#EMConf: Rheumatoid Arthritis in the ED

Rheumatoid Arthritis (RA) is the most common rheumatological disease admitted to ICU.


-Consider a difficult airway given limited neck mobility → consider video laryngoscopy.

-At risk for atlanto-axial subluxation from simple neck extension.

-Cricoarytenoid arthritis:

    -30% of RA with this; can be asymptomatic

    -stridor, dysphonia, dysphagia, tenderness over cricoid area

    -Dx = CT v. fiberoptic laryngoscopy by ENT for vocal cord edema/ dysmotility

    -Tx = high dose glucocorticosteroids 

Trauma: Have a low threshold to get CT scan, especially CT C-spine.

Cardiac: Accelerated atherosclerosis there Rheumatoid Arthritis is a risk factor for ACS.

GI: GI Hemorrhage most common GI complication secondary to NSAIDS and steroids.


-On disease-modifying antirheumatic drugs (DMARDs), can be immunosuppressed.

-RA flare and septic joint can have significant overlap clinically and on synovial fluids.




Morabito GC, Tartaglino B. Emergencies in Systemic Rheumatic Diseases. In: Tintinalli J, ed. Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, NY: McGraw-Hill; 2011:1911-1920.                                                                                                                              

Leicht M, Harrington T. Cricoarytenoid arthritis: A cause of laryngeal obstruction. Annals of Emergency Medicine. 1987;16(8):885-888. doi:http://dx.doi.org/10.1016/S0196-0644(87)80527-9.