Rheumatoid Arthritis: 17 Warning Signs of Serious Complications

Call a doctor immediately if you haverheumatoid arthritisand experience these symptoms

Doctors themselves, or with "call partners," cover urgent medical concerns for their patients when the office is closed.

People withrheumatoid arthritiscan develop certain symptoms that are 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 shortly.

Rheumatoid warning signs can represent a worsening or complications of therheumatoid disease, side effects of medications, or a new illness that is complicating the condition of patients withrheumatoid arthritis. Patients withrheumatoid arthritisshould 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 morepain, 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 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 a doctor is to get better. The doctor knows this. If a patient with rheumatoidarthritishas 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 rheumatoidarthritis. However, a truefever(temperature 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 body's immune system which is responsible for defending against infectious microbes. Furthermore, these medications can increase the risk of more serious infections when a bacterium or virus strikes. People with rheumatoid arthritis need to notify the doctor as soon as afeveroccurs so that infections are treated at the earliest time possible. This can minimize the chances of 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 ofpain, numbness, and/or tingling to the brain. This is callednerve 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 the 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).Vasculitisis not common, but it is very dangerous. Therefore, it is important to notify the doctor if numbness and/or tingling occurs.

Rash

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

Eye redness

Redness of the eyescan represent an infection of the eyes, which is more common in people with rheumatoid arthritis because of dryness of the eyes (Sjögren's syndrome). Redness can also result from blood vessel inflammation (vasculitis), especially when pain is present.

Vision loss of red/green color distinction

A rare complication of the commonly used rheumatoid arthritis drug hydroxychloroquine (Plaquenil) is an injury to the retina (the light-sensing portion of the back of the eye). The earliest sign of retinal changes from hydroxychloroquine is a decreased ability to distinguish between red and green colors. This occurs because the retina's vision area that is first affected by the drug normally detects these colors. People who are taking hydroxychloroquine and who lose red/green color distinction should stop the drug and contact their doctor.

Nausea

Nauseais a common problem in patients with rheumatoid arthritis, usually because of the medications that are required to keep thejoint inflammation最小化。药物经常used to treat rheumatoid arthritis that can causenauseainclude nonsteroidal anti-inflammatorydrugs(NSAIDssuch asibuprofen[Advil],naproxen[Aleve], and many others),prednisoneandprednisolone,azathioprine(Imuran), and methotrexate (Rheumatrex, Trexall). Nausea is usually not serious, but it is always annoying. Depending on the particular situation, the doctor may have the option of stopping the drug, lowering the dose, and/or adding a medication to treat nausea.

QUESTION

The termarthritisrefers to stiffness in the joints.See Answer

Vomiting

Vomitingcan be caused by the same drugs that cause nausea. It is also possible to have a new underlying condition that could causevomiting. It is most important to notify the doctor about this symptom, not only because of what it could represent but also because it can lead todehydration.Dehydrationis never good for patients taking arthritis medications as it can increase the chances of side effects of the drugs, such as kidney injury.

Diarrhea

Diarrheacan also lead to dehydration.Diarrheacan be caused by arthritis medications, such as NSAIDs, oral gold, and leflunomide.Diarrheais also a common side effect ofmisoprostol(Cytotec), a medication that is used to protect the stomach while taking NSAIDs. The doctor may discontinue the drug causing the problem, make a dosage adjustment, and/or add a medication to stop diarrhea.

Constipation

Constipationgenerally occurs in people with rheumatoid arthritis because of medications. Whileconstipationcan happen with almost any medication, it is most common with narcotic pain medications, includinghydrocodone(Vicodin),propoxyphene(Darvocet), and others. People taking these medications should stay well hydrated. If patients with rheumatoid arthritis notice newconstipation, the doctor should be notified.

Dark stools

Dark-colored stools can be caused by bleeding from the stomach. Bleeding from the stomach can be caused byinflammation of the stomach lining(gastritis) or ulcers. Gastritis and stomach ulcers are side effects ofaspirinor any otherNSAID. People with dark stools should notify their doctor immediately.

Insomnia

Insomniais a real hassle. It is not fun and is not healthy for people with rheumatoid arthritis, who require goodsleepto manage their inflammation.Insomniacan occur becausepainful jointskeep people with rheumatoid arthritis awake. It can also be caused by medications, particularly cortisone medications such as prednisone (Orasone) and prednisolone. There are ways of managinginsomnia, and the doctor should be notified if it becomes a regular problem.

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

Unusualheadaches应该报告给医生一般purposes and becauseheadachescan be a side effect of medications. In particular,headachescan be caused by NSAIDs. Sometimes, theheadachesare related to the dosage of the medicine. Lowering the dose can eliminate 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),英夫利昔单抗(Remicade),etanercept(Enbrel),cyclosporine(Neoral), andcyclophosphamide(Cytoxan). An infection should be treated with appropriate antibiotics as early as possible before it becomes serious.

Cough or chest pain

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

Note: The warning signs above are not meant to be all-inclusive. Many other symptoms of illness also are reasons to contact the doctor urgently. For example,vision lossfrom astrokeor chest pain from aheart attackare 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 heightened alertness for these symptoms. They should also feel free to contact their doctor about any health issues or concerns at any time.

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