1. Stone, Wanda J. BSN, RN, OCN


Rheumatoid arthritis (RA) is an immunologically mediated disorder characterized by progressive joint destruction that leads to significant impairment of functioning and quality of life. Its signs and symptoms vary, depending on disease activity. The goals of therapy in patients with RA include a reduction of symptoms, inhibition of structural damage, and improvement in physical function. The paradigm for managing RA calls for adopting a three-pronged strategy that addresses the different aspects of the disease. Infliximab, a biologic response modifier, has been shown to be an effective and safe therapy in patients with RA. Infliximab, in combination with oral or subcutaneous methotrexate, is administered intravenously, most commonly in an office-based setting. As with any intravenously administered protein, infusion-related adverse events have been reported with infliximab; however, such events are infrequent, and slowing the rate of the infusion may reduce their likelihood of occurring. These adverse events can generally be managed easily. Nurses who administer infliximab should have a thorough understanding of the product to prevent or manage adverse events. In this way, they can help ensure the safe delivery of the agent and optimize patient outcomes.


Rheumatoid arthritis (RA), an immunologically mediated chronic disease, is associated with substantial disability, lost productivity, and morbidity and mortality. 1 About 6.5% to 12% of patients with RA are severely disabled, 2 and 44% of patients with RA become work-disabled within 10 years of diagnosis. 3 Additionally, the economic costs of RA are extremely high, approximating those of coronary heart disease. 4


In recent years, tumor necrosis factor-[alpha] (TNF-[alpha]) has been shown to play a pivotal role in the pathogenesis of RA, 5 and agents that target TNF-[alpha] have been introduced to manage the disease. Such agents include the monoclonal antibodies infliximab (Remicade, Centocor, Inc., Malvern, PA) and adalimumab (Humira, Abbott Laboratories, Abbott Park, IL) and the soluble protein etanercept (Enbrel, Amgen, Inc., Thousand Oaks, Calif). 6-8 Infliximab has been approved by the Food and Drug Administration (FDA) for the treatment of patients with RA and Crohn's disease. Adalimumab has been approved by the FDA for the treatment of patients with RA, and etanercept has been approved by the FDA for the treatment of patients with RA and psoriatic arthritis. 6-8 Infliximab, adalimumab, and etanercept are parenterally administered biologic response modifiers. Infliximab is administered intravenously at an initial dose of 3 mg/kg at weeks 0 (baseline), 2, and 6, then every 8 weeks thereafter; adalimumab is administered subcutaneously at a dosage of 40 mg every 2 weeks; and etanercept is administered subcutaneously at a dosage of 25 mg twice weekly. 8-10 The presence of a physician or nurse is not required with subcutaneous injection, as such a procedure is generally handled by the patients themselves, provided they are functionally able to prepare and administer the injection. However, IV infusions performed in an office setting with physician supervision and a well-trained staff foster enhanced patient compliance 11 and patient monitoring.


This article will provide nurses with a guide to administering the biologic agent infliximab and information on how to prevent and, where necessary, manage potential adverse events that may occur with the infusion of any biologic agent.