so less likely to cause side-effects such as nausea, vomiting and diarrhoea. If you would prefer this, please discuss contact our advice line service.
Feeling sick (nausea) is a common side-effect of methotrexate, especially when treatment starts. This normally gets better, but for some people it may continue.
This feeling may be helped by:
- taking the methotrexate with or after food
- taking the methotrexate just before you go to bed; you may be able to sleep through the feeling of sickness
- making sure you take your folic acid
- switching to injectable methotrexate.
Sometimes the dose of folic acid can be changed, but this should only be done after speaking to a rheumatology team. We may tell you to take another tablet to reduce the feeling of sickness. The Rheumatology team may also change your methotrexate tablets to an injection once a week.
It is important that you take your methotrexate regularly so do not stop the drug without discussing it with the Rheumatology team or your doctor first.
Unfortunately some of the medications that are used to treat rheumatic diseases can cause side effects such as:
- Nausea
- Diarrhoea
- Vomiting
- Headache
- Dizziness
- Mouth ulcers
- Sore throats
- Rashes.
Rarely, patients can develop shortness of breath and/or a dry cough, which may require further investigation.
It is important to report any side-effects, even if not listed above, and seek advice from your GP or the Rheumatology team about continuing treatment.
Check how you are storing your medication
Biologic Medication - must be kept in the refrigerator for storage is often much less painful upon injection when brought up to room temperature. Before injecting, remove one pre-filled syringe from the refrigerator and leave the syringe out for at least 30 minutes before using. Or alternatively, while still in the wrapper, hold the syringe in your armpit to bring it to body temperature more quickly.
Methotrexate- Nordimet, Methofill and Metoject injections do not need to be stored in the Fridge
Injections Sites- Choose a site that has a little extra fat. If your Abdomen (tummy) is very lean, try injecting into your thighs. If your thighs are small, try giving the injection into your stomach Abdomen (tummy).
Do not inject into skin that is irritated, visible small blood vessels reddened, bruised, infected, or scarred in any way
Rotating the Injection site- If you notice bruising or pain, rotate your injection site. One site may be easier than others, but rotating can help reduce any pain, tension, or frustration you may experience.
Make sure to clean the area with an alcohol pad afterward. If you still experience significant pain, you may be able to use a numbing cream.
Cold skin can be hard and stiff. Inject after a warm shower/bath, when the skin is soft and supple. Or apply a warm compress to the injection site for five minutes before injecting. However, take caution in any area where sensation of temperature is impaired to avoid burning yourself.
Numb the area- If you are prone to bruising and pain, you can use ice or an ice pack to numb the injection site for several minutes prior to injecting yourself. Remember do not cause an “Ice Burn”- always place the ice/ ice pack in cloth
Numbing Cream- Some numbing creams are available over the counter, but make sure to check with your doctor before incorporating a numbing cream into your routine.
Prevent irritation by keeping injection site clean and dry- Wet alcohol on the skin can burn during injections. If you use an alcohol swab to clean the skin, let the alcohol dry before injection to avoid the sting. Then after the injection, quickly apply a cotton ball to prevent medication from potentially leaking and irritating the surrounding skin.
Relaxing- Try to relax a bit just before the injection by thinking of something pleasant that makes you happy, then massaging the injection site by before and after injecting by applying pressure with your fingers, which will help to "calm" the area... it's a great trick for getting rid of pain! Be aware that while you're massaging the injection site, there may be a few involuntary muscle spasms
Vibration- Buzzy Device- Buzzy is a vibrating device with ice pack wings that decreases sharp pain when placed upstream. It uses natural pain relief by confusing your body's own nerves, thereby dulling or eliminating sharp pain. In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn bypasses sharp pain. Remove the cool gel pad from the refrigerator and apply the Buzzy device 1-2 minutes before you are due to have your injection.
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Keep the goal in mind- If your daily injections get difficult or tiresome, think about why you are taking the medication. Keeping your disease in control and preventing disability is the main purpose of your injection, keeping your goal in mind may help ease any fear or anxiety you may be experiencing. Remembering the reason can also help you keep any discomfort you may feel in perspective.
Know when to ask for help- If you can't inject yourself or are having a difficult time with certain injection sites, have someone else, like your partner, administer the injection for you. If that's not possible, talk to the Rheumatology Clinical Nurse Specialists to show you the best way to inject yourself can make a big difference.
Please do not hesitate to contact the Department of Rheumatology Patient advice and information line if you need further advice and support – Telephone 02392286935 or email pho-tr.
DMARDs (or disease modifying anti-rheumatic drugs) are medications that are given to reduce inflammation and prevent damage to the joints. DMARDs include drugs such as methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, azathioprine and ciclosporin.
There is no clear evidence that taking these medications affects surgery, in fact coming off them can cause a flare of your arthritis, which can be more of a problem. We therefore usually recommend that you stay on your medicines but let your surgeon know what you have been prescribed.
You may be asked to stop your medication for a while before and after surgery, but this depends on the medication being taken, the type of operation and the views of the surgeon.
General advice is to stop biologics at least 2 weeks before any surgery and restart once your wound has completely healed. This is generally at least 2 weeks after your surgery but you must check this with your surgical team. If you are on an intravenous biologic (eg infliximab, rituximab, tocilizumab) please let us know if you are having surgery by contacting us so that we can advise you about what needs to be done.