Evaluation and Management of Patients with Collagen Vascular Disease

Abstract

The clinical outcome of patients with the various manifestations of collagen vascular disease (CVD) has significantly improved over the past two decades with the increased use of diuretics, cytotoxic agents, dialysis, transplantation, and the judicious use of corticosteroids and other antiinflammatory agents directed at altering or delaying end-organ damage by the underlying immunopathologic process. A more rigorous definition of the various CVD clinical syndromes and a greater sophistication in the serologic, radiologic, and pathologic diagnostic methods have meant that patients with these diseases are now coming to clinical attention earlier in the course of their illness. Consequently, the physician is now encountering a greater number of clinical problems over a longer time span for each individual patient, rather than just the well-known complications of their end-stage disease. Despite the beneficial aspects of the newer therapeutic interventions to improve the clinical outcome of patients with CVD, the incidence of infection as a cause of both morbidity and mortality in these patients has not changed significantly over the past 30 years. A number of factors discussed in this chapter most likely contribute to the persistence of infectious complications in these patients. These include underlying host-defense abnormalities not significantly altered by therapeutic interventions, prolonged therapy with corticosteroids and alkylating agents that further suppress an already abnormal immune response, and an increased frequency of hospitalizations with more aggressive medical and surgical interventions, thereby increasing the risk of nosocomial infectious complications.KeywordsRheumatoid ArthritisSystemic Lupus ErythematosusInfectious ComplicationSeptic ArthritisAdult Respiratory Distress SyndromeThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.