Treatment for rheumatoid arthritis (RA) usually starts with oral medication. But if that doesn’t do enough to slow its progression, your doctor may suggest medications that are administered through an infusion or injection.

RA infusion treatments may be prescribed as the main treatment or they can be combined with oral treatments. During an infusion, medication from an IV drip goes directly into a vein. The needle is usually placed into an arm or hand.

In this article, we’ll discuss different types of RA medications that can be delivered by infusion, and what to expect from the procedure.

Like other forms of treatment, there are advantages and drawbacks to infusions for RA.

Pros

  • You’ll receive biologic medications, which are effective in treating RA.
  • Infusions generally don’t hurt; expect a slight pinch when the needle goes in.
  • Your medication will be delivered in a medical setting by professionals.
  • You may need infusions less frequently once your treatment is in full swing.
  • You won’t need to self-inject — or have someone else do it for you at home.

Cons

  • Biologics can diminish your immune system’s ability to fight infection.
  • Infusion treatments can be expensive.
  • It can take weeks or months for your medication to start working.
  • Infusion medications aren’t pain medications, and you may need to keep taking medication for RA-related pain.
  • Infusions can take several hours to be administered.
  • Getting infusions in a medical setting means planning travel and setting appointments.
  • Allergic reactions sometimes occur during infusions.
  • You may feel significant fatigue after an infusion.
  • Infection is possible at the injection site.

There are different medications used for infusion treatments. Each one targets, or turns off, a different part of the immune system. You and your doctor can decide which medication is best for you.

  • Tocilizumab (Actemra). This medication works by blocking interleukin-6 (IL-6). IL-6 is a protein made in the immune system. It is used to reduce joint pain and swelling.
  • Tumor necrosis factor (TNF) inhibitors. Golimumab (Simponi Aria) and infliximab (Remicade) are two biologics that work by inhibiting tumor necrosis factor (TNF). TNF is a protein found in the immune system. These medications are used to prevent joint damage. They may be prescribed for use in conjunction with methotrexate, an oral medication.
  • Rituximab (Rituxan). This drug may also be marketed under the name Mab Thera. It works by targeting B cells. Rituximab is used to slow down the progression of joint and bone damage. It’s often prescribed for use in conjunction with methotrexate.
  • Abatacept (Orencia). This treatment works by targeting T cells. It may help to prevent further joint and bone damage.

Infusion medications are expensive, and can cost upwards of $45,000 annually.

Many health insurance plans only cover one or two of the medications used for these treatments. You may have to take what your insurer is willing to pay for into account when you are deciding which type to get.

You may also incur copays or deductibles. Most Medicare Part D plans cover at least one of the medications used in infusion therapy. If you have a Medicare Advantage Part C plan, check which medication, if any, it covers.

First things first: You need to make an appointment at a clinic or infusion center in order to start treatment.

Infusion amounts are determined by body weight, so you may be weighed before it starts. You might also be given medications before your infusion to help you relax, reduce allergic reactions, or alleviate discomfort.

The needle that delivers medication from the IV into your system is typically placed in the arm or hand. The process may take as little as 20 minutes or as long as 4 hours, or more. But don’t worry — you’re allowed to take bathroom breaks.

How to prepare

Infusion sessions can take time, so be prepared to stick around for a bit.

Infusion centers usually have comfortable couches or overstuffed chairs for you to sit in during treatment. Many have blankets and pillows, and you’ll be situated into a comfortable position prior to being hooked up to the IV.

Here are some things to bring in order to make your stay feel more relaxing:

  • comfy clothes (like pajamas)
  • snacks
  • water to stay hydrated
  • books or magazines
  • laptop/tablet to stream movies, play games, etc.
  • any chargers you need for your phone or other devices

A nurse or technician will monitor you during your infusion for adverse reactions.

Common side effects include:

  • headaches caused by fluid imbalance
  • allergic reactions such as redness and hives
  • pain, redness, or swelling at the injection site
  • fatigue

More serious side effects may also occur. They include:

  • shortness of breath
  • abdominal pain
  • chest pain
  • nausea
  • fever
  • chills

Oral medications are the first line of defense against RA. But when oral drugs are not enough, an infusion may significantly alter RA progression.

Infusion treatments are done with medications known as biologics. They may be used alone, or alongside oral drugs. There are several types of biologics used to treat RA. Infusion treatments are done in an infusion center or clinic.

These medications can be expensive, but many insurance plans provide coverage for at least one of the drugs used for RA infusions.