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Emergency conditions associated with rheumatoid arthritis Ryosuke HANAOKA 1 1Division of Rheumatology Department of Internal Medicine Kamitsuga General Hospital pp.887-895
Published Date 2018/10/1
DOI https://doi.org/10.11477/mf.3102200570
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Rheumatoid arthritis (RA) greatly affects a patient's prognosis. While the most frequent direct cause of death is a cardiovascular event, the clinical features may not be different from those of patients without RA. However, respiratory failure, mostly due to lower respiratory tract infections, should be given maximum consideration in patients with RA, especially when encountered in the emergency room. Bilateral diffuse ground glass opacities on chest X-ray suggest pneumocystis pneumonia, drug induced interstitial pneumonia, or collagen vascular disease associated interstitial pneumonia. Infiltration of one lung may prioritize lower respiratory tract infections including opportunistic infections. When the presence of a pleural effusion is confirmed, diagnostic thorascentesis should be performed considering bacterial pleurisy, malignant pleurisy, and RA pleurisy. If chest X-ray reveals no abnormality despite increased AaDO2, one must suspect a secondary infection with airway involvement of RA or pulmonary embolism. Hypoxia with normal AaDO2 and normal lung appearance on X-ray suggests upper cervical spinal involvement due to RA.


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電子版ISSN 2186-7852 印刷版ISSN 1883-4833 メディカル・サイエンス・インターナショナル

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