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

Dizziness, lightheadedness, ringing in the ears: Dizziness, lightheadedness, or balance problems are dangerous. Common causes include medications, such as aspirin or other NSAIDs, and low red blood counts (anemia). Ringing in the ears (tinnitus) is a frequent side effect of aspirin and NSAIDs. The doctor must be notified should any of these symptoms be noticed.

Headache: Unusual headaches should be reported to the doctor for general purposes and because headache can be a side effect of medications. In particular, headaches can be caused by NSAIDs. Sometimes, the headaches are related to the dosage of the medicine. Lowering the dose can eliminate the headaches while still providing a beneficial effect. All medication changes should be guided by the doctor.

Infection: People with rheumatoid arthritis are at increased risk for infection. This risk occurs because the rheumatoid disease is an immune-suppressed condition and because many of the medications that are used to treat rheumatoid arthritis can suppress the immune system. Examples of rheumatoid medications that suppress the immune system are methotrexate (Rheumatrex, Trexall), azathioprine (Imuran), infliximab (Remicade), etanercept (Enbrel), cyclosporine (Neoral), and cyclophosphamide (Cytoxan). An infection should be treated with appropriate antibiotics as early as possible before it becomes serious.

Cough or chest pain: Chest pain that is caused by arthritis of the chest wall is not an emergency and does not warrant notifying the doctor immediately. However, unexplained chest pain or cough can represent serious underlying disease of the heart or lungs. It should be remembered that people with rheumatoid arthritis are at increased risk for infection of the breathing passages and lungs. Such infection requires antibiotic treatment. Furthermore, methotrexate (Rheumatrex, Trexall) can cause lung inflammation, the first sign of which is often a persistent cough. Chest pain can also be caused by the reflux of acid from the stomach into the esophagus. This condition can be aggravated by aspirin and other NSAIDs.

Note: The warning signs above are not meant to be all inclusive. There are many other symptoms of illness that also are reasons to contact the doctor urgently. For example, vision loss from a stroke or chest pain from a heart attack are reasons to contact a doctor immediately. The symptoms listed above are warning signs that occur more commonly as a result of rheumatoid disease. People with rheumatoid arthritis, therefore, should have a heightened alertness for these symptoms. They should also feel free to contact their doctor about any health issues or concerns at any time.


Klippel, J.H., et al. Primer on the Rheumatic Diseases. New York: Springer, 2008.

Last Editorial Review: 1/31/2012