Rheumatoid Arthritis - When Do I Call the Doctor? (cont.)

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.

Rash: Rashes can occur for many reasons in anybody. However, in people with rheumatoid arthritis, the medications or, rarely, the disease can cause rashes. Medications that commonly cause rashes as side effects include gold (Solganal, Myochrysine), methotrexate (Rheumatrex, Trexall), leflunomide (Arava), and hydroxychloroquine (Plaquenil). A rare, and serious, complication of rheumatoid arthritis is inflammation of blood vessels (vasculitis), which can cause rash that most commonly appears in the finger tips, toes, or legs.