A Guide to Navigating the ER with Arthritis
Living with inflammatory arthritis can be scary. Symptoms range from joint pain, stiffness and swelling to fatigue, flares and serious, life-threatening complications like infections, heart attacks, strokes and blood clots. For this reason, it’s important to understand when to seek emergency care.
According to Dr. Kam Shojania, a rheumatologist at Vancouver General Hospital and clinical trialist at Arthritis Research Canada, there are three main reasons a person living with arthritis should go to the ER: severe pain in one joint, as it could indicate an infection; chest pain or atypical pain in the neck or arm, which could be a heart attack or stroke; swelling in the calf, shortness of breath, seizures or altered mental status, as these symptoms might indicate a possible blood clot.
“Always go to the ER quickly for these symptoms,” Shojania said. “People living with inflammatory arthritis are at an increased risk for infections, as well as heart attacks and strokes.”
He added that people with arthritis can also experience treatment-related conditions. For example, some medications are immunosuppressants, so individuals are at higher risk for infections. They are also at higher risk for drug toxicity, which occurs when someone accumulates too much of a prescription drug in their bloodstream.
“Someone might take methotrexate daily instead of weekly by accident,” Shojania said. “Liver toxicity and reactions to medications are serious issues for people with inflammatory arthritis and are another reason to seek care in the emergency department.”
To help people decide when to go to the ER, how to navigate the experience, and how to prevent ER trips, we’ve put together a comprehensive guide from both the patient and rheumatologist perspectives.
The Patient Perspective
Once a person living with arthritis decides a trip to the ER is necessary, what steps can they take to ensure the visit is both safe and successful? Members of Arthritis Research Canada’s Arthritis Patient Advisory Board have compiled some helpful tips they use to navigate the ER.
What to Bring
Essential Items
- Personal Identification: Government-issued ID and health insurance card.
- List of Medications: Include all current medications (prescription and over-the-counter), dosages, and allergies.
- Medical Records: Recent test results, imaging (e.g., X-rays, MRIs), and details about surgeries or past treatments. Take the time to create your own document tailored to your patient journey. Keep this handy on your phone or print it out. Include phone numbers for your primary care doctor and specialists.
- Symptom History: A written log describing your symptoms, their onset, and any triggers or patterns.
Comfort and Practical Items
- Mobility Aids: Bring canes, walkers, or anything else needed to move comfortably.
- Entertainment: Books, puzzles, or games to help pass the time, as ER wait times can be lengthy.
- Phone and Charger: To stay connected and access important information.
- Snacks and Water: In case of a long wait (but check with the staff before consuming anything).
- Personal Belongings: Items like eyeglasses, hearing aids, or dentures, as well as basic toiletries.
For Immunocompromised Individuals
- Masks and Hand Sanitizer: To protect against germs in a crowded environment, bring extra masks, gloves, and wipes for added safety.
Tips for Avoiding the ER
While emergencies happen unexpectedly, people living with arthritis can also take proactive steps to minimize the need to seek care in the ER. Here are some strategies recommended by people living with different types of arthritis:
Proper Medication Management
- Stick to Your Schedule: Take prescribed medications as directed and avoid skipping doses.
- Monitor Side Effects: Keep track of any adverse reactions and report them to your healthcare provider promptly.
- Avoid Interactions: Always inform your doctor or pharmacist about all medications you take, including over-the-counter drugs and supplements, to prevent harmful interactions.
Schedule Regular Checkups
- Keep Appointments: Regular visits to your rheumatologist or general practitioner can help monitor your condition and catch issues early.
- Update Treatment Plans: As your condition changes, work with your doctor to adjust your medication or therapy.
- Ask Questions: Use checkups to discuss any new or worsening symptoms, even if they seem minor.
Recognize Early Warning Signs
- Pain or Swelling: Address joint pain or swelling early before it becomes severe.
- Signs of Infection: Watch for symptoms like redness, warmth, fever, or fatigue, as these could indicate an underlying issue.
- Unusual Changes: Report sudden changes in mobility, stiffness, or overall health to your doctor as soon as possible.
Healthy Lifestyle Habits
- Stay Active: Engage in low-impact exercises like swimming or yoga to maintain joint flexibility and strength.
- Prioritize Nutrition: A balanced diet with anti-inflammatory foods can support overall health.
- Stress Management: Practice relaxation techniques to reduce stress, which can exacerbate arthritis symptoms.
The Rheumatologist Perspective
Medical History at the ER
If you need emergency care quickly, rest assured that the hospital can view some of your medical records. In British Columbia, all doctors have access to hospital lab tests and consultation notes done at the hospital.
Medical notes taken at the Mary Pack Arthritis Program – which offers arthritis education and treatment services to people in BC – as well as all specialty clinics, are uploaded to Care Connect, a clinical information system. When a doctor sees a patient, they can view the patient’s hospitalization history, labs, and imaging done in the hospital.
Physicians (including ER doctors) do not have access to records from some private doctors’ offices. They are also unable to view scans taken at private radiology clinics. However, many inflammatory arthritis patients are complex and are seen in specialty clinics. ER physicians can view notes taken at these clinics.
“When I send a patient to the emergency room, I always send information about that patient,” Shojania said.
He also provides patients with summaries of their health and labs if they have plans to travel. “It’s a good idea to carry these records with you, so ER doctors – especially in foreign countries – don’t have to scramble,” he said.
Health Risks at the ER
While many people with arthritis worry about contracting viruses at the ER, Shojania said the risk is low.
“The danger of infection is not significant,” he said. “The risk of receiving the wrong diagnosis and treatment is.”
People who come to the ER due to an arthritis flare may receive too high of a dose of prednisone (50mg) to quickly lower inflammation. According to Shojania, being overtreated with steroids is not suitable for inflammatory arthritis flares, as it can mask other symptoms.
Post ER-Visit Steps
Arthritis patients should always request that emergency room notes be sent to their family doctor and specialists.
Shojania also advises patients to call their specialists to let them know that they visited the ER and that records are available through Care Connect.
“Tell your doctor, ‘I was in the ER yesterday and they diagnosed me with pneumonia,’ for example,” Shojania said. He added that this communication is key in case changes need to be made to medications and courses of treatment following an ER trip or diagnosis.
Avoiding the ER
While some arthritis symptoms make a trip to the ER necessary, there are alternative ways to seek care when a person can’t see their family doctor or rheumatologist and is dealing with new non-emergency symptoms.
Shojania said that having a flare management plan in place can be helpful. He also recommends that people living in British Columbia call 811 for free, non-emergency health advice. Most primary care doctors and specialists also have systems in place for after-hours coverage. This can include AI technology apps that send questions to physicians via text or email.
