Notfälle in der Rheumatologie – Die Sicht des internistischen und orthopädischen Rheumatologen

Abstract

▼Medical emergencies due to rheumatoid arthritis (RA) and ankylosing spondylitis (AS) can occur as a result of vasculitis, spinal instability, increased risk of fracture, tenosynovialitis with subsequent tendon rupture and septic arthritis. Structural changes in the cervical spine in long-standing RA render the joint facets and ligaments unstable. These patients are at high risk to develop neurological damage including myelopathy due to a narrowing of the spinal canal. Once neurological defi cits occur, surgical treatment is generally indicated. Even minor injuries can cause fractures, especially in the thoracic spinal column as the most susceptible part. Because conventional Xray images may not reveal these fractures, CT scans or MRI may be indicated. Neurological deteoration requires immediate surgical treatment. Also in RA, infl ammation and glucocorticoidinduced osteoporosis increase the risk of fractures, including periprosthetic fractures. Surgical options are often demanding due to the reduced bone structure. Tendon ruptures on exposed bone structures and regions of high mechanical wear in the hand and foot need reconstructive surgery in a timely manner. Septic arthritis is a disabling and potentially life-threatening condition that requires prompt diagnosis and treatment. Aspiration and culture of synovial fl uid are crucial for the diagnosis. Immediate antibiotic treatment, initially intravenously and then orally for sometimes prolonged periods of time as well as either arthroscopic intervention or open synovectomy are necessary.Heruntergeladen von: University of Pittsburgh. Urheberrechtlich geschützt.