Evaluation of patients with rheumatic diseases admitted at emergency department: 5-year analysis in a single centre

Abstract

Background: Chronic inflammatory diseases can lead to emergency admissions with various acute complications. Unfortunately, there is limited data on emergency admissions because of rheumatological diseases.

Objectives: To evaluate the patients with rheumatic diseases presenting to the emergency department (ED).

Methods: A total of 1788 patients with a diagnosis of inflammatory rheumatic disease admitted to the ED of a tertiary university hospital between March 2016 and March 2021 were included. The patients' socio-demographic and clinical characteristics, diagnosis and treatments in the ED were recorded. Patients' complaints were classified as rheumatological or non-rheumatological.

Results: Over 5 years, 1788 patients with an inflammatory rheumatic disease presented to the ED. The mean duration of rheumatological disease was 7 ± 3.4 years, and the mean number of emergency admissions was 4.4 ± 5. The four most common groups attending the ED were patients with rheumatoid arthritis, ankylosing spondylitis, familial Mediterranean fever and vasculitis. Of the complaints of the 1788 ED visitors, 1106 (61.9%) were rheumatological, 681 (38.1%) were non-rheumatological and other acute or chronic conditions. Twenty-three patients (1.3%) had the rheumatic disease and died after admission to the ED. When the univariable model results are examined, the risk of hospitalisation increases 1.024 times with increasing age. The risk of hospitalisation is 2.318 times higher in those with ankylosing spondylitis and 2.722 times in those with rheumatoid arthritis compared with those with a diagnosis of vasculitis. The risk of hospitalisation in patients with comorbid diseases is 1.807 times higher than those without. When the results of the multivariable model are examined, the risk of hospitalisation is 2.227 times higher in those with ankylosing spondylitis and 2.615 times in those with rheumatoid arthritis compared to those with vasculitis. Other risk factors were not statistically significant (P > .050).

Conclusion: Patients with the rheumatic disease most frequently presented to the ED with musculoskeletal complaints and were discharged from the ED. True rheumatological emergencies are rare, but ED physicians should be aware of serious and life-threatening conditions.