Viral arthritis

Viral arthritis is inflammation of the joints set off by a viral infection. Sometimes the virus itself reaches the joint; more often the joint lining is inflamed by the immune system's response to the virus. Either way the joints become painful and stiff, and some of them swollen, during the illness or in the weeks that follow.

It is not the same as the all-over aching of flu, which is felt mostly in the muscles. In viral arthritis the joints themselves are inflamed: tender, stiff and, some of them, swollen. Where a virus has left joints that ache but look normal, our joint pain without swelling guide is the one to read.

Most viral arthritis clears by itself and leaves no lasting effects. For as long as it lasts, though, it can closely resemble the beginning of rheumatoid arthritis. So the right course is to treat the symptoms, and to have a GP look, within days, at any joint whose swelling has lasted a week or two.

Many viruses can do it. These are the ones most worth knowing:

• Parvovirus B19, the virus of slapped cheek syndrome and the one found most often. Children get the red cheeks. Adults do not usually get the rash on the face, and around half of them develop pain and stiffness in the joints, women more often than men. The infection calls for advice straight away in pregnancy, and within days for people with a blood disorder or a weakened immune system, as the seek-help section says.
• Rubella (German measles), rare now, which can cause aching fingers, wrists or knees, especially in adults. A rash in pregnancy, or contact with rubella, needs a call to a midwife, maternity unit or GP straight away. The MMR vaccine, which protects against it, can itself be followed by aching joints two to three weeks later. This is a common side effect, usually mild, and it passes in two or three days.
• Hepatitis B and hepatitis C, infections of the liver passed on through blood, and hepatitis B through other body fluids as well. With hepatitis B the joints can become painful early on, before any yellowing of the skin or eyes; yellow skin or eyes are for a GP urgently, or NHS 111, that same day. With long-standing hepatitis C, joint pains can be among the symptoms and a true arthritis is less usual.
• HIV, which can cause a short flu-like illness two to six weeks after infection, and joint problems of several kinds over the longer course of the infection.
• Chikungunya, caught from mosquito bites, which brings a sudden fever with joint pain that can be disabling. It is found mostly in tropical and subtropical countries, though it has reached Italy and the south of France. Zika and dengue are spread the same way and can cause joint pain as well, and Zika can swell the joints; dengue also turns up, between spring and autumn, in parts of southern Europe. Anyone who feels unwell after a trip to a country where one of these infections, or malaria, is found should tell a GP urgently, or NHS 111, the same day, and say where they have been.
• The virus that causes COVID-19, which can be followed by Long Covid, where joint pain and aching muscles are among the most common symptoms; the Long Covid guide covers them. A joint that swells after COVID-19 should be assessed like any other swollen joint, by the rules the seek-help section gives.

The list is not complete: other viruses do the same now and then.

Viral arthritis tends to start abruptly, and to follow a recognisable pattern:

• Pain and stiffness in several joints at once, usually the same joints on both sides of the body
• The small joints of the hands, the wrists, the knees and the ankles affected more than others
• Swelling of some of those joints
• An illness at the same time or in the days or weeks before: a fever, a headache, aching muscles, feeling unwell, and sometimes a rash
• Other people at home or at school unwell at about the same time

Joint pain that comes while you still have a fever, or feel shivery or unwell, should be assessed the same day by a GP or through NHS 111, even when a virus seems the likely explanation, because infection in a joint must first be excluded. If there is also a rash that does not fade when you press it, or another sign of the first list in the seek-help section, such as shaking with a high fever, rapid breathing, feeling dramatically worse over hours, a very bad headache, a stiff neck, confusion or a seizure, treat it as a 999 or A&E emergency, whatever a virus might otherwise explain.

How long the joints take to settle depends on the virus. With most, it is a few weeks, sometimes months. After parvovirus, several weeks is usual; rarely the joint symptoms last for months, or come back some months after the infection. After chikungunya the joint pain usually ends within days or weeks, but in some people pain and arthritis persist for several months or even years. None of these figures is a reason to wait with a swollen joint: a week or two of swelling in one joint, swelling in small joints of the hands or feet or in more than one joint, and swelling that worsens or comes back are all for a GP within days.

It starts with what you can tell the doctor: the illness that preceded the joint pain, any rash, who else was unwell, where you have travelled, and whether there has been any risk of an infection carried in the blood. An examination follows, because a joint that is swollen means more than a joint that only aches.

Point-of-care ultrasound is part of the consultation with Dr Borukhson, and the scan is done there and then on the joints that are affected. Ultrasound can detect inflammation in the small joints and around the tendons that an examination does not always find, and the scan of that first visit is kept, so that a later one can be set beside it. Our ultrasound clinic page describes the scan.

Which blood tests are done depends on what the account and the examination suggest:

• The inflammation markers, CRP and ESR, are usually raised while the joints are inflamed, but they do not say why, and normal markers do not rule a lasting arthritis out. Our raised inflammatory markers guide explains them.
• Tests for the virus itself can be done where the answer would change something: for parvovirus where the pattern fits, for hepatitis B, hepatitis C and HIV where there has been any risk, and for the infections caught from mosquitoes after travel.
• Rheumatoid factor and anti-CCP antibodies need careful reading. Rheumatoid factor can turn weakly positive for a time during a viral infection, and about one person in twenty without rheumatoid arthritis tests positive for it in any case. In viral arthritis anti-CCP is typically negative, which is why a positive test weighs heavily in favour of rheumatoid arthritis; a negative one does not prove a virus, and joints that stay swollen are referred whatever the blood tests show. Both tests have a guide of their own, rheumatoid factor and anti-CCP.
• The antinuclear antibody, ANA, can also appear for a while after some viral infections, at a low level. The positive ANA and autoimmune blood tests guide says what a result means.

Often time gives part of the answer, since most viral arthritis is over within weeks to months; the joints are looked at again to see that they are following that course.

Several other conditions begin in the same way, and telling them from a viral arthritis is the purpose of the assessment:

• Rheumatoid arthritis and the other lasting kinds of inflammatory arthritis. Swelling and long morning stiffness that persist, and a positive anti-CCP test, point this way. Joints that stay swollen are referred to a specialist without waiting for the cause to be certain, and urgently when small joints in the hands or the feet, or more than one joint, are involved, or when three months have passed since the symptoms began. Three months is the time that matters: treatment for a lasting arthritis does most when it starts within about three months of the first symptoms, so see a GP within days once a joint has been swollen for a week or two, and do not spend those months waiting to see whether it was a virus. Our early inflammatory arthritis guide describes that stage, and the rheumatoid arthritis guide the condition itself.
• Reactive arthritis. It starts, as a rule, one to four weeks after an infection such as food poisoning or one caught through sex, usually affects the knees and the feet, and can involve the eyes: an eye gone red and painful, or any change in sight, needs an eye casualty or urgent eye clinic the same day, though sight that is suddenly lost, even for a short time, is a 999 or A&E emergency, as the first list under When to seek help says; in pregnancy, any change in sight, blurring or flashing lights among them, is also for your midwife or maternity unit straight away, since it can be a sign of pre-eclampsia; the reactive arthritis guide has more.
• Gout, pseudogout or an infected joint. One joint that has gone hot and very swollen is a different question from several aching joints. With a fever or feeling unwell it has to be seen the same day, either at A&E or by calling NHS 111, and with shaking, confusion, rapid breathing, or feeling dramatically worse over hours it is a 999 or A&E emergency, as the first list under When to seek help says; without a fever or feeling unwell, it is still a same-day matter, through an urgent GP appointment, NHS 111 or a specialist clinic that can see you that day. Our gout, pseudogout and septic arthritis guides describe the three.
• Lupus and the other connective tissue diseases. Joint pain with a rash and a positive ANA can also be how lupus begins, and parvovirus in particular can imitate it for a while; after a virus the antibodies fade within weeks to months, and where they do not the question is looked at again. The lupus and connective tissue disease guides describe these conditions.

Our joint swelling guide sets out the full range of what a swollen joint can be.

Treatment eases the symptoms while the infection runs its course:

• Rest at first, then a gradual return to activity as the joints allow.
• Pain relief with paracetamol, or with an anti-inflammatory painkiller such as ibuprofen where it is suitable for you. In pregnancy paracetamol is the one to use, and the seek-help section says when to ring a midwife; with hepatitis a doctor should advise on which painkillers are safe. Illness after travel to a country where dengue is found is a further exception: see a GP urgently or call NHS 111 that day, and until then keep to paracetamol, since ibuprofen, aspirin and the other anti-inflammatory painkillers can cause bleeding problems in dengue.
• Drawing off fluid from a joint where the inflammation is severe, which can relieve the pain and allows the fluid to be tested; our joint aspiration guide describes how it is done.

An arthritis that is settling by itself does not need the disease-modifying medicines that rheumatoid arthritis is treated with, and telling the two apart spares people treatment that would do them no good.

Where the virus is hepatitis B, hepatitis C or HIV, care turns to the infection itself, under the specialists in that infection: hepatitis C can be cured, and hepatitis B usually clears by itself, with antiviral medicines the usual treatment where it becomes long-lasting. And where an arthritis persists for months, as it can after chikungunya in particular, a rheumatologist may treat the joints with the disease-modifying medicines used for other persistent inflammatory arthritis. You and Dr Borukhson settle the plan together.

While the joints settle:

• Rest when you need to, and build your activity back up gradually.
• Take paracetamol or ibuprofen if you are uncomfortable and they are suitable for you, and drink plenty of fluids. In pregnancy keep to paracetamol, and ring your midwife, maternity unit or GP straight away if you think the cause could be slapped cheek syndrome or rubella; with hepatitis ask your doctor first. If you became ill after visiting a country where dengue is found, choose paracetamol, leave ibuprofen and aspirin out, and speak to a GP urgently or NHS 111 that day.
• Think about who you could pass it to, which for slapped cheek syndrome is no one by the time the rash or the joint pains appear, so there is no need to stay off work once they have. Rubella spreads from a week before the symptoms until at least five days after the rash appears: if you think you have it, ring the surgery before going in, stay off work for at least those five days, and try to avoid close contact with anyone who is pregnant.
• Ask for a test if you think you could have been exposed, weeks or months ago, to hepatitis B, hepatitis C or HIV: a GP can arrange it, and for HIV and hepatitis C so can a sexual health clinic.
• Mention any travel abroad in the past year to whoever assesses you, because an infection caught from a mosquito can take months to show itself. If you are unwell after a trip to a country where such infections are found, ring a GP for an urgent appointment, or NHS 111, that same day, as the next section sets out.

Most viral arthritis needs time and not urgency. The lists below hold what cannot be left: a joint that will not work or looks infected, a fever with the joint pain, the signs of sepsis and a rash that does not fade when you press it, the signs of a stroke or of an inflamed brain, illness after travel, the eye, a severe allergic reaction to a medicine, and a few signs tied to particular viruses or to pregnancy.

Treat any of these as a 999 or A&E emergency: call 999 and do not drive yourself to A&E.

• A joint you cannot put weight on or move, or that has moved out of place, or, after a fall or injury, very bad pain or any tingling or numbness
• Severe illness with suspected sepsis: a high fever with shaking, confusion, rapid breathing, or feeling dramatically worse over hours
• With a fever or feeling unwell, a rash that does not fade when you press it, a very bad headache, a stiff neck, eyes that cannot bear bright light, confusion, a seizure, or skin, lips or tongue turning blue, grey, pale or blotchy, since meningitis can begin like flu, and a rash or skin of this kind can also be a sign of sepsis, though a blotchy rash of flat or slightly raised spots, of the kind dengue and other viral infections can bring, is not the blotchy skin meant, unless it does not fade when you press it; on black or brown skin the rash and the change of colour may be easier to see on the palms of the hands or the soles of the feet
• Sudden weakness or numbness on one side, a drooping face or difficulty speaking, a sudden severe headache, sudden confusion or a seizure, or sudden loss of vision, any of which can be a stroke, even if it stops after a short time, and with a viral illness the brain itself can become inflamed, which can bring on confusion, a seizure, difficulty speaking, weakness in part of the body, a change in personality or behaviour, or a loss of consciousness over hours, days or weeks rather than all at once
• An eye that suddenly and completely loses its sight
• Lips, mouth, throat or tongue that suddenly swell, a throat that feels tight, very fast breathing or a struggle to breathe or to swallow, skin, tongue or lips turning blue, grey or pale (on black or brown skin this may be easier to see on the palms of the hands or the soles of the feet), becoming suddenly very confused, drowsy or dizzy, or fainting and not being able to be woken, since this can be a severe allergic reaction, anaphylaxis, which can follow a dose of any medicine
• After travel to a country where dengue is found, severe tummy pain, being sick again and again, fast breathing, bleeding from the gums or nose, or blood in your vomit or poo, since these can be signs of severe dengue
• Numbness, pins and needles, weakness or pain that spreads from the feet and hands to the arms and legs, or trouble swallowing, in the weeks after an infection or after travel to a country where Zika is found, since a rare condition of the nerves, which needs treatment in hospital, can follow infections, Zika among them

Any of these needs an assessment that is urgent, on the same day, from your GP or NHS 111:

• A joint that is hot and swollen, with a fever or feeling unwell, since an infected joint has to be ruled out at once, at A&E or through NHS 111
• A joint that has become hot and very swollen suddenly, or is worsening quickly, even without a fever, since an infected joint does not always announce itself with one
• Joint pain with a fever, or feeling hot, cold or shivery, or generally unwell, since an infection in or around a joint has to be found the same day
• Feeling unwell after travelling to a country where chikungunya, dengue, Zika or malaria is found, for example with a fever, a rash or painful joints, since infections caught from mosquitoes have to be tested for; say where you have been, and when
• Tingling, numbness or pins and needles confined to the feet, the hands or both, on both sides, or weakness there, in the weeks after an infection, since a rare condition of the nerves can begin this way; once any of these spreads to the arms and legs, it belongs to the first list, as does weakness or numbness on one side that came on suddenly, which can be a stroke, or weakness on one side or in one part of the body that has come on over hours, days or weeks, which can be an inflamed brain
• Skin or the whites of the eyes turning yellow, which can be a sign of hepatitis
• With slapped cheek syndrome, very pale skin, shortness of breath, extreme tiredness or fainting, since these can be signs of severe anaemia, a risk for people with a blood disorder or a weakened immune system; with a fever or feeling unwell, pale skin belongs to the first list, as does skin, lips or tongue turning blue, grey or blotchy, and, fever or not, so does skin that turns pale after a dose of a medicine, since that can be a severe allergic reaction; breathlessness that is severe, with gasping, choking or no breath to get words out, or a faint from which the person cannot be woken, is a 999 or A&E emergency: call 999 and do not drive yourself to A&E
• If you are pregnant, a new rash, suspected slapped cheek syndrome, or close contact with someone who has it or rubella: ring your midwife, maternity unit or GP straight away, since either infection can affect an unborn baby; if you have a rash, stay away from antenatal clinics and maternity units until it has been assessed, so that other pregnant women are not exposed
• A new red, painful eye, or sight that has blurred, dimmed or changed, which needs an eye casualty or urgent eye clinic the same day, as does an eye that light hurts, since joints inflamed after an infection can turn out to be reactive arthritis, which can inflame the eye as well; the uveitis guide describes it; in pregnancy, any change in sight, blurring or flashing lights among them, is also for your midwife or maternity unit straight away, since it can be a sign of pre-eclampsia

Joints that are simply aching and on the mend usually need nothing but time. With none of the signs listed above, see a GP within days, however plainly a virus seemed to be the start of it, about a joint that has stayed swollen for a week or two; about swollen small joints in the hands or feet, or more than one swollen joint; about swelling that is getting worse or has come back; and about joints that are still stiff more than half an hour after you get up. For these joint problems, booking a specialist assessment yourself is the alternative to the GP. Within days, too, speak to a GP about slapped cheek syndrome, or contact with it, if you have a blood disorder or a weakened immune system, since in both the infection can cause severe or lasting anaemia. A routine GP appointment will do for a swollen joint with no evident cause that a few days have not settled; for joint pain that has not improved after two weeks, that is getting worse, that keeps coming back or that gets in the way of ordinary activity or of sleep; and for suspected rubella, ringing the surgery first because it spreads. If you cannot tell how urgent something is, asking is never a mistake.

A viral arthritis that behaves as expected is looked after at home and by a GP, and for most people it ends there. When joints do not settle, a rheumatologist's assessment is useful whichever way it comes out. If the lining of a joint is inflamed and staying inflamed, treatment begins early, while it can still protect the joint. If the account, the examination, the scan and the blood tests all point to a virus, you avoid medicines you do not need and know roughly how long recovery should take. What the visit settles is which of the two you have.

How long does viral arthritis last?

Usually weeks, sometimes months. With most viruses the joints settle over a few weeks as the infection clears, and they are left unharmed. After slapped cheek syndrome, which parvovirus causes, joint pain commonly goes on for several weeks; rarely it lasts months, or returns some months later. Chikungunya, a virus caught from mosquito bites abroad, is the notable exception in how long it can last: its joint pain usually ends within days or weeks, but for some people it continues for months, even years. Whatever set it off, a GP should assess within days a joint that has stayed swollen for a week or two, swollen small joints of the hands or feet, more than one swollen joint, and swelling that worsens or has come back, because early on a viral arthritis can closely resemble rheumatoid arthritis.

Can a virus cause arthritis that looks like rheumatoid arthritis?

Yes. Several viruses, parvovirus most often, inflame the wrists, the knees and the small joints of both hands, and rheumatoid arthritis too tends to begin in small joints on both sides at once. A blood test can add to the confusion: rheumatoid factor can turn weakly positive for a while during a viral infection, although the other antibody of rheumatoid arthritis, anti-CCP, usually stays negative. What happened beforehand helps to tell them apart, an illness or a rash shortly before and perhaps others at home unwell at the same time, and so does the passing of a few weeks. With small joints swollen in the hands or feet, or two or more swollen joints, though, see a GP within days, as you would for a single joint whose swelling has lasted a week or two: time alone should not be left to prove that a virus was the cause; our early inflammatory arthritis guide sets out what is at stake in the first three months.

Which viruses can cause joint pain and swelling?

A good many. The one found most often is parvovirus B19, the virus of slapped cheek syndrome, which adults usually catch from a child. Rubella, which is rare now, can make the fingers, wrists or knees ache, especially in adults. The hepatitis B and hepatitis C viruses and HIV can each bring joint pain or arthritis. Chikungunya, spread by mosquitoes mainly in tropical and subtropical countries, causes a sudden fever with joint pain, and Zika and dengue, spread the same way, can cause joint pain too; dengue is also found at times in parts of southern Europe. Illness after a stay in a country where these infections, or malaria, occur should be reported the same day, to a GP urgently or to NHS 111, with the travel mentioned. The joint pain of Long Covid belongs on the list as well, and our Long Covid guide deals with it; a joint that swells after COVID-19 is assessed like any other swollen joint: by a GP within days if small joints of the hands or feet or more than one joint are swollen, or if one joint stays swollen for a week or two. In pregnancy, rubella or slapped cheek syndrome, or close contact with either, is a reason to ring a midwife, maternity unit or GP straight away.

My child had slapped cheek syndrome and now my joints hurt. Is it the same virus?

It may well be: slapped cheek syndrome is caused by parvovirus B19, and around half of the adults who catch it get painful, stiff joints, women more often than men. Adults do not usually get the rash on the face, so the joints can be the first thing noticed. The hands, wrists, knees and ankles are the usual places, on both sides. It normally clears within several weeks with rest and simple painkillers such as paracetamol, though severe or persistent joint symptoms are a reason to see a GP, and swollen joints, or stiffness that takes over half an hour to ease each morning, should be shown to one within days. By the time the rash or the joint pains show, the virus is no longer being passed on. If you are pregnant and think you have it, or have been in close contact with someone who does, ring your midwife, maternity unit or GP straight away. With a blood disorder or a weakened immune system, speak to a GP within days of the illness or the contact, because in both the infection can cause severe anaemia. Breathlessness that is severe, with gasping, choking or no breath to get words out, or a faint from which the person cannot be woken, is a 999 or A&E emergency; with a fever or feeling unwell, so is pale skin, or skin, lips or tongue turning blue, grey or blotchy; and, fever or not, so is skin that turns pale after a dose of a medicine, since that can be a severe allergic reaction, as the first list under When to seek help says. Short of those, very pale skin, shortness of breath, extreme tiredness or fainting, in anyone with slapped cheek syndrome, is for a GP urgently, or NHS 111, that day, since these can be signs of severe anaemia.

How is viral arthritis treated?

By easing the symptoms while the body deals with the virus. Rest in the first days, paracetamol or an anti-inflammatory painkiller such as ibuprofen if it suits you, and a gradual return to your usual activity are generally all that is needed; where the inflammation in a joint is severe, drawing off some of its fluid can relieve the pain. The painkillers come with cautions. Anyone who fell ill after a trip to a country where dengue is found should take paracetamol and not ibuprofen or aspirin, because anti-inflammatory painkillers can cause bleeding in dengue, and should speak to a GP urgently, or NHS 111, the same day. In pregnancy paracetamol is the painkiller to use, and joint pain that could be slapped cheek syndrome or rubella is a reason to ring your midwife, maternity unit or GP straight away. With hepatitis your doctor should say which painkillers are safe for you. The disease-modifying medicines used for rheumatoid arthritis have no part in an arthritis that settles by itself, which is one reason an accurate diagnosis matters. Swollen joints are for a GP within days, whatever the likely cause, and are not something to treat at home on the assumption of a virus. With hepatitis B, hepatitis C or HIV, it is the infection that needs attention, from the specialists who look after it. And where joints are still inflamed after months, as can happen after chikungunya, a rheumatologist may use the treatments of a persistent inflammatory arthritis.

When does joint pain after a virus need a doctor?

A joint you cannot move or put weight on, or one that has moved out of place, is a 999 or A&E emergency, and after a fall or injury so are very bad pain and any tingling or numbness. With a fever or feeling unwell, so is a rash that does not fade when you press it, and so are confusion, a seizure, a very bad headache, a stiff neck, eyes that cannot bear bright light, or skin, lips or tongue turning blue, grey, pale or blotchy (on black or brown skin the rash and the change of colour may be easier to see on the palms of the hands or the soles of the feet), though a blotchy rash of flat or slightly raised spots, of the kind dengue and other viral infections can bring, is not the blotchy skin meant, unless it does not fade when you press it; and so is a high fever with shaking, confusion, rapid breathing, or feeling dramatically worse over hours, which can be sepsis. Numbness, pins and needles, weakness or pain creeping from the feet and hands up the arms and legs, or trouble swallowing, within weeks of an infection or after a trip to a country with Zika, is a 999 or A&E emergency too, as are severe tummy pain, repeated vomiting, fast breathing or bleeding after a trip to a country with dengue. The signs of a stroke are a 999 or A&E emergency as well, even if they stop after a short time: weakness or numbness on one side that came on suddenly, a face that droops, speech that slurs or will not come, a sudden severe headache, sudden confusion, a seizure or a sudden loss of sight. With a viral illness an inflamed brain can also bring on a loss of consciousness, a change in personality or behaviour, confusion, a seizure, trouble speaking or weakness in a part of the body more slowly, over hours, days or weeks, and that is a 999 or A&E emergency too. So is breathlessness that is severe, with gasping, choking or no breath to get words out, or a faint from which the person cannot be woken, and so are the signs of a severe allergic reaction to a medicine, which the first list under When to seek help sets out. Call 999 and do not drive yourself to A&E. Aching that is easing as you recover can be given time. Book a routine GP appointment for pain that has not improved after two weeks, is getting worse, keeps coming back or stops you sleeping or doing everyday things, and for a joint that has swollen without an obvious cause and is no better in a few days; with suspected rubella, ring the surgery before going in. Within days is how soon to be seen for a joint still swollen a week or two on, for swollen small joints of the hands or feet or more than one swollen joint, for swelling that is worsening or has come back, and for joints stiff beyond half an hour each morning: for these you can go to a GP or straight to a specialist, no referral needed, and in this practice next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible. A GP within days is also right for slapped cheek syndrome, or contact with it, in anyone with a blood disorder or a weakened immune system. Ring a GP urgently or NHS 111 that day about joint pain while you have a fever or feel shivery or unwell; about skin or the whites of the eyes turning yellow; about feeling unwell after travel to a country where chikungunya, dengue, Zika or malaria is found, saying where you have been; about tingling, numbness or weakness that is in the feet, the hands or both, on both sides, and nowhere else, within weeks of an infection; and, with slapped cheek syndrome, about very pale skin with no fever or feeling unwell, breathlessness, extreme tiredness or fainting, though skin that turns pale after a dose of a medicine can be a severe allergic reaction, which belongs to the first list. A joint that has turned hot and swollen is for the same day too: should you also be feverish or feel ill, that means A&E or a call to NHS 111, and if you are not, an urgent GP appointment, NHS 111 or a specialist clinic that can see you that day. If you are pregnant and have a new rash, think you may have slapped cheek syndrome, or have had close contact with rubella or with slapped cheek syndrome, ring your midwife, maternity unit or GP straight away. An eye that turns red and painful, or that light hurts, or sight that changes, is for an eye casualty or urgent eye clinic the same day; in pregnancy, any change in sight, blurring or flashing lights among them, is also for your midwife or maternity unit straight away, since it can be a sign of pre-eclampsia; an eye that suddenly and completely loses its sight is a 999 or A&E emergency.