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Systemic rheumatic diseases are chronic, inflammatory, autoimmune disorders, such as rheumatoid arthritis, systemic sclerosis (scleroderma), or systemic lupus erythematosus. ED patients with systemic rheumatic diseases have complex clinical and pharmacologic histories, and multi-organ system pathology. Many extra-articular manifestations of rheumatic diseases can result in serious morbidity and mortality if not recognized and properly managed. This chapter discusses rheumatologic emergencies from an organ system perspective. Table 279-1 describes some emergencies associated with systemic rheumatic diseases,1–3 and Table 279-2 reviews clinical manifestations of the diseases.

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Table 279-1 Emergencies in Systemic Rheumatic Diseases
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Table 279-2 Clinical Signs and Symptoms Associated with Systemic Rheumatic Diseases
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Rheumatoid arthritis is the most common rheumatic disease requiring intensive care unit admission, followed in decreasing frequency by systemic lupus erythematosus and systemic sclerosis.4–6 Infection is the leading cause for intensive care unit admission (more than 50%), followed by rheumatic disease flare (25% to 35%). The typical complications of rheumatic diseases are listed in Table 279-3.

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Table 279-3 Common Features and Complications of Systemic Rheumatic Diseases

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