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Der rheumatologische Patient auf der Intensivstation

Rheumatic patients in the intensive care unit

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Zusammenfassung

Patienten mit rheumatischer Systemerkrankung haben auf der Intensivstation trotz ihres allgemein jüngeren Altersdurchschnitts ein höheres Mortalitätsrisiko. Die Diagnose der Grunderkrankung, die Unterscheidung zwischen akutem Schub und infektiöser Komplikation sowie die Komplexität der spezifischen antirheumatischen Therapie können Probleme bereiten. Der Artikel gibt eine Übersicht über die Besonderheiten bei der Diagnose und Behandlung von Autoimmunerkrankungen auf der Intensivstation.

Abstract

The mortality of patients with rheumatic diseases in the intensive care unit is generally high despite their relatively young age. In these patients, it is often difficult to make the diagnosis of the underlying autoimmune disease or to differentiate between septic complications and an acute flare; likewise, the complexity of the specific antirheumatic therapy can also be accompanied by problems. The following article gives an overview of problems in the diagnosis and treatment of critically ill patients with autoimmune diseases in the intensive care unit.

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Literatur

  1. Moreels Ml, Mélot C, Leeman M (2005) Prognosis of patients with systemic rheumatic diseases admitted to the intensive care unit. Intensive Care Med 31(4):591–593

    Article  PubMed  Google Scholar 

  2. Dong Mj, Zhao K, Liu ZF et al (2011) A meta-analysis of the value of fluorodeoxyglucose-PET/PET-CT in the evaluation of fever of unknown origin. Eur J Radiol 80(3):834–844 (In Press, Corrected Proof)

    Article  PubMed  Google Scholar 

  3. Schmidt J, Duhaut P, Bourgeois AM et al (2009) Procalcitonin at the onset of giant cell arteritis and polymyalgia rheumatica: the GRACG prospective study. Rheumatology 48:158–159

    Article  PubMed  CAS  Google Scholar 

  4. Sleglova O, Dejmkova H, Uhrova J, Belacek J (2010) Usefulness of procalcitonin measurement in differentiating between activity of systemic autoimmune disease and bacterial infection. Arthritis Rheum 62(Suppl):687

    Google Scholar 

  5. Limper M, Kruif MD de, Duits AJ et al (2010) The diagnostic role of Procalcitonin and other biomarkers in discriminating infectious from non-infectious fever. J Infect 60:409–416

    Article  PubMed  CAS  Google Scholar 

  6. Saravanan V, Kelly CA (2004) Reducing the risk of methotrexate pneumonitis in rheumatoid arthritis. Rheumatology 43(2):143–147

    Article  PubMed  CAS  Google Scholar 

  7. Chikura B, Lane S, Dawson JK (2009) Clinical expression of leflunomide-induced pneumonitis. Rheumatology 48:1065–1068

    Article  PubMed  CAS  Google Scholar 

  8. Lehmann P, Fleck M, Schoelmerich J, Haerle P (2010) Azathioprine-associated hypersensitivity reaction in a patient with Churg Strauss vasculitis. J Clin Rheumatol 16(5):242–243

    Article  PubMed  Google Scholar 

  9. Kramer L (1998) Indikation und Komplikation der Plasmapherese im Rahmen der Intensivmedizin. Intensivmed 35(5):349–355

    Article  Google Scholar 

  10. Lionaki S, Falk RJ (2007) Removing antibody and preserving glomeruli in ANCA small-vessel vasculitis. J Am Soc Nephrol 18:1987–1989

    Article  PubMed  CAS  Google Scholar 

  11. Stone JH, Merkel PA, Spiera R et al (2010) Rituximab versus Cyclophosphamide for ANCA-associated vasculitis. N Engl J Med 363:221–232

    Article  PubMed  CAS  Google Scholar 

  12. Zhu LJ, Yang X, Yu XQ (2010) Anti-TNF-α therapies in systemic lupus erythematosus. J Biomed Biotechnol

  13. Jong MFC de, Beishuizen A, Schijndel RJMS van et al (2011) Risk factors and outcome of changes in adrenal response to ACTH in the course of critical illness. J Intensive Care Med

  14. Haerle P Straub R, Fleck M (2010) Perioperative management of immunosuppression in rheumatic diseases – what to do. Rheumatol Int 30(8):999–1004

    Article  Google Scholar 

  15. Marik PE (2009) Critical illness-related corticosteroid insufficiency. Chest 135:181–193

    Article  PubMed  Google Scholar 

  16. Schneeweiss S, Setoguchi S, Weinblatt ME et al (2007) Anti-tumor necrosis factor α therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis. Arthritis Rheum 56(6):1754–1764

    Article  PubMed  CAS  Google Scholar 

  17. Listing J, Strangfeld A, Kary S et al (2005) Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum 52:3403–3412

    Article  PubMed  CAS  Google Scholar 

  18. Dixon WG, Watson K, Lunt M et al (2006) Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum 54(8):2368–2376

    Article  PubMed  CAS  Google Scholar 

  19. Bongartz T, Sutton AJ, Sweeting MJ et al (2006) Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies. JAMA 295(19):2275–2285

    Article  PubMed  CAS  Google Scholar 

  20. Fachinformation Leflunomid, Stand 07/2010. 2010

  21. Charpin C, Guis S, Colson P et al (2009) Safety of TNF-blocking agents in rheumatic patients with serology suggesting past hepatitis B state: results from a cohort of 21 patients. Arthritis Res Ther 11:R179

    Article  PubMed  Google Scholar 

  22. Cavallasca JA, Rosario Maliandi Ma del, Sarquis S et al (2010) Outcome of patients with systemic rheumatic diseases admitted to a medical intensive care unit. J Clin Rheumatol 16

  23. Feng PH, Lin SM, Yu CT et al (2010) Inadequate antimicrobial treatment for nosocomial infection is a mortality risk factor for systemic lupus erythematosus patients admitted to intensive care unit. Am J Med Sci 340(1):64–68

    PubMed  Google Scholar 

  24.  Ñamendys-Silva SA, Baltazar-Torres JA et al (2009) Prognostic factors in patients with systemic lupus erythematosus admitted to the intensive care unit. Lupus 18:1252–1258

    Article  PubMed  Google Scholar 

  25. Sherer Y, Shepshelovich D, Shalev T et al (2007) Outcome of patients having dermatomyositis admitted to the intensive care unit. Clin Rheumatol 26(11):1851–1855

    Article  PubMed  Google Scholar 

  26. Shalev T, Haviv Y, Segal E et al (2006) Outcome of patients with scleroderma admitted to intensive care unit. A report of nine cases. Clin Exp Rheumatol 24:380–386

    PubMed  CAS  Google Scholar 

  27. Camargo JF, Tobó n GJ, Fonseca N et al (2005) Autoimmune rheumatic diseases in the intensive care unit: experience from a tertiary referral hospital and review of the literature. Lupus 14(4):315–320

    Article  PubMed  CAS  Google Scholar 

  28. Hsu CL, Chen KY, Yeh PS et al (2005) Outcome and prognostic factors in critically ill patients with systemic lupus erythematosus: a retrospective study. Crit Care 9:R177–R183

    Article  PubMed  Google Scholar 

  29. Whitelaw DA, Gopal R, Freeman V (2005) Survival of patients with SLE admitted to an intensive care unit – a retrospective study. Clin Rheumatol 24(3):223–227

    Article  PubMed  CAS  Google Scholar 

  30. Alzeer AH, Al-Arfaj A, Basha SJ et al (2004) Outcome of patients with systemic lupus erythematosus in intensive care unit. Lupus 13(7):537–542

    Article  PubMed  CAS  Google Scholar 

  31. Williams FMK, Chinn S, Hughes GRV, Leach RM (2002) Critical illness in systemic lupus erythematosus and the antiphospholipid syndrome. Ann Rheum Dis 61(5):414–421

    Article  PubMed  CAS  Google Scholar 

  32. Thong BY, Tai DY, Goh SK, Johan A (2001) An audit of patients with rheumatic disease requiring medical intensive care. Ann Acad Med Singapore 30:254–259

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland

    P. Lehmann, T. Brünnler, B. Salzberger & M. Fleck

  2. Klinik für Rheumatologie/Klinische Immunologie, Asklepios-Klinikum Bad Abbach, Bad Abbach, Deutschland

    P. Lehmann & M. Fleck

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  1. P. Lehmann
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  2. T. Brünnler
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  3. B. Salzberger
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  4. M. Fleck
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Correspondence to P. Lehmann.

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Lehmann, P., Brünnler, T., Salzberger, B. et al. Der rheumatologische Patient auf der Intensivstation. Med Klin Intensivmed Notfmed 107, 391–396 (2012). https://doi.org/10.1007/s00063-011-0073-y

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  • DOI: https://doi.org/10.1007/s00063-011-0073-y

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