RHEUMATOLOGIC EMERGENCIES
AIRWAY & BREATHING:
1) Relapsing Polychondritis
a. Inflammation of cartilage
i. Ears, nose
ii. May affect trachea/larynx  obstruction
iii. Throat tenderness, hoarseness, cough, SOB, stridor
b. Treatment: airway stabilisation, high dose steroids
2) Cricoarytenoid obstruction (RA, up to 25%)
a. Instability  pain on swallowing
b. Severe: hoarseness, stridor, obstruction
3) Resp muscle weakness
a. Polymyositis, dermatomyositis
b. Monitor PEFR
4) Pleuritic chest pain
a. RA, SLE,
5) Pleural effusions
a. All rheum diseases
b. Often exudate
6) Pulmonary haemorrhage
a. Goodpasture’s, SLE, vasculitis
7) Pulmonary fibrosis
a. Ank spond, slceroderma, rarely RA & others
CARDIOVASCULAR DISEASES:
1) Pericarditis
a. SLE (with flareup), RA
b. Tamponade uncommon
2) Accelerated atherosclerosis
a. Always consider IHD in SLE/RA & chest pain (not just
chondritis/serositis)
3) AMI
a. PAN & Kawasaki’s
4) Rheumatic fever (see STREPTOCOCCAL INFECTION NOTES)
5) Valvular Heart Disease
a. Seronegative Spondyloarthopathies (HLA-B27)
b. + conduction defects from scarring
6) Aortic Regurgitation/aneurysm
a. Relapsing polychondritis
b. Ankylosing spondylitis
7) Myocardial fibrosis
a. Scleroderma
8) Hypertension
a. PAN/Wegener’s
b. SLE + renal involvement, RA + drug induced renal disease
c. Systemic sclerosis  kidney sclerosis, Rx = ACEI
CERVICAL SPINE
1) Atlanto-axial instability
2)
3)
4)
5)
a. RA
b. Atlanto-dental distance >3.5mm
c. May get overt cord injury
d. Or: subtle signs: bowel/bladder changes, weakness, paraesthesia
e. NB: Strength may be difficult to assess in RA – REFLEXES best clue
Fracture with minor trauma
a. Espec Ank Spond
Transverse myelitis
a. SLE
Spinal vascular issues (infarcts, dissection)
a. Vasculitis
AIRWAY ISSUES:
a. RA: assume instability – manual in line stabilisation, most experienced
operator
OPHTHALMOLOGICAL
1) TEMPORAL ARTERITIS
a. Vasculitis of thoracic aorta & branches
b. Age > 50
c. Occurs in 30% with PMR
i. PMR: Unexplained anaemia, fatigue, prox limb pain
d. Symptoms:
i. Headache
ii. Scalp Tenderness
iii. Jaw/tongue/upper extremity claudication
iv. Fluctuating vision
v. Diminished or lost brachial pulse
e. Investigations
i. ESR > 50mm/hr
ii. CRP > ____ (additive sensitivity)
f. NB Visual changes: prodromal Syx usually present prior to permanent
damage/blindness
g. Diagnosis
i. Biopsy
h. Treatment: Prednisolone
i. START PRIOR TO BIOPSY (biopsy unaffected if done < 1
week of treatment)
2) SJOGREN’S SYNDROME
a. Lymphocytic infiltration of lacrimal & salivary glands
b. Can occur alone or as Cx of Rheum diseases
c. Complications:
i. Corneal ulceration +/- infection
3) SCLERITIS = very rare
a. Severe RA/Vasculitis (& IBD)
b. Exquisite occular tenderness/pain, deep, boring pain
c. Pain not relieved by topical LA
d. Eye looks more BLUE du to thin sclera
e. Urgent referral – can rupture
4) EPISCLERITIS
a. More common, less serious, self limiting, painless, pink-red
RENAL
1) ANY Rheumatic disease can cause kidney damage (& treatments)
2) GN:
a. SLE, Wegener’s
i. Haem/proteinuria & HT present before Ur/Cr 
b. Scleroderma (as above)
3) RHABDO (& ARF)
a. Polymyositis flare
4) MEDICATION:
a. NSAIDS