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THU0744-HPR Assessment of adalimumab subcutaneous injection related pain and effectiveness of nurse support for patients with rheumatoid arthritis
  1. M Fusama1,
  2. M Suzaki2,
  3. T Hirasawa3,
  4. M Takemoto4,
  5. Y Asano4,
  6. K Higashi1,
  7. T Tsuru2,
  8. K Tanimura5,
  9. M Natsumeda6,
  10. H Nakahara7
  1. 1Division of Nursing, NTT West Osaka Hospital, Osaka
  2. 2PS Clinic, Fukuoka
  3. 3Division of Nursing, Hokkaido Medical Center for Rheumatic Diseases, Sapporo
  4. 4Division of Nursing, Sweet Hospital, Kurashiki
  5. 5Hokkaido Medical Center for Rheumatic Diseases, Sapporo
  6. 6Sweet Hospital, Kurashiki
  7. 7NTT West Osaka Hospital, Osaka, Japan


Background Subcutaneous injection of biologic agents gives more freedom and independence for patients with rheumatoid arthritis (RA) than intravenous injection. Despite this, patients with RA sometimes select intravenous injections due to concerns over self-injection, such as injection anxiety, including pain, and lack of confidence in giving a self-injection [1]. It is reported that one in five people are estimated to experience injection anxiety [2]. Therefore, an understanding of subcutaneous injection pain and anxiety and support for anxiety of patients with RA are important for appropriate usage of subcutaneous biologics.

Objectives The aim is to evaluate pain and anxiety caused by adalimumab (ADA) subcutaneous injection and assess the effectiveness of nurses' care.

Methods Patients with RA using ADA self-injections were enrolled. Pain was assessed in 4 categories: general, needle insertion, drug injection, needle removal. Pain was evaluated using Visual Analogue Scale (VAS) scale. Effectiveness of support by nurses was also assessed using self-questionnaires and free-format comments. Statistical analyses were performed utilizing Wilcoxon's signed rank test and Spearman's rank correlation coefficient.

Results Twenty patients (Male: Female, 4: 16) completed the questionnaire. Average age and disease duration were 68 and 12.6 years, respectively. Mean ± SD of Pain VAS were 34.9±28.1 mm (General), 30.3±30.6 mm (needle insert), 42.5±35.6mm (drug injection) and 11.8±18.4mm (needle removal). There were no statistically significant differences between general pain and needle insertion (p=0.631), or general pain and drug injection (p=0.121). However, statistically significant differences were found between general pain and needle removal (p=0.001). Moreover, there were statistically significant differences between needle insertion and removal (p=0.003), and drug injection and needle removal (p=0.00048). General pain showed statistically significant correlation with needle insertion pain (r=0.653, p=0.0018) and drug injection pain (r=0.615, p=0.004). However, general pain was not correlated with needle removal pain (r=0.137, p=0.565).

Patients with RA answered that support by nurses was effective for relieving pain (30%), reduction of anxiety (35%) and improving treatment motivation (50%). According to the patients, nurses helped raise motivation by explaining that treatment prevents the progression of RA and allows many patients to feel better and have less pain. Interaction with nurses appears to be effective in reducing injection pain and anxiety and improving motivation for self-injection treatment.

Conclusions These data indicate that needle insertion and drug injection pain have great influences on general pain. Support by nurses is likely to reduce injection anxiety and pain, resulting in higher motivation toward self-injection treatment.


  1. Keininger D, et al. Health Qual Life Outcomes. 2011 Jan 13; 9:2.

  2. Nir Y, et al. Am J Trop Med Hyg 2003, 68: 341–4.


Disclosure of Interest None declared

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