Aetiologies of Acute Complications in Autoimmune Rheumatologic Diseases: A Hospital-Based Cross-Sectional Study

Area of Science:

• Rheumatology
• Critical Care Medicine
• Endocrinology

Background:

• Autoimmune rheumatic diseases (ARD) pose diagnostic challenges during medical emergencies.
• Distinguishing between sepsis, disease flare, and Addisonian crisis (AC) is complicated by overlapping symptoms.
• Existing biomarkers may be insufficient for accurate differentiation, requiring comprehensive investigations.

Purpose of the Study:

• To explore the presentation of rheumatologic emergencies with differentials of sepsis, disease flare, and AC.
• To assess the prevalence of sepsis, disease flare, and AC in patients with ARD requiring unplanned hospitalization.

Main Methods:

• A hospital-based cross-sectional study involving adult patients with ARD experiencing acute worsening.
• Collection and analysis of hematological, immunological, and hormonal parameters, including morning cortisol.
• Evaluation of Quick Sequential Organ Failure Assessment (qSOFA) scores, procalcitonin (PCT), and C-reactive protein (CRP) levels.

Main Results:

• The study analyzed 41 patients, predominantly female, with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) being common diagnoses.
• While 26.8% had evidence of infection, only 7% had Addisonian crisis (AC).
• qSOFA scores correlated with PCT and CRP but did not reliably distinguish infection or AC; PCT showed no significant correlation with infection presence.

Conclusions:

• Infections and sepsis are primary concerns in ARD emergencies, alongside disease flare and AC.
• Current inflammatory biomarkers (CRP, PCT) have limited value in differentiating infectious from non-infectious sepsis in ARDs.
• Improved biomarkers and further research are crucial for managing ARD emergencies effectively.