If this is a medical emergency, call 10177 (ambulance) or go to your nearest emergency room immediately.
AS is a chronic condition, but serious complications can occur. This article covers urgent clinical scenarios and coverage battles you may face.
Medical Emergencies in Ankylosing Spondylitis
Cauda Equina Syndrome
Severe AS with spinal fusion creates a rigid, brittle spine. Minor trauma (even a fall) can cause vertebral fractures in a fused spine — and in the lumbar region, this can cause cauda equina syndrome, with compression of the nerve roots at the base of the spinal cord.
Symptoms: Sudden severe back pain after trauma, new onset leg weakness, numbness in the saddle area (inner thighs, perineum), loss of bladder or bowel control.
Action: Call 10177 or go to the ER immediately. Cauda equina syndrome is a neurosurgical emergency — delayed treatment results in permanent paralysis. This is PMB-covered as an emergency spinal condition.
Acute Anterior Uveitis (Iritis)
Symptoms: Sudden painful, red eye, photophobia (pain in bright light), blurred vision, small pupil.
Action: Go to an ophthalmologist same day (not the ER, unless unavailable). Uveitis is urgent — inadequately treated uveitis leads to permanent eye damage.
Coverage: Ophthalmologist visit and steroid/mydriatic drops are funded from day-to-day benefit. If the uveitis is severe or sight-threatening, emergency ophthalmology assessment is covered.
Vertebral Fracture from Minimal Trauma
A fused AS spine is highly susceptible to fracture from minor trauma. Any fall or impact in an AS patient with significant spinal fusion should be assessed with imaging. A vertebral fracture in AS is a PMB emergency (spinal trauma DTP).
Acute Severe Flare
Most AS flares are managed with NSAID escalation and rest. If a flare is so severe that you cannot function (unable to walk, severe pain) and cannot be controlled at home: - Go to the ER for assessment and pain management - IV NSAIDs or corticosteroid injection may be required - This is an acute event covered under the PMB
Emergency Coverage Summary
| Situation | PMB Status | Action |
|---|---|---|
| Cauda equina syndrome (spinal emergency) | Yes — emergency PMB | 10177 immediately |
| Vertebral fracture (trauma in AS) | Yes — PMB (trauma DTP) | ER/10177 immediately |
| Acute anterior uveitis | Day-to-day + emergency ophthalmology | Same-day ophthalmologist; ER if unavailable |
| Severe acute AS flare (unable to function) | PMB (acute disease management) | ER for IV pain management |
| Surgical joint replacement (severe hip/shoulder disease) | PMB (joint replacement DTP) | Planned procedure — pre-authorise |
If Your Biologic Therapy Is Suddenly Withdrawn
If your scheme stops funding your biologic (formulary change, MCO decision, benefit year change):
- Do not stop the biologic suddenly without medical guidance. Abrupt discontinuation can cause a severe disease flare.
- Contact your rheumatologist immediately to discuss options.
- Contact your scheme's MCO to understand the reason for the change and the appeals process.
- If the withdrawal is mid-treatment: appeal on the grounds that treatment discontinuation constitutes a breach of the PMB obligation for a condition that is being actively managed.
- Council for Medical Schemes: 0861 123 267 — PMB disputes involving ongoing treatment withdrawal are within CMS jurisdiction.
Biologic-Related Side Effects — When to Seek Help
TNF inhibitors (adalimumab, etanercept) and IL-17 inhibitors (secukinumab) suppress the immune system. Side effects requiring urgent assessment:
- Serious infections: High fever, signs of chest infection, sepsis — go to ER. TNF inhibitors increase susceptibility to bacterial and opportunistic infections (TB reactivation is a specific risk — all patients starting a TNF inhibitor should be screened for latent TB first).
- TB reactivation: Cough, night sweats, weight loss, fever in a patient on a TNF inhibitor — urgent GP assessment and chest X-ray. TB treatment must be initiated before restarting biologic.
- Severe skin reaction or anaphylaxis (rare, usually infusion-related): ER immediately.
If Your Pre-Authorisation Is Declined During an Active Flare
If you are in an active, severe AS flare and your biologic pre-authorisation is declined:
- Have your rheumatologist contact the scheme's medical director directly — not the call centre.
- Request emergency expedited review of the clinical motivation.
- In parallel, manage the acute flare with maximum NSAID dosing and, if indicated, corticosteroid injection — document the severity.
- Escalate to CMS immediately if denial persists during a documented severe active disease state.
Resources and Helplines
Emergency services: 10177 (ambulance) | 10111 (police) Arthritis Foundation of South Africa: arthritis.org.za SASOC (SA Society of Rheumatology): sasoc.co.za Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za Talk to Eldon →