#EMConf: Rheumatoid Arthritis in the ED
Rheumatoid Arthritis (RA) is the most common rheumatological disease admitted to ICU.
-Consider a difficult airway given limited neck mobility → consider video laryngoscopy.
-At risk for atlanto-axial subluxation from simple neck extension.
-30% of RA with this; can be asymptomatic
-stridor, dysphonia, dysphagia, tenderness over cricoid area
-Dx = CT v. fiberoptic laryngoscopy by ENT for vocal cord edema/ dysmotility
-Tx = high dose glucocorticosteroids
Trauma: Have a low threshold to get CT scan, especially CT C-spine.
Cardiac: Accelerated atherosclerosis there Rheumatoid Arthritis is a risk factor for ACS.
GI: GI Hemorrhage most common GI complication secondary to NSAIDS and steroids.
-On disease-modifying antirheumatic drugs (DMARDs), can be immunosuppressed.
-RA flare and septic joint can have significant overlap clinically and on synovial fluids.
Morabito GC, Tartaglino B. Emergencies in Systemic Rheumatic Diseases. In: Tintinalli J, ed. Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, NY: McGraw-Hill; 2011:1911-1920.
Leicht M, Harrington T. Cricoarytenoid arthritis: A cause of laryngeal obstruction. Annals of Emergency Medicine. 1987;16(8):885-888. doi:http://dx.doi.org/10.1016/S0196-0644(87)80527-9.