Rheumatology Patients and the Emergency Room

Arthritis is generally considered a chronic condition, something you will live with for the rest of your life, and a condition you need to learn how to manage. But, there are acute situations, even related to arthritis, that can create an emergency. A rheumatologic emergency is serious and requires immediate medical attention. It's important for you to recognize these potential situations and know that you need to seek immediate medical attention if it should develop.

Safe to say, no one wants to go to the emergency room. It's nearly impossible to admit to yourself that you are in crisis. In that time of crisis, you have to circumvent the emotional aspects of an emergency and just get the help you need and get it fast. It helps to know ahead of time what circumstances and medical situations are true emergencies. When you are in the midst of an emergency, there can be no denying it.

Usual Warning Signs of a Medical Emergency

The American College of Emergency Physicians offers a list of warning signs that point to a medical emergency. The warning signs include:

• Difficulty breathing or shortness of breath
• Chest or upper abdominal pain or pressure
• Fainting, sudden dizziness, weakness
• Changes in vision
• Confusion or mental status changes
• Sudden or severe pain
• Uncontrolled bleeding
• Severe or persistent vomiting or diarrhea
• Coughing or vomiting blood
• Suicidal thoughts
• Difficulty speaking
• Unusual abdominal pain

There are not many surprises on the list. The dozen or so signs and symptoms listed are well-recognized emergency situations, deserving of a trip to an emergency room or a 911 call for emergency assistance and transport. Beyond these well-known emergency situations, there are other circumstances recognized as critical for rheumatic disease patients. Especially in patients with connective tissue diseases or vasculitis, there can be unique dangerous and life-threatening circumstances that require immediate treatment.

Rheumatologic Emergency

Other situations that are considered rheumatologic emergency include:

• Septic arthritis
• Gout attack
• Atlantoaxial subluxation with spinal cord damage (e.g., rheumatoid arthritis)
• Renal crisis (e.g., scleroderma)
• Digital ulcers/gangrene (e.g., scleroderma)
• Blood clots (e.g., antiphospholipid antibody syndrome)
• Amaurosis fugax—sudden, painless, temporary loss of vision in one eye (e.g., giant cell arteritis)
• Pulmonary-renal syndrome (e.g., vasculitis)
• Severe infection

The Bottom Line

It is important to be aware of usual medical emergencies, but rheumatic disease presents another level of complication and the possibility of emergency situations. You must be vigilant and have a keen awareness of sudden physical changes. Don't talk yourself out of the potential severity of what is occurring. Let healthcare professionals decide.

Discuss with your healthcare provider the possibility of emergency situations that could arise related to your rheumatic disease or the treatments and medications you use regularly. Know the potential side effects and adverse events that can occur. Develop a heightened awareness so that you can recognize what is happening if it does occur, and get the necessary emergency care. Also, trust your first instinct about going to the emergency room. Don't overthink whether you should go or not. It's better to be safe than sorry.