Rheumatologic diseases in the intensive care unit: epidemiology, clinical approach, management, and outcome

Rheumatoid arthritis, systemic lupus erythematosus, and scleroderma account for 75% of rheumatic cases admitted to the ICU. The respiratory system is the organ system most commonly affected, followed by the renal, gastrointestinal, and nervous systems. More than 50% of patients are admitted for acute infections resulting from immunosuppressive therapy; 25% to 355 are admitted because of exacerbation of the rheumatic condition. Some patients are admitted because of adverse effects of drug therapy, and others are admitted for acute serious illnesses unrelated to the rheumatic disease. Outcome is worse in patients with rheumatic diseases than in nonrheumatologic ICU admissions. Infection, renal failure, coma, and acute abdomen are associated with poor outcome. Aggressive diagnostic workup and prompt treatment of infection or disease exacerbations help reduce mortality.