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Arthritis und Rheuma 2016; 36(04): 245-254
DOI: 10.1055/s-0037-1617741
Kinderrheumatologie/Übersichtsartikel
Schattauer GmbH

Notfälle in der Kinderund Jugendrheumatologie

Herausforderungen des klinischen AlltagsCases of emergency in paediatric rheumatologyChallenges in everyday clinical practice
T. Schwarz
1   Klinik für Kinderund Jugendrheumatologie, Rheumatologisches Kompetenzzentrum Nordwestdeutschland, St. Josef-Stift, Sendenhorst
,
F. Weller-Heinemann
2   Prof.-Hess-Kinderklinik, Klinikum Bremen-Mitte, Bremen
› Author Affiliations
Further Information

Publication History

Publication Date:
27 December 2017 (online)

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Zusammenfassung

Notfallsituationen sind in der Kinder- und Jugendrheumatologie selten. Gerade deshalb stellt die frühzeitige Erkennung und Behandlung von Notfällen im klinischen Alltag jedoch eine besondere Herausforderung dar. Zu den häufigsten Notfällen in der Kinder- und Jugendrheumatologie gehören infektiöse Erkrankungen wie die septische Arthritis, Osteomyelitis oder Pyomyositis. Persistierendes oder chronisch rekurrierendes Fieber erfordert immer den Ausschluss eines malignen Prozesses, bevor differenzialdiagnostisch entzündlich rheumatische Erkrankungen in Betracht gezogen werden müssen. Akute pulmonale, kardiale, neurologische oder thromboembolische Ereignisse im Rahmen der Primärmanifestation einer rheumatischen Erkrankung stellen Raritäten dar und bedürfen in der Regel einer individuellen Abklärung. Aber auch bei Patienten mit einer bekannten rheumatologischen Erkrankung können sich hinter einer Verschlechterung des Allgemeinzustandes oder Fieber lebensbedrohliche Ursachen verbergen, wie beispielsweise unerwünschte Arzneimittelwirkungen, ein Makrophagen- Aktivierungssyndrom oder ein neu aufgetretenes Antiphospholipidsyndrom bei bekanntem systemischem Lupus erythematodes.

Summary

Cases of emergency are rare in paediatric rheumatology. For just that reason early diagnosis and treatment of an emergency poses a particular challenge. Among the most frequent emergencies in paediatric rheumatology are infectious diseases such as septic arthritis, osteomyelitis or pyomyositis. Persistent or recurrent episodes of fever always require the exclusion of a malignant disease before an inflammatory rheumatic disease has to be taken into account. Acute pulmonary, cardiac, neurological or thromboembolic events rarely are primary manifestations of a rheumatic disease and require individualized diagnostic assessment. Regarding patients with a known rheumatic disease, a deterioration of the general condition or fever could imply a life-threatening situation, for example an adverse drug reaction, a macrophage activation syndrome or an antiphospholipid syndrome, secondary to a known systemic lupus erythematosus.

Schlüsselwörter

Notfall - septische Arthritis - MakrophagenAktivierungssyndrom - Antiphospholipid-Syndrom - Vaskulitis

Keywords

Emergency - septic arthritis - macrophage activation syndrome - antiphospholipid syndrome - vasculitis
 

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