Emergencies In Systemic Rheumatic Diseases

Mary Chester Morgan Wasko

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Complaints related to the musculoskeletal system account for 1 of 7 visits to the primary care provider and an abundance of emergency room visits. Evaluating the patient with musculoskeletal problems requires a thorough, thoughtful history and examination to determine whether the symptom is a local problem or a manifestation of a systemic disease, and whether a local problem is potentially catastrophic, as in the case of an unrecognized septic joint in a rheumatoid arthritis patient.

Life-threatening manifestations of rheumatic disease are infrequent. They most often result directly from internal organ involvement from systemic conditions such as systemic lupus erythematosus (SLE) or other vasculitides; examples include alveolar hemorrhage in SLE and aortic arch dissection in temporal arteritis. Alternatively, they may be a complication of treatment itself, such as infection in the setting of immunosuppression, or gastrointestinal hemorrhage complicating nonsteroidal anti-inflammatory drug (NSAID) use. Either can lead to serious morbidity and increased mortality if not recognized and managed promptly.

T.a.ble,,2.76.-,1, highlights common presenting musculoskeletal complaints that warrant prompt evaluation and a fundamental differential diagnosis for each. Before diagnostic tests are obtained, an accurate clinical assessment is imperative.

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