Rheumatoid Arthritis - When Do I Call the Doctor?
Medical Author:
William C.
Shiel Jr., MD, FACP, FACR
Medical Editor: Jay W. Marks, MD
Rheumatoid Warning Signs
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!
Persons 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 healthcare practitioner 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 degrees F or 38 degrees C) is not expected and
can represent an infection. Persons 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 persons 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
persons 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
persons 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.
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