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Emergent Complications of Rheumatoid Arthritis

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Berman S1, Bucher J2, Koyfman A3, Long BJ4. J Emerg Med. 2018 Sep 22. pii: S0736-4679(18)30748-0. doi: 10.1016/j.jemermed.2018.07.030. [Epub ahead of print]

Abstract

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1 Department of Emergency Medicine, Rush University Medical Center, Rush Oak Park Hospital, Chicago, Illinois.

2 Department of Emergency Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey.

3 Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.

4 Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas.

Abstract

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disease resulting in polyarthritis and systemic effects that may result in morbidity and mortality.

OBJECTIVE: This review provides the emergency physician with an updated analysis of acute complications seen with RA, as well as an evidence-based approach to the management of these complications.

DISCUSSION: While the joint characteristics of RA are commonly recognized, the extra-articular manifestations may be overlooked. Of most concern to the emergency clinician is the involvement of the airway, cardiovascular, and pulmonary systems; however, RA can affect all organ systems. In addition, complications can arise from the specific therapies used to treat RA. Certain patient populations can have atypical presentations of the disease or may have an exaggerated response to the medications. An understanding of the involvement of these organ systems and complications can direct physicians to a broader differential that can identify disease processes that may have otherwise gone unnoticed. It is not necessarily the role of the clinician to diagnose RA in its earliest phases or initiate long-term immunosuppressive therapy from the emergency department; however, detection of some of the disease's characteristics can lead to earlier referral to specialists to begin therapy and potentially avoid life-threatening complications. If those problems are encountered in the emergency department, this review aims to provide insight into management of those conditions.

CONCLUSIONS: Prompt recognition of the acute complications of RA is crucial to treat these conditions. This review investigates these issues in a succinct manner for emergency clinicians.