Intensive care unit admission and mortality in rheumatic diseases

Rheumatic diseases (RDs) comprise a heterogeneous group of autoimmune and autoinflammatory disorders marked by systemic inflammation, immune dysregulation, and progressive multiorgan damage. Despite advances in immunopathology and targeted therapies, acute complications requiring intensive care unit (ICU) management remain a major cause of morbidity and mortality in RDs. Infections and disease flares are the leading triggers of ICU admission, while mortality rates range from 14% to 60%, depending on disease severity and organ failure. Catastrophic antiphospholipid syndrome, pulmonary–renal syndrome, macrophage activation syndrome, and scleroderma renal crisis represent the most lethal rheumatologic emergencies. Systemic lupus erythematosus and idiopathic inflammatory myopathies exhibit the highest ICU mortality, followed by systemic sclerosis, rheumatoid arthritis, and primary Sjögren syndrome. Adverse outcomes are compounded by corticosteroid exposure, chronic immunosuppression, and respiratory or renal failure. Although biologic agents, intravenous immunoglobulin, and extracorporeal support have improved selected outcomes, survival remains inconsistent. Early recognition, multidisciplinary management, and standardized, evidence-based care pathways are essential to optimize outcomes and reduce ICU mortality in critically-ill patients with RDs.