AB1156 OVERVIEW OF INFLAMMATORY RHEUMATIC DISEASES AT THE EMERGENCY DEPARTMENT
Authors: I. San, A. Erden, O. Küçükşahin
Journal: Annals of the Rheumatic Diseases (2020)

Background: Patients with rheumatological diseases can also apply to the emergency room due to acute attacks or complications. Especially in recent years, more patients, due to the increased use of immunosuppressant drugs in treatment, have applied to emergency services due to infection. On the other hand, data on applications to emergency services for rheumatological reasons are very few. Objectives: In this study, applications to emergency departments for inflammatory rheumatic diseases were investigated. Methods: 2715 patients from Atatürk Training and Research Hospital Rheumatology Clinic who were followed-up with the diagnosis of inflammatory rheumatic diseases between 2014 and 2018 were included in this study. The clinical and laboratory information of the patients were achieved from the hospital file records and the hospital data bank. The patients were classified according to the 5-stage triage system (T1: resuscitation, T2: critical, T3: urgent, T4: less urgent, T5: non-urgent). Results: 21.3% (577) of 2715 patients applied to the emergency department. Among the emergency admissions, the first three diseases were; rheumatoid arthritis 19.7%, ankylosing spondylitis 19.2%, and familial Mediterranean fever 15.9% [Vasculitis 8.8%, Behcet’s disease 7.6%, Gout 5.7%, Systemic lupus erythematosus 3.9%, Sjogren’s Syndrome 3.6%, Scleroderma 3.2%, Still Disease 1.5%, Polymyalgia rheumatica 0.6%, others 9%]. 343 patients (59.5%) were discharged from the emergency department. 36.8% (212) of the patients were hospitalized in services and 3.6% (21) of them in intensive care. The first three reasons of the applications to the emergency department were: fever, malaise and fatigue in 1. 150 patients (25.9%), musculoskeletal system complaints in 2. 124 patients (21.4%) and abdominal pain in 3. 89 patients (15.4%), respectively. Vasculitis was the most common cause of hospitalization in the service in 38 patients (17.9%), whereas scleroderma was the most common cause of hospitalization in intensive care in 7 patients (33.3%) (table). 16 (76.1%) of the patients followed in intensive care unit were hospitalized with the diagnosis of respiratory system diseases. Death was observed in 10 (1.7%) of 577 patients. Five (50%) of the ex-patients had scleroderma (table). 8 (80%) of the deaths were related to rheumatological disease and occurred after being hospitalized in intensive care unit. Conclusion: The patients with inflammatory rheumatic diseases usually apply to the emergency department with urgent or less urgent clinical pictures. Rheumatoid arthritis, one of the most common inflammatory rheumatic diseases in almost all societies, was also the most common diagnosis in our study. In the vast majority of applications, infectious causes and disease activations related to immunosuppressive treatments were in the foreground. In addition, although vasculitis is the most common reason for the in-patients in clinical service, since the most frequent in-patients in intensive care unit and death is seen in the scleroderma group; caution should be exercised in the emergency applications of patients with these two groups. References: [1]Rheumatology consultation in the emergency department: Annual results. RAED 2014 Table. Examination of the diagnosis of 233 patients who were hospitalized and/or died from the emergency department Parameters In-patients in clinical service n, (%) In-patients in intensive care units n, (%) Died patients n, (%) Vasculitis 38 (17.9) 5 (23.8) 1 (1) Ankylosing spondylitis 33 (15.5) Rheumatoid arthritis 31 (14.6) 3 (14.2) 2 (20) Behcet’s disease 25 (11.7) 2 (9.5) Systemic lupus erythematosus 16 (7.5) 1 (4.7) 5 (50) Scleroderma 10 (4.7) 7 (33.3) Antiphospholipid syndrome 10 (4.7) Psoriatic arthritis 9 (4.2) Family Mediterranean fever 8 (3.7) Sjogren’s Syndrome 8 (3.7) Still Disease 7 (3.3) 1 (4.7) 1 (10) Gout 7 (3.3) Undifferentiated connective tissue disease 7 (3.3) 2 (9.5) 1 (10) Dermatomyositis 3 (1.4) Total 212 (100) 21 (100) 10 (100) Disclosure of Interests: None declared