Rheumatologic Crises

Blood, Clots & Transfusion · ICU Decoded chapter 48 · Free in full

Cited to ACR/EULAR.

Key points

Lupus flare or sepsis? High CRP favors infection; low complement + high dsDNA favors flare; screen ferritin/HLH.
Vasculitis crises such as RPGN, alveolar hemorrhage, or mesenteric ischemia get pulse methylpred 1 g ×3 plus cyclophosphamide or rituximab ; reserve plasma exchange (PLEX) for selected indications (e.g., anti-GBM disease or selected severe ANCA-associated vasculitis) rather than routine use.
New HTN with AKI in scleroderma is a renal crisis: start an ACEi immediately, even if creatinine rises.
Remember adrenal insufficiency after chronic steroids, and screen for TB/HBV before biologics.

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