1. Community
  2. Bones, joints and muscles
  3. Rheumatoid Arthritis

is Arthritis classed as an emergency?

Posted , 11 users are following.

laura333
laura333

Hey,

I really need some help so would be grateful for any advice! I'm having a really bad flare up and it's probably the worst it's ever been!! My knee is actually swollen to look at and I have only ever had one swollen joint before and that was my thumb. I'm 22 years old and have been diagnosed with arthritis almost two years ago, I think. I have been on methotrexate around 8 months, which I am really struggling with as it makes me really really ill, even just the thought of it makes me want to throw up! Methotrexate is my second medication I have tried as the first option didn't help, but I fear methotrexate isn't working now too!! I've struggled to do anything this week and I'm desperately trying to get an emergency appointment at the hospital for a steriod injection but I am unable to speak with anyone over the phone.

Does anyone know if I just went to hospital like to A and E, would they be able to give me a steriod injection? Or is this not acceptable and would I be wasting their time as 'not an emergency'? I'm really desperate and in so much pain please does anyone have any advice?

Thanks in advance!

1 like, 49 replies

49 Replies

Next
  • Rowbirdie
    Rowbirdie laura333

    Posted

    Hi laura

    i don't know if it's the same for you, but  I have a number to call for advice, the rheumatology nurse. I have done this several times and they can ask the consultant for advice/ then medication via GP. I have had this once for steroid jab, another time for increase in meds, another time she was able to book me into the flare clinic the next day at the hospital. I doubt A and E could help as this was all run by my consultant , even though I didn't actually see him. Hope you have a number to be able to do this.

    • laura333
      laura333 Rowbirdie

      Posted

      Hi Rowbirdie

      Thanks for your reply. Unfortunately I don't have a number for my hospital. At the moment they don't have a arthritis helpline for me to ring. I have rang the secretary for my doctor and I am waiting a call back so hopefully my doctor can advise.

    • anne04253
      anne04253 laura333

      Posted

      just wondering if you have been to the hospital A and E yet? As 4 days ago you were in a lot of pain with RA.  Most people can't  get a GP appointment for a few days and rheumatology appointments take ages! I don't know where in the UK you are but it's amazing you even have a number for the secretary of 'your doctor' at rheumatology - is it not a reheumatology clinic then, with multiple consultants?

      Anyway I really hope that with your swollen knee you have manged to get to a hospital A and E for help over the past 4 days instead of asking random strangers over the internet.

      I think you wrote you are 22 not 82 so apart from the severe pain and swollen knee you should be able to function in an A &  E wIting room.

  • vickie3
    vickie3 laura333

    Posted

    Hey,

    I'd be so tempted to go to A&E too. But I think it would be best to try other options first.

    Try calling your doctor and telling them it's an emergency (I would say it is as swelling for any length of time in RA is a sign that joint damage is actively happening, which needs addressing to avoid future joint deformaties). Doctors surgeries often have slots reservered for emergency patients. If the doctor deems it to be necessary, he/she then may be able to call ahead to a hospital and get you seen to relatively quickly.

    The only other thing I would suggest is an NHS walk-in centre. I'm not sure if they'd be able to administer an injection then and there, but again they may be able to arrange some help for you.

    I had a similar situation a while ago. My feet were crippling me so I hobbled to the doctor and asked to be seen. They said they there were no appointments that day. But I was so desparate that I started crying and told them that I was happy to sit and wait all day just in case they had a cancellation. I felt pathetic, but they were very understanding and managed to fit me in pretty quick. Not something I would recommend though smile

    Vic

  • EileenH
    EileenH laura333

    Posted

    I assume you are in the UK so try calling 111 and ask them for advice. They will advise you - they aren't all bad if you've heard bad things about their service. They are more likely to tell you to go to A&E than dismiss you though.

    A GP should also be able to send you to hospital - and this would be an emergency as far as they are concerned. 

    But as Rowbirdie says - you should have access to a rheumatology specialist nurse. My experience of one was I was told she'd call me back and nothing happened in the next month so it wasn't much use!

    Frankly though - if you are in so much pain I doubt A&E would accuse you of time wasting - so I wouldn't rule out going there. 

  • bronwyn97278
    bronwyn97278 laura333

    Posted

    Hi Laura;  as an ex ED staffer, it really is only for Accidents and Emergency (meaning has this only started today/last few hours after normal GP's working hours)?   However, if it were me answering your call as the Triage, I would suggest you firstly, ring an After hours clinic,explain your Pain Level (they should ask "out of a score of 10"....you reply 11 +  ), hopefully they can give you a shot of Pethidine/morphine or something similar, to get you through the night; and advise you to ring your Rhuematologist first thing in the morning, as they are really the only ones who can administer Cortisone into your joint?  (in Australia anyway).  If you try this, and get no results, then ring the ED, explain that you have tried other avenues (eg the after hours clinics)...and explain to the person answering, exactly the above....tell them you are hoping that they can give you something for the pain (don't mention what, as you will be classed as an abuser of Narcotics)....hopefully they will adminsiter a stong analgesia, to get you through the night, and they too will advise you to ring your Rhuematoligist first thing in am....hoping this gives you something to work on?    Will be waiting to hear how you get on......Bron
    • EileenH
      EileenH bronwyn97278

      Posted

      I assume Laura is in the UK. Here the A&E department functions as an after-hours clinic for anything much more than needing a prescription for abx. There are no walk-in ones outside very large cities - the 111 number I mentioned is the equivalent.

      Nor is it possible to "ring your rheumatologist in the morning" - all NHS specialists provide their services from a hospital department with clinics for out-patient access unless they offer private consultation for megbucks which is NEVER covered by the state system. Laura says she has tried calling the hospital for an emergency appointment but can't speak to anyone. Hence her problem.

    • bronwyn97278
      bronwyn97278 EileenH

      Posted

      Oh gosh;  once again I am grateful that our system is better in Australia...you guys certainly don't have a lot of choices, do you?   So sorry for the misunderstanding/advice as at the time of my original response (which although it says 2 hours ago was actually last night...about 12 hours ago)...and our system is very different -   there is No being able to make "an appointment at our A&Es" ...we Do have Private Rhuematologists,,,who do get subsidized by our Public health System...with some out of pocket (about $30 or so) expense...There are these "clinics" popping up, but still only have GPs..no Specialists..they only work 8am - 5pm, even the hospital clinics....very different, and sorry for not being of any help....I do hope Laura was able to get the help she needed for her unstable pain....as I feel for her;  was she able to get the pain relief she needed by ringing 111  ???  perhaps I need to try and Reserch the UK's Health System....so many differences....eek   Bron
    • EileenH
      EileenH bronwyn97278

      Posted

      Sorry - I don't understand, we don't make appointments at A&E either. It is an emergency system - the 111 number is a telephone triage system who will help you decide the most appropriate course of action. They can give you a time to be seen at the out-of-hours (OOH) doctor to make the best use of their time so they aren't driving to do house calls when they could be seeing a patient but it is to save you sitting around for long, not an appointment in the normal sense of the word. Quite a few of them are based in a clinic room in a hospital which makes it easy for them to send you across to A&E if that is more appropriate. The telephone triage system may tell you to go to A&E if you can get there and will also pass the call over to the ambulance service for ambulance response if they think that is the right approach. Or they may explain it is a chronic problem ("I've had backache for 3 weeks" ) which you should take to your GP. 

      GPs don't work overnight, but some work into the evening, maybe 8pm, to provide access for people who work.But that means their appointments for the day are fairly full and an emergency is covered by the person assigned to be duty doctor. They see last minute appointments and do house calls where possible. Laura was likely to need an injection and the person doing on-call that day wasn't able to provide that - another doctor might have been able to do so.

      I know people who live in the sticks in Australia who have told me they don't have your options either - like one GP locally and anything up to 3 or 4 hour journeys to see a rheumatologist. It is similar in the UK - if you live in London, for example, there are far more options than if you live in a rural area. Some very rural areas have a paramedic and ambulance who provides mobile emergency cover - but they couldn't give a steroid shot either, they would assess if this was something requiring transport to hospital which might be a 3/4 hour journey even on blue lights during which time (1 1/2 hours there and back) they are unable to respond to another call. And the patient has to get home again too - it isn't a taxi service!

      There are a lot of problems in the NHS because of too many people and high costs but I don't think it is fair to say a blanket "our system is so much better". It is DIFFERENT. I can't imagine even in a big Australian city you could get an appointment at the drop of a hat - that would mean the doctor was working at 80% full capacity all the time. And on any day, the emergency slots could be filled and you would still have to wait. 

      It is perfectly possible that the best course of action for Laura would have been to head to A&E at the hospital where her rheumatology department is based. The A&E staff would then call one of the rheumatology team to make a decision about the best action to take about what is probably a flare of active RA - which needs dealing with quickly to cover the flare and a reassessment of the on-going medical treatment. The MTX doesn't appear to managing it alone. A GP could also make that decision - and hand her a letter to take to A&E. A&E is always thought to be Accident and Emergency - not always, it is Admissions and Emergencies in some hospitals. 

  • Rowbirdie
    Rowbirdie laura333

    Posted

    Hi

    i think your gp can do a steroid injection in the backside. I am not sure about    In the joint as I had mine done in rheumatology clinic. But pester your gp or rheumy nurse. As someone said, you could at least get a strong painkiller to tide you over. But it sounds like they need to look again at your meds to try and control this flare in general. Hope you manage to get some help.

  • AnnaDevs
    AnnaDevs laura333

    Posted

    Hi Laura

    Rheumy Nurse would be good because they can advise on meds but for quick fix while you wait for appointment would be gp. I have been advised that it is classed an an emergency at the gp's so can get appointment same day. I have a steroid injection in my bum and that does me until appointment with rheumy. Good luck x

  • daniela12054
    daniela12054 laura333

    Posted

    Hi Laura, I am so sorry you are so young dealing with such problems. Have you ever been tested for Lyme Disease? Have you ever gone camping, done gardening, golfed, hiked, walked through the woods, tall grass or across a grassy lawn? You may have been bitten by a tick.
    • EileenH
      EileenH daniela12054

      Posted

      " typically wayyy too young to be afflicted with arthritis"

      There are more cases of juvenile arthritis (ages up to 16)  in the UK than cases of Lyme disease (all ages). Lyme is increasing in the UK but there are relatively few areas where is is endemic.

      Juvenile arthritis can affect children as young as 2. This isn't osteoarthritis we're talking about which is caused by wearing away of the cartilage by use - this is one of the autoimmune diseases where the body attacks and destroys the tissues, in this case joints, and destroys them. Too many people think it is only "old" people who have arthritis.

  • cheria
    cheria laura333

    Posted

    Yes, this can certainly be a need to go to the emergency room. They can access you and give you steroid injections to help you relieve this horrible pain. Methotrexate is toxic to many, including myself, and is not tolerated, and a sign that my body was rejecting this toxin. It felt as though I was taking arsonic each time I took this, and induced terrible flares that seemed unbearable. I went off after 2 months, as this was not effective and was toxic to me. From my research, Methotrexate only helps 30% of those taking it. It is one of the first medications doctors try, to see if this helps or hurts. If you read the literature that goes with this drug, you will read that if you experience these toxic side effects, this should be STOPPED. This medication caused tremendous pain and flares, lowering my immune system, and causing systemic body infections, making my RA intolerable. When I stopped this toxic medication, my nausia, all over joint and muscle pain, and continuous flares in my knee and hands, wrists and feet. Like I said, I tolerated this noneffective toxic medication for only 2 months. I hope you go to the emergency room and find relief very soon.
    • cheria
      cheria

      Posted

      What often happens is that methotrexate, and even biologics can induce temporary lupus, which goes away when these medications are withdrawn. I take plaquinil for my RA, mobic for the much needed inflammatory, and a low dose of 5 mg prednisone to help me effectively manage my RA. No methotrexate or biologics at all.
    • laura333
      laura333 cheria

      Posted

      Hi Cheria

      Thanks for the reply. So do you think if I go to A and E they will be able to give me a steroid injection? I'm absolutely desperate here! Really need help sad

    • laura333
      laura333 cheria

      Posted

      Hi Cheria

      Thanks for the reply. So do you think if I go to A and E they will be able to give me a steroid injection? I'm absolutely desperate here! Really need help sad

    • cheria
      cheria laura333

      Posted

      Yes, I do believe very strongly that going to the A & E will give you the relief you are needing. Be sure to tell them your pain is very high, when they ask, and if asked to rate this on a scale from 1 to 10 that it is in the very high numbers. The emergency care is there for relief of high pain, and its extremely inefficient and wrong to have a doctor on call that does not do what is needed as an on call physician. Look for another RA doctor.
    • laura333
      laura333 cheria

      Posted

      I think I am going to have to go to A and E and hope they provide me with thr help I need. My RA doctor has not contacted me back as yet so still waiting but it is my actual GP who advised they cannot gove me a steroid injection this afternoon.
    • EileenH
      EileenH laura333

      Posted

      If the A&E is at the same hospital as your specialist they will be able to get one of his team to see you - don't worry, A&E staff don't mind dealing with someone who really has got a problem and you do. They are less enthusiastic about the person who turns up with a cold or a broken nail - and that does happen believe me!

      Good luck - hope they can sort you out. Do tell them how ill the methotrexate is making you feel too and you will probably get an emergency rheumy clinic appointment as well at the same time.

    • EileenH
      EileenH cheria

      Posted

      Laura is in the UK - there isn't a choice of RA doctors working in offices - all specialists work in hospitals. Not all GPs have the experience to give intraarticular cortisone shots and it is a GP who can't do it. 
Back to top
Next

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.