Rheumatoid Arthritis - When Do I Call the Doctor?

Rheumatoid Warning Signs

Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editor: Jay W. Marks, MD

Doctors pay for beepers. So what are these beepers for? This article is about a reason that my beeper battery commonly wears down. And I am happy that it is being used for this purpose!

People with rheumatoid arthritis can develop certain symptoms that are really warning signs of something occurring in their bodies that is not what the doctor expects to happen. These are signs that can also sometimes represent a significant danger. These "rheumatoid warning signs" are reasons to call the doctor so that they can be interpreted in light of the patient's overall condition. When the doctor who is aware of your condition hears of these symptoms he/she can determine whether or not they are serious and if any action should be taken immediately or in the near future.

Rheumatoid warning signs can represent a worsening or complications of the rheumatoid disease, side effects of medications, or a new illness that is complicating the condition of patients with rheumatoid arthritis. Patients with rheumatoid arthritis should be aware of these rheumatoid warning signs so that they can contact their health care professional before their health is jeopardized.

Here are some warning signs that I like my patients to call me about:

Worsening of joint symptoms: This includes more pain, more swelling, additional joint involvement, redness, stiffness, or limitation of function. The doctor will determine whether or not these are significant, not the patient. Sometimes, patients have just begun a medication and some minor increase in joint problems might be occurring while the medication is taking effect. However, worsening symptoms can also mean that the medications are not working and that they require adjustments in dosing or a change in the medications.

Lack of improvement of joint symptoms: One major purpose of seeing the doctor is to get better. The doctor knows this. If a patient with rheumatoid arthritis has seen the doctor and is started on a treatment program and is not showing improvement but is worsening, notification of the doctor is appropriate. After starting a new treatment program, it sometimes takes time for the medications, physical therapy, etc., to control the inflammation. It is up to the doctor to decide if things are on course.

Fever: A mildly elevated temperature is not unusual in a person with active inflammation from rheumatoid arthritis. However, a true fever (temperature is above 100.4 F or 38 C) is not expected and can represent an infection. People with rheumatoid arthritis are at increased risk for infection because of their disease and frequently because of their medications. Many of the medications used to treat rheumatoid disease suppress the immune system of the body that is responsible for defending against infectious microbes. Furthermore, these medications can increase the risk of a more serious infection when a bacterium or virus strikes. It is important for people with rheumatoid arthritis to notify the doctor as soon as a fever occurs so that infections are treated at the earliest time possible. This can minimize the chances for many serious complications of infections.

Numbness or tingling: When a joint swells, it can pinch the nerves of sensation that pass next to it. If the swelling irritates the nerve, either because of the inflammation or simply because of pressure, the nerve can send sensations of pain, numbness, and/or tingling to the brain. This is called nerve entrapment. Nerve entrapment most frequently occurs at the wrist (carpal tunnel syndrome) and elbow (ulnar nerve entrapment). It is important to have nerve entrapment treated early for best results. A rare form of nerve disease in patients with rheumatoid arthritis that causes numbness and/or tingling is neuropathy. Neuropathy is nerve damage that in people with rheumatoid arthritis can result from inflammation of blood vessels (vasculitis). Vasculitis is not common, but it is very dangerous. Therefore, it is important to notify the doctor if numbness and/or tingling occurs.



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