Does size matter with methotrexate injection needles?

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If a patient is prescribed injectable methotrexate, she will eventually face the needle question. What is the “right” needle for injecting methotrexate? It’s more confusing than which topping to pick at Cold Stone Creamery. And a lot less fun. Last year, I was watching a video from Johns Hopkins Universityabout methotrexate injections. What a surprise when I heard the nurse describe the tiny needle used to inject methotrexate subcutaneously (into the fat layer under the skin). All of the rheumatologists that I had met had advocated an intramuscular injection (into the thigh or hip muscle) with a larger needle for better absorption. This is pretty confusing for patients. Determined to find an answer, I pressed my new doctor and a couple of pharmacists for their best recommendations. They agreed that injecting into the muscle is slightly better, but not critically important. It seemed like the most important thing is that the patient is comfortable enough that the injection actually ... more
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