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Aktuelle Rheumatologie 2010; 35(1): 61-75
DOI: 10.1055/s-0030-1249012
Übersichtsarbeit

© 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)I. Arnold1 , J. Andresen2
  • 1Rotes Kreuz Krankenhaus, Rheumaorthopädie, Bremen
  • 2Rotes Kreuz Krankenhaus, Klinik für Internistische Rheumatologie, Bremen
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Publication History

Publication Date:
25 February 2010 (online)

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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

Phone: +49/0421/559 95 01

Fax: +49/0421/559 95 08

Email: Arnold.I@roteskreuzkrankenhaus.de

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