Warning signs: when to get help
These are the warning signs from our rheumatoid arthritis, Pilates for rheumatoid arthritis, arthritis and neck pain guides, word for word. This is general information, not a diagnosis. A&E means accident and emergency. In the US, call 911 for 999, and use your doctor's urgent line or urgent care for NHS 111.
Get urgent advice the same day
Contact your rheumatology advice line, GP or NHS 111 the same day for:
- Pins and needles, weakness, unsteadiness, clumsy hands or loss of power, especially with neck pain: these can be signs of pressure on the spinal cord, which NICE treats as urgent.
- A hot, swollen joint with a fever or feeling unwell, especially a replaced joint: it could be an infection.
- A flare that won't settle.
Sources 3, 13, 17
New problems walking or a sudden loss of coordination: call 999
Call 999 or go to A&E: new problems walking, loss of bladder or bowel control, or a sudden loss of coordination, such as difficulty doing up buttons. These can be signs of pressure on the spinal cord.
Sources 13, 3
Your neck
Long-standing RA can affect the joints at the top of the spine, which can slip and press on the spinal cord (cervical myelopathy). It is uncommon but serious: NICE asks for an urgent MRI scan and a surgeon's opinion for symptoms such as pins and needles, weakness or unsteadiness, and you may need a neck check before a general anaesthetic.
Tell your team about an electric-shock feeling down your back or arms when you bend your neck forward, or a feeling of your head clunking forward: these can be signs of the neck problem.
Sources 3, 56
A hot, swollen joint
Get help the same day for a hot, swollen joint with a fever, or severe pain and swelling that came on suddenly in one joint.
Some pain when you start is common and isn't a sign of harm if it settles. A hot, swollen joint is different: rest it from strengthening.
Source 14
In a flare
In a flare, rest the inflamed joints but keep them moving gently, then build back up.
NICE says everyone with RA should have rapid access to specialist care for flares. If a flare doesn't settle, or comes with feeling unwell, call your rheumatology advice line rather than pushing through.
Sources 9, 3
Contact your rheumatology team soon
- An activity always makes your joints warm and swollen or causes severe pain.
- New breathlessness or a dry cough that won't go away if you take methotrexate, or frequent infections on biological treatment.
- A tendon that suddenly stops working, or numbness and tingling in your hand.
- Before a new programme, if you have badly damaged joints, joint replacements, heart disease or another condition that needs monitoring.
Sources 14, 20, 3, 13
A possible spinal fracture
Unexplained back pain with muscle spasms, loss of height, or a curved spine or change in posture: a possible osteoporotic spinal fracture, more likely with older age or long-term steroid tablets.
Source 61
Steroids and your bones
If you take steroid tablets, ask your team about your bones. Never stop or change steroids yourself.
Source 61
Chest pain or fainting: call 999
Call 999 if:
- You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
- The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
- You have chest pain and feel sweaty, sick, light-headed or short of breath.
- Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.
Sources 70, 71
Unusual breathlessness
Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.
Source 72
Before you start
The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.
Never stop or change your RA medicines because of exercise or a flare without your team.
During yoga
"If it hurts, stop", the Johns Hopkins arthritis team says. Stop and rest if a pose makes a joint warm and swollen or causes severe pain, and ease off next time if a joint aches more the next day.
Arm symptoms are the exception, as in our neck pain guides. If a pose sends pain, tingling or numbness further down your arm, or the extra symptoms last more than an hour afterwards, make the movement smaller or leave it out.
Source 52