Rheumatological conditions in critical care

### Key points Traditionally thought of as disorders of the joints and musculoskeletal system, rheumatological diseases (RDs) can affect any organ system and many have debilitating systemic effects. These conditions, and the sequelae of the immunosuppressive medications used to treat them, can also cause catastrophic complications and can pose many diagnostic and therapeutic challenges to the intensivist (Table 1). While RDs are relatively common in the general population, they remain a comparatively rare cause of intensive care admission. However, such patients have a reported intensive care unit (ICU) mortality of 15–55% and poor long-term outcomes.1 View this table: Table 1 Why rheumatological diseases are important The most common rheumatological causes for admission to the ICU include:2 In reality, these presentations tend to overlap, further complicating the ICU course. A common scenario, for example, would be attempting to differentiate between sepsis and a flare-up of underlying inflammatory disease. This can be a major diagnostic challenge, given that the management of infection differs substantially from control of the underlying disease. Early consultation with a rheumatologist is therefore paramount and treatment of both infection and the …