Initial management in rheumatologic emergencies

Bhaskar Dasgupta

What should be the initial management in rheumatologic emergencies? Which patients should be transported to the intensive care unit (ICU)?

Bhaskar Dasgupta, MD: I am not sure that they need immediate transport to intensive care. I think they need a specialist opinion. First of all they need a good rheumatological opinion, so that the rheumatologist is able to confirm or not confirm the suspected diagnosis. But nowadays we have lots of extra imaging available to us. Particularly I refer to vascular ultrasound. And vascular ultrasound is critical for the diagnosis of giant cell arteritis (GCA).

We have lots of other imaging tests that are available to us such as magnetic resonance imaging (MRI), positron emission tomography–computed tomography (PET/CT), or computed tomography angiography (CTA). Those things should be done on an urgent basis. [We should also perform] blood tests such as antineutrophil cytoplasmic antibody (ANCA). And of course, if the patient is acutely unwell, particularly if they are hemodynamically disturbed or if they have lactate or lactic acidosis, respiratory involvement, or renal involvement, they should be transferred to the ICU.

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