Reasons Why Patients with Inflammatory Arthritis Decide to Seek Emergency Care

A new study discovered patients with inflammatory arthritis seek out emergency department care for 2 common reasons: challenges in healthcare system coordination and system pressures.¹

The Arthritis Foundation states on its website when to visit a primary care provider or rheumatologist, when to go to urgent care, and when to go to the emergency department.² If a patient cannot get a hold of their doctor, the organization recommends going to urgent care if they have a high fever with rash, red, hot, and swollen joints, unusual pain and swelling in a joint, severe and sudden abdominal pain, a severe and atypical disease flare, and sudden spine pain which may signal a vertebral fracture.

The foundation only recommends seeking the emergency department if a patient has life-threatening symptoms—severe chest pain, stroke, sudden vision loss, and uncontrolled bleeding or trauma. A patient would also need to go to the emergency department if their JAK inhibitor such as tofacitinib is causing them serious blood clots or a heart attack. Arthritis drugs may cause a patient to have a severe infection requiring emergency department attention.

Yet, despite the recommendations, patients may seek emergency department care without life-threatening symptoms.

A study in 2022 found patients with inflammatory arthritis often prefer a person-centered approach where providers respect their patients’ preferences, values, and listen to experiences to shape their personalized care.³ Investigators identified 3 sub-themes from the research: patients wanted to be in control and make the decisions over their relatives, more communication and coordination, and help with everyday life after discharge.

A professional not using a person-centered approach may explain why patients seek care elsewhere. Patients tend to use emergency departments to address their medical concerns when ambulatory care systems are doing an inadequate job.

Investigators, led by Emilie Pianarosa, BSc, MPH, from the Cumming School of Medicine at the University of Calgary, aimed to understand the reasons why a person with inflammatory arthritis may decide to have an emergency department visit.¹ They also wanted to know these individuals’ experiences with the emergency department care and post-discharge follow-up.

Pianarosa and colleagues used an embedded mixed methods approach to analyze the quantitative data and free text responses from an online survey. The survey was distributed to residents of Alberta with a diagnosed inflammatory arthritis condition and an emergency department visit.

The sample (n = 82) included respondents with RA (48%), PsA (12%), SpA (6%), and Gout (34%). Respondents were aged 16 – 55 years old. Less than half of the respondents were female (48%) and 50% were urban residents.

The reported concerns included arthritis flare (37%), chest pain (15%), injury (12%), and infection (11%).

In total, 29% of respondents headed directly to the emergency department, 35% tried accessing ambulatory care first, and 32% made a return visit.

Of respondents who reported having an arthritis flare, only 9% knew the emergency department provider contracted a rheumatology service for advice.

Overall, the study found respondents sought out emergency care if they faced challenges in healthcare system coordination and system pressure. The quality of communication and the relationship between patients with inflammatory arthritis and healthcare providers shape the experiences of emergency department care.

“Modifying rheumatology ambulatory care models could better meet patient needs and ultimately reduce avoidable [emergency department] use by [inflammatory arthritis] patients,” investigators concluded.

References

1. ^{Pianarosa E, Roach P, Barber C, et al. Inflammatory Arthritis Patient Decision Making to Attend, and Experience of, Emergency Department Use. J Rheumatol. Published online June 1, 2024. doi:10.3899/jrheum.2024-0111}
2. ^{Rath, L. Know When to Go to the Emergency Room. Arthritis Foundation. February 14, 2024. https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/when-to-go-to-emergency-room. Accessed June 14, 2024.}
3. ^{Feddersen H, Søndergaard J, Andersen L, Munksgaard B, Primdahl J. Barriers and facilitators for coherent rehabilitation among people with inflammatory arthritis – a qualitative interview study. BMC Health Serv Res. 2022;22(1):1347. Published 2022 Nov 14. doi:10.1186/s12913-022-08773-x}