Joint Injection Therapy

Many rheumatic and autoimmune diseases require infusions as an advanced treatment. If you need an infusion of any of the biologic drugs listed on this page, you can receive them in the comfort of our office infusion suite with the healthcare team you trust. At Suncoast Rheumatology, you can expect personalized, quality care with staff who will know you, your condition and how to provide excellent care.

Our suite features a semi-private treatment area whereby you can interact with others receiving similar treatment. If you prefer private enjoyment however, our TV and web enabled iPads, personal earphones, wireless internet, recliner heat, massage and lift chairs will provide just the relaxing atmosphere you desire.

Patients also have access to refrigerators, a microwave and a coffee/tea bar. Our office takes care of all insurance pre-certification for the procedures provided, coordinates care with pharmacies if needed, performs pre-authorizations, and anything else that is required to provide treatment. The suite is staffed by the highest quality infusion nurses highly trained in infusion and intravenous (IV) therapies, who are sensitive to the unique challenges of our patients. They are experienced in maintaining central venous access devices including implanted ports and are committed to assist in the education of patients about their treatment and health outcomes. Our team really strives to provide a convenient and personal setting. Let us know if you need any additional accomodations, as we aim to make your treatment as therapeutic emotionally as possible too, not just medically.

INFUSION THERAPIES

All FDA-approved infusion therapies for rheumatologic illnesses are available in our infusion center.
These treatments include:
- Actemra® (tocilizumab) is a prescription medicine called an interleukin-6 (IL-6) receptor inhibitor. It is available in weight based intravenous and standard SQ forms. ACTEMRA is used to treat adults with moderately to severely active rheumatoid arthritis (RA). It is also indicated to treat temporal arteritis / giant cell arteritis. ACTEMRA blocks a substance in the body called interleukin-6 which is overproduced by people with RA and temporal arteritis/GCA. Improvements of symptoms have been reported within a few weeks after starting treatment. If you are prescribed ACTEMRA, you will receive an intravenous (IV) infusion given over 1 hour every 4 weeks.
- Benlysta® (belimumab) is a prescription imedication used to treat adults with active systemic lupus erythematous (SLE or lupus), who are receiving other lupus medicines. It is available in weight based intravenous and standard SQ forms. BENLYSTA is a biologic therapy that works by reducing certain cells in your immune system that can make lupus active. If you are prescribed BENLYSTA, you will come to the office for an intravenous (IV) infusion given over 1 hour every 4 weeks. Preparation time before the infusion may vary. For the first three infusions, you’ll need an infusion every two weeks. After the first three, you’ll come in every 4 weeks for an infusion.
- Boniva® (ibandronate sodium) is an intravenous prescription medication used for osteoporosis treatment in women who have completed menopause. The drug helps build and maintain bone density to help reduce bone fractures. BONIVA infusions are an alternative for patients who have difficulty with medicines taken by mouth. This may be due to difficulty swallowing, forgeting to take the osteoporsis pills, the inability to sit or stand for 30-60 minutes after taking the medication or the need to avoid oral medications. BONIVA is also a good option for patients who are unable to fast (postpone food and drink) before taking the oral medications. If you are prescribed BONIVA, you will come to the office for an infusion every 3 months.
- Cimzia (certolizumab) is a prescription medication which is an injection used to treat adults with moderately to severely active rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. It is referred to as "anti-TNF therapy". By blocking tumor necrosis factor (TNF)-alpha, CIMZIA helps reduce inflammation, stiffness and joint damage in RA. CIMZIA may be taken with or without other RA medications like methotrexate. In clinical trials, CIMZIA has been shown to reduce RA pain, stiffness, and fatigue in as fast as 1 to 2 weeks. Many patients experienced lasting relief at both 6 months and 1 year. If you are prescribed CIMZIA, you’ll come to our office to receive an injection under the skin. After your first 3 doses, you’ll need a new injection every 4 weeks.
- Intravenous fluids is a therapy that delivers hydration directly into the vein. This may be used for fluid replacement to correct dehydration or to correct electrolyte imblances and maintain homeostasis (balance) within the body. Normal saline contains sodium choloride o replace lost fluid and correct electrolyte imblances. A solution of dextrose and water treats dehydration and hypoglycemia. Lactated ringer's contains sodium chloride, sodium lactate, potassium chloride and calcium chloride for more comprehensive replacement. The above can also be administered with other vitamins and minerals for other therapeutic effects as well.
- Iron- Parental intravenous iron therapy is used for patients who are intolerant or unresponsive to oral iron therapy. There are three parental iron products available- iron dextran, ferric gluconate and iron sucrose. The infusions are usually given over 30-60 minutes and vary in frequency as determined by your conditon.
- IVIg (intravenous immunoglobulin therapy) also known as normal human immunoglobulin NHIG, is the use of a mixture of antibodies (immunogloblulins) to treat a number of health conditions including chronic inflammatory demylinating polyneuropathy, primary immunodeficiency, chronic variable immunodeficiency, Kawasaki disease and select immunoglobulin deficiencies. Depending upon the formulation of the ivig the effects can last weeks to months. IVIG has been used since the 1930s but was FDA approved in 1981. It is on the World Health Organization's list of "most effective and safe" medications needed in healthcare.
- Krystexxa® (pegloticase) is a presription intravenous medication used as a treatment of chronic gout in adults. It is usually given after other gout medications have been tried without success. Gout is caused by a build up of uric acid in your blood. KRYSTEXXA is an enzyme that breaks down uric acid so that it can be eliminated from the body in urine. If you are prescribed KRYSTEXXA, you will receive an intravenous (IV) infusion at a frequency determined by your doctor based on your diagnosis. Each infusion takes about 2 hours with an additional 60 minutes of observation afterwards.
- Orencia® (abatacept) is a prescription medication which is a weight based infusion, used in adults to reduce signs and symptoms of moderate to severe rheumatoid arthritis (RA) and psoriatic arthritis. It also has a form that is a standard SQ non-weight based formula. It may prevent further bone and joint damage and improve physical function. ORENCIA may be used alone or with other RA treatments such as methotrexate or other DMARDS. ORENCIA is a biologic therapy that works by reducing certain cells in your immune system that can make RA and PsA active. If you are prescribed ORENCIA, you will come to the office for an intravenous (IV) infusion given over 30 minutes. Preparation time before the infusion may vary. After your first three doses, you will come to the office for this intravenous (IV) infusion every 4 weeks.
- Prolia® (denosumab) is a prescription medication injection used for the treatment of post-menopausal osteoporosis in women. The injections can help reduce fracture risk and strengthen your bones. PROLIA is also used to increase bone mass in men with osteoporosis who have a high risk for bone fracture. It is also used to treat patients who have not benefitted from or are unable to tolerate other available osteoporosis treatments. If you are prescribed PROLIA, you will come to the office to receive a shot of the drug once every 6 months.
- Reclast®(Zoledronic acid) is the only FDA-approved once-a-year osteoporosis treatment. RECLAST, along with daily calcium and vitamin D, helps to increase bone density, protecting and strengthening your bones. RECLAST is approved for: the treatment and prevention of osteoporosis in postmenopausal women, reducing the incidence of new bone fractures in patients at high risk of fractures (those with recent low-trauma hip fracture), treatment to increase bone mass in men with osteoporosis, treatment of Paget’s disease of the bone for both men and women. If you are prescribed RECLAST, you will come to the office to receive one dose through intravenous (IV) infusion treatment once a year. If you have osteopenia, it will be every 2 years. The infusion takes at least 15 minutes to administer.
- Remicade® (infliximab) is a prescription infusion medication that is classified as a tumor necrosis factor (TNF)-inhibitor and helps stop inflammation and joint damage. When used with methotrexate to treat rheumatoid arthritis (RA), infusions of REMICADE can reduce signs and symptoms, help prevent further joint damage, and improve physical function for patients with moderately to severe RA. REMICADE is also used to treat: Psoriatic Arthritis (PsA), Ankylosing Spondylitis (AS), Plaque Psoriasis, Crohn’s Disease (CD) and Ulcerative Colitis (UC). REMICADE is given by intravenous (IV) infusion in our office. If you are prescribed REMICADE, after your first three doses, you will most likely return for about 6-10 infusions per year. Each infusion takes up to 2 hours.
- Rituxan® (rituximab) is a prescription infusion medication used to treat adult patients who have moderately to severely active rheumatoid arthritis (RA). It is often used for patients who have not responded well to other RA treatments. RiITUXAN reduces signs and symptoms of RA and can slow progression of joint and bone damage. Patients who receive infusions of Rituxan often see improvements that can last through six months. RITUXAN is also approved to treat Wegener’s granulomatosis and microscopic polyangilitis. If you are prescribed RITUXAN, you will come to the office for IV infusions at a frequency determined by your doctor based on your diagnosis. Infusion times vary from 2-6 hours.
- Simponi ® (golimumab) / SIMPONI ARIA is a prescription medication that is classified as a tumor necrosis factor (TNF)-inhibitor used in combination with methotrexate for adults with moderate to severe rheumatoid arthritis (RA). This medicine has been proven to help relieve the pain, stiffness, and swelling of RA, stop further joint damage and improve the ability to perform every day activities with less difficulty. It is also indicated for the treatment of psoriatic arthritis and ankylosing spondylitis as well. If you are prescribed SIMPONI ARIA, you will come to our office to receive an infusion through a needle placed in your vein, or medi-port. After two starter doses, 4 weeks apart, you will return for an infusion once every 8 weeks. Each infusion takes about 30 minutes.
- Solu-Medrol (methylprednisolone sodium succinate) or Decadron (dexamthasone intensol) infusions are glucocorticoid steroid medications that are given intravenous (in a vein) when a very fast response to reduce inflammation is needed. They can treat or prevent allergies, allergic reactions, flares in chronic diseases, inflammation and many other medical problems. They can be administered with the other medications on this list or with intravenous fluids. Time for administartion will vary from minutes to an hour with hydration.
- Stelara® (ustekinumab) is a prescription medicine classified as an interleukin-12 and 23 antagonist used to treat adults with Crohn’s, active psoriatic arthritis and psoriasis. STELARA can help reduce symptoms and possibly cause the diseases to go into remission. For the treatment of the Crohn’s patient, the initial treatment starts with a one-time intravenous infusion followed by subcutaneous injections every 8 weeks. STELARA for the treatment of psoriatic arthritis and psoriasis works by targeting an underlying cause of an overactive immune system. STELARA for the treatment of psoriatic arthritis and psoriasis starts with the administration of an initial subcutaneous injection followed by an injection at 4 weeks then a continued treatment every 12 weeks.
Infusions are administered by certified intravenous nurses.

CLINICAL MONITORING

Prior to receiving IV treatment, all patients are evaluated by our clinical team for proper medication dosing and interactions with outstanding conditions.
All nurses are trained to monitor vitals and to observe for potential side effects.

IV FAQ

Read through some commonly asked questions about our infusion suite service. If you have any other questions please feel free to ask us!

What is an infusion?
An infusion is a method of delivery of medications and fluids through a vein.

Who administers my infusion treatment?
A certified iv nurse administers the treatment.

Where can I go for infusions?
Hospitals, private infusion clinics, and at home. These all have varying costs and pros/cons such as level of comfort, privacy, safety, etc.

Will my doctor be at my infusion?
Yes, at Suncoast Rheumatology your doctor will be in an adjacent room, close by, during your infusion.

How long will it take to receive my infusion?
It depends on what drug/therapy is being infused and how well the patient tolerates it.

Can I bring anyone to my appointment?
Yes, but depending on how busy the infusion suite is, they may or may not be able to sit with you during your treatment. They are always welcome to wait in our waiting room. It is always recommended to have someone else drive you to and from your first appointment with a new medication until you know how well you tolerate it.

What can I expect at my appointment?
You can expect to come into the office and check-in at the front desk. They will verify your insurance info, collect a co-pay if indicated and verify that all of your paperwork is completed/up-to-date. You will then be taken back to the infusion suite when the nurse is ready to begin your infusion. The nurse will start with an assessment to include checking your vitals, reviewing your chart, medications, and noting any changes since your previous appointment. The nurse will also provide teaching about your infusion for new patients. The nurse will then start your IV and administer any premeds as ordered. The infusion of your medication will then begin. Vitals will be checked periodically and when complete. New patients can expect to be observed for several minutes after the infusion, during which time a saline flush may be administered. Upon discharge, verbal or written instructions as appropriate are provided and you will be scheduled for your next infusion before you leave the suite.

What should I wear to my infusion?
You can wear anything you would like, but we recommend comfortable clothing and request that you wear clothing that allows easy access to arms so that we can start your IV without complication. Avoid sleeves that are too tight as they may restrict the flow of your IV. If you have a mediport, you will want to wear a button-up shirt or a shirt with a v-neck or lower neckline so that we can easily access your port.

What can I do during my appointment?
During your appointment, you may watch TV on one of our iPads that also provide a platform for games, shopping, web surfing, etc. You can also utilize our free WiFi to enjoy on your own device (cell phone, laptop, tablet), read, sleep, color, etc. Please remember that our infusion suite is a shared space however, so we kindly request that you limit cell phone calls to short, essential ones (coordinating rides or urgent matters only), and please use headphones for music/movies/games etc. (We have several or bring your own). We also have pillows and blankets on hand for comfort.

Will I be allowed to eat during my infusion?
You may eat during your infusion, but we do request that you avoid bringing in odoriferous foods as the infusion suite is a shared space and we want to be sensitive to other patients that may not feel well. We do have a refrigerator and a microwave on site as well as light snacks, a water cooler and a coffee/tea bar.

If you have any other questions, feel free to contact us!

Need help paying for your infusion?

This is a partial list of financial assistance programs that may be available to help:

Infusion Drug Assistance Programs
The following is a list of infusion drugs and the phone numbers for programs offering financial assistance that may be available to you. Call these numbers if you are interested in talking to someone to see if you are eligible and to apply.

Trigger points are often associated with chronic musculoskeletal disorders. Trigger point injections often involve more than one trigger point injected at a time at the discretion of the physician. These injections often include a combination of lidocaine and a steroid derivative, and can be effective in relieving pain in the tender area.

Advantages of Diagnostic and Musculoskeletal Ultrasound Guided Joint Injections

Joint injections can also be ultrasound guided to provide an additional level of confidence and assurance of ideal medication placement. Ultrasound also has many advantages over x-rays, MRI and CT scans in the clinical setting. These include:

better resolution of soft tissue than MRI
convenient in-office service; no need to go to another facility  no exposure to ionizing radiation
no claustrophobia
the ability to perform a dynamic or "live" study; we can see the injured area move and look for evidence of injury
more cost-effective
ability to see inflammation
ability to guide injections

For example, ultrasound has been shown to be equal to or even better than MRI for looking at the rotor cuff. Also, musculoskeletal ultrasound allows the physician to look for signs of joint instability, unlike x-rays or MRI.
While Musculoskeletal Ultrasound has many advantages, there are some restrictions.

Ultrasound cannot penetrate bone to "see" inside joints, so some cartilage and joint surfaces are not visualized as well.
Musculoskeletal ultrasound is generally not as good as x-rays at looking at the overall structure of bones.
Performing and interpreting musculoskeletal ultrasound takes months of training and practice.

One of the greatest advantages of musculoskeletal ultrasound is its ability to help the physician guide the needle when performing injections. Whether for a joint aspiration or a joint injection, using ultrasound guidance can decrease the incidence of procedural complications and improve the success rate, according to the medical literature. Needle guidance can facilitate visualization of needle passage in ultrasound-guided joint, tendon and carpal tunnel injections.

This is in contrast to the “blind” technique, which uses surface anatomy to determine where to accurately place the needle. This also might be the ideal option for number of scenerios. Ultrasound is an excellent tool however that we at Sucoast Rheuamtology use to evaluate: effusions/synovial proliferation, joint surface irregularities/erosions, tenosynovitis, bursitis, enthesitis, tears of tendons, ligaments and muscles, peripheral nerve disorders, calcifications and osteophytes and loose joint bodies.   For more information on this techniqu, please visit www.mskus.com.

Laboratory Services

Our laboratory does both general and specialized testing designed for the diagnosis and treatment of several rheumatic conditions. We are also able to draw and send to Quest, LabCorp and Baycare to maximize patient conveinence.

Infusion Therapy Services

Cutting edge biologic therapies infused by expertly trained professional staff nurses in the comfort of our infusion suite are also an integral part of rheumatology care. We feature heated massage lift chairs with free high speed Wi-fi and individual tablets for viewing TV, movies, games, shopping, etc. Pillows, blankets, snacks and complimentary drinks help to add ease to your infusion experience as well. Please see our infusion section for further information.