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What to Expect When Getting an Infusion Medicine for RA

In an earlier post, I wrote about the fact that needles and RA go hand in hand. When patients are prescribed injectable methotrexate or one of the first line biologic medicines like Enbrel or Humira, they tend to stress over the fact that needles are becoming part of their healthcare regimen. These medicines are usually self-injected at home. While it takes a little gumption to poke yourself, it can be done relatively quickly. There are, however, several RA medications that are required to be administered via intravenous (IV) infusion at a clinic under the supervision of a nurse. The reasons that these drugs must be administered via infusion include the facts that the volume of medicine is beyond what can be packaged in a portable syringe and potential side effects of the drugs. The four RA drugs that are infusion-based are Remicade, Orencia, Actemra, and Rituximab (Rituxan). Remicade takes about 3-4 hours per infusion, Orencia and Actemra takes about an hour, and Rituxan takes 5-6 hours for the total process.

Personally, I’ve been on all four of these medicines and it’s old hat for me to go into the clinic for an infusion. I know the process, what to expect, and the nurses even know me by name. But when a patient is a “newbie” to the process, it can be a little intimidating. I thought it might be helpful to provide a personal description of the process – sort of a play by play.

Infusion centers have patients with other conditions as well

My infusion clinic is near the oncology offices because many cancer patients are receiving chemotherapy via infusion. It feels a little strange walking into such a place as many of the patients around you are in serious and life threatening situations. But then that reminds me the serious nature of rheumatoid arthritis. The clinic contains small and private cubicles for each patient. Unlike other doctor offices, you just walk in and immediately meet a nurse who escorts you to a cubicle that contains a lounge chair, TV, guest chair, infusion pump machine, and a drawer full of equipment and supplies.

Steps before infusion

Once settled in the chair, the nurse takes blood pressure measurements and then an infusion needle is inserted into a vein. I’ve had infusions in my elbow, arm and hand depending on which vein seems to be popping out the best. Staying hydrated before the infusion helps keep the veins ready. Sometimes vials of blood are drawn to run typical RA blood tests like complete blood count (CBC), sedimentation rates, and liver panels.

The medicine is contained in a solution and is infused, not dripped, meaning that a pump provides the force pushing it into your body. The pump makes a whirring sound every few seconds.

Being prepared to sit at the infusion center

For infusions lasting several hours, it is good to bring something to keep yourself occupied such as music, videos, books, and food. I get up periodically to stretch and go to the restroom when needed. The entire IV and pump set up is mobile and can be wheeled around if needed. The pump is battery operated but must be plugged in when not moving so the battery can remain fully charged.

The nurse periodically comes by to check on how I’m feeling. When the medicine bag is empty, a beeper on the infusion pump sounds and the nurse comes to shut everything down and to remove the IV. Towards the end I find myself constantly checking the bag to see how close it is to being empty! Some saline solution may be pushed through the drip line to flush all of the expensive medicine into your body. When this happens I feel a cold sensation in my arm. Finally, a pressure bandage is wrapped to keep the site from bleeding and they suggest leaving it on for 15-30 minutes.

I’m currently on Rituxan and the infusion clinic likes to schedule these infusions early in the day since the entire process can take up to six hours. Rituxan requires a set of pre-medications that are designed to squelch possible infusion reactions. The pre-meds include Tylenol, Solu-medrol, and Benadryl. The Solu-medrol, a corticosteroid, is injected directly into the IV but the nurse does it slowly in order to avoid a “head rush” as she calls it. The 100mg dose seems massive compared to the 4mg pills that I take periodically. This amount tends to keep me awake far into the next morning and makes me constantly hungry for the next 24 hours. The Benadryl is an anti-histamine and is infused from a bag. Some clinics will allow patients to take oral Benadryl before coming in. One side effect of the Benadryl for me is that it makes me rather loopy and groggy and I usually sleep for about an hour. During my first Rituxan infusion, I also had 500mg of saline solution infused to make sure I was hydrated. They did not do this on the second infusion.

The entire infusion process is usually pretty uneventful and side effects from the infused drugs are possible but not very common. I’ve found that the infusion clinic nurses are the best and most professional in the health care world and they are amazing at making the process as comfortable as possible.

Below are some pictures of one of my infusions.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Debra Lujan
    6 years ago

    Hi Andy
    I agree will the procedure you laid out. I have been doing Orencia for a few years now. Was diagnose with juvenile RA 38 years ago. Have tried Humera, Remicade. It’s been a long procedure and then when you think you are on the right track it stops working and then you try a new one. I wish I would of seen this post several years ago when I started with the Remicade infusion. Thank you for your description.
    Have a great day.

  • Andrew Lumpe, PhD moderator author
    6 years ago

    Debby, glad you liked the description. Yes, I wish I would’ve had some insight before going in for my first infusion as it was a little scary.

  • Damian
    6 years ago

    Howdy Andrew
    The infusion went really well…Better than the past 3. They have made major renovations to the Chemotherapy ward at my local hospital. In was nowhere as ‘Bad’ as past treatments 🙂

    I agree with ‘Flu’ like symptoms. I also get very hot, perspiring like a hot flush that comes and goes. I’ve found that the treatment does help. I’m still on Prednisolone & Leflunomide.

    To all have a great day


  • Andrew Lumpe, PhD moderator author
    6 years ago

    Glad your infusion went well! I’ve heard of the flushing before and I get that went I get solu-medrol injected before my Rituxin infusion.

  • Damian
    6 years ago

    Hi Andrew

    Thank you for your very detailed & analysed account of getting an infusion for RA.

    As it is often, the treatments that you’ve had are very similar to mine. The only exception is when I have my infusion I’m sitting with – beside me with patients suffering life threatening cancer….some look days away from death. I’ve witnessed loved ones breaking down, I seen patients vomiting, crying…..
    I’m not sure whether I get psychosomatic but I do get very nauseous having the infusion.
    As I’m off shortly to have my infusion today reading this has brought my emotions to the forefront..
    My infusion is not a fun one…

    Have a ripper of a day to all


  • Andrew Lumpe, PhD moderator author
    6 years ago

    Damian, glad you liked the article. I’ve had cancer patients talk to me and they usually assume I’m like them and getting chemotherapy. The oncologist typically walks up and down the clinic meeting with his patients, especially those getting their first chemo.

    With Rituxan, I sometimes get a flu-like feeling for the next 24 hours.

    Hope your infusion went well.

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