People living in rural areas with psoriatic arthritis (PsA) are more likely to visit the emergency room (ER) for pain and symptoms, even when it’s not an urgent situation. While this might seem like the quickest solution, experts warn it may not always be the best choice.
PsA, a chronic condition causing joint pain and swelling, can sometimes lead to severe symptoms like high fevers or swollen toes that make walking painful. For those living far from their rheumatologist, getting immediate medical advice can be tough. This often leads to ER visits, according to a recent study published in the Journal of Rheumatology.
The study analyzed data from 4,984 PsA patients in rural Canada between 2007 and 2018. It found that nearly half (47.6%) visited the ER annually, even though 44.2% of these visits were for non-urgent issues. Rural patients were twice as likely to visit the ER compared to those in urban areas. However, these visits rarely resulted in hospital admission, highlighting a gap in appropriate care.
Why the ER Isn’t Always Ideal
While the ER can provide quick relief, it has drawbacks. ER doctors may not know your medical history or understand PsA well. “We don’t want patients to avoid ERs if they’re the only option, but we also don’t want them to receive care that isn’t ideal,” says Dr. Elena Schiopu, a rheumatology professor at the Medical College of Georgia.
For example, PsA symptoms like dactylitis (swollen fingers or toes) are often mistaken for infections in the ER, leading to unnecessary antibiotic use. Additionally, ER doctors may overprescribe painkillers like glucocorticoids or high-dose NSAIDs, which can have harmful side effects, such as worsening diabetes or kidney damage.
Dr. Marissa Blum, a rheumatologist at Temple University Hospital, adds that ER visits often provide only temporary relief. “Patients may get a ‘band-aid’ solution but miss out on expert care to manage their condition long-term,” she says.
Better Alternatives to the ER
If you’re experiencing PsA symptoms, calling your rheumatologist should be your first step. Even if you can’t get an immediate appointment, they can offer advice or adjust your treatment plan.
Telehealth is another great option. “Even if I can’t fully examine a patient, I can guide them on managing their pain until they can visit the office,” says Dr. Orrin Troum, a rheumatologist at Providence Saint John’s Health Center.
If your rheumatologist isn’t available, consider speaking with a nurse practitioner or physician’s assistant, who can also prescribe medications.
When to Go to the ER
While ER visits aren’t always necessary, there are times when they’re crucial. Seek emergency care if you experience:
- A sudden, unexplained fever, which could indicate an infection, especially if you’re on immune-suppressing medications.
- A hot, swollen joint, which might signal an infection or severe inflammation.
- Red, swollen, or sensitive eyes, which could point to uveitis or other vision-threatening conditions.
In these cases, immediate care is essential. However, for ongoing PsA management, staying in touch with your rheumatologist is key. Always update them after an ER visit to ensure your treatment plan stays on track.
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