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DOI: 10.1055/s-0030-1249012
© Georg Thieme Verlag KG Stuttgart · New York
Notfälle in der Rheumatologie – Die Sicht des internistischen und orthopädischen Rheumatologen
Medical Emergencies due to Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS)Publikationsverlauf
Publikationsdatum:
25. Februar 2010 (online)

Zusammenfassung
Im Kontrast zu den sich eher allmählich entwickelnden inflammatorischen Folgeerscheinungen insbesondere bei der rheumatoiden Arthritis, stehen spezielle Erscheinungsformen und Komplikationen, die ein dringliches therapeutisches Eingreifen erforderlich machen. Diese Übersichtsarbeit soll den Blickwinkel aus internistischer und orthopädischer rheumatologischer Sicht diesbezüglich schulen helfen und umfasst so unterschiedliche Krankheitsbilder wie die Begleitvaskulitis im Rahmen einer RA, oder aber die Besonderheit einer Beteiligung der Crycoarytenoidgelenke. Eine enge und rasche internistisch-orthopädische rheumatologische Zusammenarbeit erfordert aber auch der Umgang im Rahmen einer septischen Arthritis des immunkompromitierten Patienten. Zu den rheumaorthopädischen Notfällen zählen Verletzungen wie die häufig übersehene Fraktur im Rahmen eines fortgeschrittenen Befalls bei ankylosierender Spondylitis, aber auch Spontanverläufe wie ein sich schleichendes entwickelndes neurologisches Defizit, hervorgerufen durch eine Myelopathie im Zusammenhang mit horitzontalen oder vertikalen/zervikalen Instabilitäten des Rheumatikers. Ein gebotenes rasches Handeln erfordern auch die Sehnenrupturen, insbesondere palmarseitig im Bereich der Finger.
Abstract
Medical emergencies due to rheumatoid arthritis (RA) and ankylosing spondylitis (AS) can occur as a result of vasculitis, spinal instability, increased risk of fracture, tenosynovialitis with subsequent tendon rupture and septic arthritis. Structural changes in the cervical spine in long-standing RA render the joint facets and ligaments unstable. These patients are at high risk to develop neurological damage including myelopathy due to a narrowing of the spinal canal. Once neurological deficits occur, surgical treatment is generally indicated. Even minor injuries can cause fractures, especially in the thoracic spinal column as the most susceptible part. Because conventional X-ray images may not reveal these fractures, CT scans or MRI may be indicated. Neurological deteoration requires immediate surgical treatment. Also in RA, inflammation and glucocorticoid-induced osteoporosis increase the risk of fractures, including periprosthetic fractures. Surgical options are often demanding due to the reduced bone structure. Tendon ruptures on exposed bone structures and regions of high mechanical wear in the hand and foot need reconstructive surgery in a timely manner. Septic arthritis is a disabling and potentially life-threatening condition that requires prompt diagnosis and treatment. Aspiration and culture of synovial fluid are crucial for the diagnosis. Immediate antibiotic treatment, initially intravenously and then orally for sometimes prolonged periods of time as well as either arthroscopic intervention or open synovectomy are necessary.
Schlüsselwörter
Rheumaorthopädie - septische Arthritis - Vasculitis - Fraktur AS-Patient - zervikale Myelopathie
Key words
surgery for rheumatoid arthriti - septic arthritis - vasculitis - fractures in AS patients - cervical myelopathy
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Korrespondenzadresse
Dr. Ingo Arnold
Rotes Kreuz Krankenhaus
– Klinik operative Rheumatologie und Orthopädie
St. Pauli Deich 24, Bremen
28199 Bremen
Telefon: +49/0421/559 95 01
Fax: +49/0421/559 95 08
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