Critical care clinics
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Critical care clinics · Oct 2002
ReviewNew therapies: plasmapheresis, intravenous immunoglobulin, and monoclonal antibodies.
Rheumatologic emergencies may pose a serious threat to life, and the treatment of patients with these illnesses continues to be challenging. In the last decade extensive animal and human research has led to development of new therapies. Considerable progress has been made in the therapy for RA. ⋯ Evidence is accumulating for the use of IVIGs in several immune-mediated conditions. The outlook for some emergencies continues be grim, however, and various therapies are used based on evidence from anecdotal case reports and case series. The new therapies are relatively safe, but careful monitoring is needed, because there is potential for serious adverse events.
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Critical care clinics · Oct 2002
ReviewRheumatologic diseases in the intensive care unit: epidemiology, clinical approach, management, and outcome.
Patients with systemic rheumatic diseases may be admitted to the ICU because of worsening of or development of a new manifestation of the rheumatic disease, infections caused by immunosuppression, or adverse effects of drugs used to treat rheumatic diseases. Sometimes an unrelated, acute disorder may become life threatening because of the underlying rheumatic disorder. Rheumatoid arthritis is the most common rheumatic disease seen in ICU patients, followed by systemic lupus erythematosus and scleroderma. ⋯ The mortality may exceed 50% in patients admitted for infection; the prognosis is comparatively better for patients with exacerbations of disease activity. Renal failure, coma, and acute abdomen are predictors of poor outcome. Early recognition of abdominal complications requiring surgical intervention may help reduce mortality.
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Renal disease associated with pulmonary hemorrhage is seen in a variety of clinical disorders and is a common cause of admission to intensive care units. Recent advances in the understanding of the pathogenesis of these disorders have improved the therapeutic options significantly and have favorably influenced the course of many of these disorders. This article discusses rheumatologic diseases that involve both the kidney and lungs, with emphasis on pathogenesis and therapeutic options. Common pulmonary-renal syndromes including anti-glomerular basement membrane disease and anti-neutrophil cytoplasmic autoantibodies-associated vasculitis.
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Acute arthritis in critically ill patients may be caused by local or systemic infection, by a flare of chronic joint disease such as rheumatoid or crystal-associated arthritis, or by less common entities such as hemarthrosis. Diagnosis requires analysis of synovial fluid, and appropriate treatment is based on its findings. Prompt diagnosis and treatment are usually necessary to prevent the significant morbidity associated with these conditions.
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Critical care clinics · Oct 2002
ReviewCatastrophic antiphospholipid syndrome in the intensive care unit.
CAPS is characterized by development of widespread microvascular thrombosis. Patients at risk are those with positive aCL or LA factor. Precipitating events, such as infection, trauma, surgical procedures, or reduction in anticoagulation therapy, may contribute to the development of CAPS. ⋯ Cardiopulmonary failure has been the major contributor to mortality. A variety of therapeutic modalities have been used in an attempt to offset the widespread thrombosis and organ damage from high aCL levels. Anticoagulation therapy and high dosages of steroids seem to have a positive effect on survival.