Nurkowanie z akwalungiem u chorych na choroby reumatyczne i autoimmunologiczne: przegląd zakresowy obszarów ryzyka, oceny zdolności do nurkowania i pułapek diagnostycznych

Scuba diving exposes individuals to hyperbaric pressure, immersion physiology, decompression stress, and environmental factors capable of triggering endothelial activation, oxidative stress, and immune signaling pathways. As therapeutic advances allow patients with rheumatic and autoimmune diseases to maintain physically active lifestyles, clinicians increasingly face questions regarding the safety of underwater activities. However, the intersection between rheumatology and diving medicine remains poorly defined, with most available guidance originating from hyperbaric physiology rather than autoimmune disease frameworks. This scoping review synthesizes biomedical literature and authoritative diving medical resources to identify clinically relevant risk domains, including pulmonary involvement, neurologic stability, vasospastic disease, thrombotic risk, functional musculoskeletal capacity, and disease activity. Particular attention is given to diagnostic overlap between rheumatic manifestations and decompression illness. Current evidence suggests that diving risk is primarily determined by organ involvement and functional status rather than diagnosis alone. An evidence-informed framework for clinical assessment is proposed, integrating molecular physiology, vascular biology, and clinical rheumatology perspectives.