What to Know About Enbrel Injections for Psoriatic Arthritis

If you have psoriatic arthritis (PsA), you know how painful and disruptive the condition can be. This autoimmune disorder can lead to painful, swollen joints in many parts of your body, like the hands and feet. It can also cause itchy or tender patches of skin.

While there isn’t a cure for PsA, lifestyle modifications and medications can help improve your health and quality of life. Many treatment options, such as disease-modifying antirheumatic drugs (DMARDs), help relieve PsA symptoms and prevent the condition from getting worse. 

One common medication used to treat PsA in adults is Enbrel (etanercept). Your healthcare provider may prescribe this medication to help with PsA. But there can be a lot to know about Enbrel, and you may have questions about it. Read on below to learn more about taking Enbrel injections for PsA.

What is Enbrel?

Enbrel is an injectable medication that’s FDA approved to treat several autoimmune disorders, including:

• PsA

• Rheumatoid arthritis (RA)

• Ankylosing spondylitis (AS)

• Plaque psoriasis (PsO)

• Polyarticular juvenile idiopathic arthritis (JIA)

Enbrel is a type of biologic DMARD. Biologics are complex medications that are made from natural or living sources. As a DMARD, Enbrel aims to lessen inflammation, prevent PsA progression, and improve quality of life.

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How do Enbrel injections work for psoriatic arthritis?

Enbrel works by interfering with a protein called tumor necrosis factor (TNF). People with PsA generally have higher levels of TNF in their joints, which can lead to joint and skin damage caused by PsA. Enbrel blocks TNF’s activity in the body, which reduces inflammation, joint pain, and skin symptoms caused by PsA. 

How is Enbrel given when treating psoriatic arthritis?

Enbrel is administered subcutaneously, in the fatty tissue under the skin, as a 50 mg once-weekly injection. You can inject it into the stomach, thighs, or outer area of the upper arms. You should change injection locations with each dose to help limit skin irritation.

There are also a few different forms of Enbrel injections you and your healthcare provider can choose from. The directions for use are different for each device. So make sure to follow the instructions for the device you’re prescribed:

• Enbrel single-dose prefilled syringe

• Enbrel SureClick autoinjector

• Enbrel Mini prefilled cartridge (used with AutoTouch reusable autoinjector)

• Enbrel vial and syringe

If you’re not sure how to inject your medication, double check with your healthcare provider or pharmacist.

Tip: You should store Enbrel in the fridge until you’re preparing to inject your dose. Some people find Enbrel injections are less comfortable to receive when they’re cold. If you want, you can leave the medication at room temperature for about 30 minutes before injecting it.

What are potential side effects of Enbrel?

Many people receiving Enbrel don’t experience any side effects. Those who do usually find they are mild. But if you think you’re having a bothersome side effect from Enbrel, talk to your healthcare provider to discuss next steps.

Common Enbrel side effects

The most common Enbrel side effects include:

• Injection site reactions

• Upper respiratory infections

• Diarrhea

• Fever

• Cough

• Sore throat

Side effects like these should get better with time. But there are still ways to manage them. 

If you catch an upper respiratory infection, such as a common cold or sinus infection, it’s important to stay hydrated and get plenty of rest. Try to be patient and give your body time to recover. But you can also check in with your pharmacist to see if you should try any over-the-counter (OTC) treatments, such as acetaminophen (Tylenol), dextromethorphan (Delsym), or oxymetazoline (Afrin).

Injection site reactions may include redness, itchiness, or swelling where you injected Enbrel. These are usually mild and go away in a few days. In the meantime, you can try applying warm compresses or ice packs to the affected areas of skin. OTC pain relievers and anti-itch medications can also help. 

Diarrhea should also improve as your body gets used to the medication. You can help keep it under wraps by drinking plenty of fluids, temporarily sticking to bland, starchy foods, or taking an OTC anti-diarrhea medication like loperamide (Imodium A-D).

Rare but serious side effects

Even though most people tolerate Enbrel well, it may lead to serious side effects in some people, notably with long-term use. This is because of how the medication affects the immune system. 

Serious infections are possible with Enbrel. Enbrel can weaken your immune system or make it less active. You’ll be tested for tuberculosis (TB) and hepatitis B before starting Enbrel and regularly while using it. You shouldn’t start this medication if you’re currently sick, either.

Other rare but serious Enbrel side effects include:

• Low blood cell counts

• Certain cancers, including lymphoma and skin cancer

• Heart failure, including symptoms like worsening fatigue, swelling, or shortness of breath

• Nerve problems (e.g., seizures, unusual nerve sensations)

If you develop any signs or symptoms of side effects like these, it’s important to speak with your healthcare provider right away. They’ll also be monitoring these risks on their own.

Does Enbrel interact with any medications?

Yes. Enbrel interacts with several medications. To avoid Enbrel interactions, make sure your pharmacist and healthcare provider are aware of all of the medications and supplements you’re taking.

As mentioned, Enbrel can weaken your immune system and increase your risk of infection. There’s an even larger infection risk if you combine Enbrel with other medications that weaken your immune system, such as:

• Corticosteroids like prednisone

• Methotrexate

• Chemotherapy

• Immune-modulating biologic medications like anakinra (Kineret)

Enbrel may also lower blood glucose (sugar) levels. This can be especially problematic if you have diabetes. The risk of low blood glucose is higher when combined with certain diabetes medications:

• Insulin

• Sulfonylureas like glipizide (Glucotrol XL)

• Glinides like repaglinide

Live vaccines can interact with Enbrel, too. They contain a weakened version of a bacteria or virus. Your body may not be able to safely handle these vaccines while you’re receiving Enbrel. It’s recommended to avoid live vaccines when taking Enbrel and for 4 weeks after stopping it. Examples of live vaccines include:

• Yellow fever

• Varicella zoster

• Rotavirus

• Measles, mumps, rubella (MMR)

• Oral typhoid

Should you avoid certain foods while taking Enbrel?

No, there aren’t any direct interactions between foods, drinks, and Enbrel injections. 

Still, some parts of your diet could affect inflammation levels in your body. When possible, it’s best to avoid foods that cause inflammation, such as processed meats, foods high in sugar, and refined carbohydrates.

Other foods have a different effect. Anti-inflammatory foods and drinks — such as berries, leafy green vegetables, and green tea — can play a more positive role in PsA management.

How effective is Enbrel when treating psoriatic arthritis?

Enbrel may not be the first medication you try for PsA. But it’s quite effective for treating PsA when needed — especially if oral medications haven’t done the trick.

One study found that people using Enbrel were significantly more likely to experience symptom relief compared to people receiving placebo (an injection with no medication in it). In another small study, Enbrel was effective at relieving PsA symptoms among people who didn’t find relief with other treatments.

Other studies with similar findings are also available, but living with PsA is a unique experience for each person. The most effective medication for someone else may not be the best medication for you. Your healthcare provider can help you decide if Enbrel is a good choice for you based on your treatment goals, symptom severity, and health background.

How to save on Enbrel

There are ways to save on Enbrel, which is only available as a brand-name medication. GoodRx can help you navigate between patient assistance programs and copay savings cards to save money on your prescription.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Enbrel’s patient assistance program, which offers the medication free of cost.

• Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $5 for Enbrel using a savings card from the manufacturer.

What are some alternative psoriatic arthritis injections?

Enbrel is a safe and effective PsA treatment for many people. But it's far from the only one. Some people take oral medications to keep their symptoms under control. Others turn to injectable medications. Many people rely on some combination of the two. 

Other injectable biologic medications that treat PsA include:

• Humira (adalimumab)

• Remicade (infliximab)

• Simponi (golimumab)

• Cimzia (certolizumab)

• Stelara (ustekinumab)

• Skyrizi (risankizumab)

• Tremfya (guselkumab)

• Cosentyx (secukinumab)

• Taltz (ixekizumab)

• Orencia (abatacept)

Another psoriatic arthritis injection is methotrexate, but it’s not a biologic.

Why trust our experts?

Written by:

Nidhi Gandhi-Patel, PharmD, BS

Nidhi Gandhi-Patel, PharmD, is a licensed pharmacist in Illinois. She's worked in the field for over 6 years.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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