The following list of medications are in some way related to, or used in the treatment of this. Clinical and laboratory features of mas include sustained fever. In pediatric rheumatology, the term macrophage activation syndrome mas refers to a condition caused by excessive activation and expansion of t lymphocytes and macrophagic histiocytes that exhibit hemophagocytic activity. Depending upon the different medical literature the treatment of macrophage activation syndrome are as follows. Macrophage activation syndrome symptoms, treatments. A subanalysis of a randomized clinical trial indicated sepsis survival benefit from interleukin il1 blockade in patients with features of the macrophage activationlike syndrome mals. Macrophage activation syndrome mas is a lifethreatening inflammatory complication of childhoodonset systemic lupus erythematosus csle. Macrophage activation syndrome mas is a potentially lifethreatening complication of sjia as well as sometimes complicating other rheumatologic conditions, such as juvenile systemic lupus erythematosus thought to result from immune activation of pathogenic t cells and hemophagocytic macrophages.
Predictive factors and prognosis of macrophage activation syndrome associated with adultonset stills disease x. Macrophage activation syndrome treated with anakinra the. Hemophagocytic syndrome, hemophagocytic lymphohistiocytosis hlh, histiocytic erythrophagocytosis. Boom v, anton j, lahdenne p, quartier p, ravelli a, wulffraat nm, et al. We read with great interest the article by minoia et al which named development and initial validation of the macrophage activation syndrome massystemic juvenile idiopathic arthritis sjia ms score for diagnosis of mas in sjia. After extensive workup and lack of improvement with broadspectrum antimicrobial therapy, intravenous immunoglobulin and steroids, the patient was diagnosed with macrophage activation syndrome after bone marrow biopsy and levels of soluble cd25 soluble ncbi. Anakinra 100 mg subcutaneously daily was initiated, along with pulse methylprednisolone 1 gday for 3 days, then prednisone 25 mg twice daily. Macrophage activation syndrome page 6 of 7 the rheumatologist. Frontiers the immunology of macrophage activation syndrome. Recent findings in hemophagocytic lymphohistiocytosis, a disease that is clinically sim. Hemophagocytic syndrome, hemophagocytic lymphohistiocytosis hlh, histiocytic erythrophagocytosis icd9 code.
Macrophage activation syndrome is a severe, potentially lifethreatening, complication of several chronic rheumatic diseases of childhood. Macrophage activation syndrome mas is a phenomenon characterized by cytopenia, organ dysfunction, and coagulopathy associated with an inappropriate activation of macrophages. Evidencebased diagnosis and treatment of macrophage. Patients with adultonset still disease with macrophage activation. Macrophage activation syndrome angelo ravelli, md macrophage activation syndrome mas is a serious complication of childhood systemic inflammatory disorders that is thought to be caused by excessive activation and proliferation of t lymphocytes and macrophages.
The inflammation can be in any organ system including the bone marrow, liver, and spleen. In pediatric rheumatology, the term macrophage activation syndrome mas refers to a condition caused by excessive activation and expansion. There are four uncommon medical conditions characterized by high levels of ferritin, namely the macrophage activation syndrome. Application of ms score in macrophage activation syndrome. Macrophage activation syndrome as the presenting manifestation of rheumatic diseases in childhood. The term mas designates a clinicopathologic entity that occurs in different hemophagocytic syndromes hss. Prognostic factors of macrophage activation syndrome, at. A febrile patient with known or suspected sjia must be considered for macrophage activation if. Soluble hemoglobinhaptoglobin scavenger receptor cd163 as a lineagespecific marker in the reactive hemophagocytic syndrome.
Within 48 hours of anakinra treatment, blood count increased and fever abated. Macrophage activation syndrome mas is a rare, lifethreatening disease in which early diagnosis and aggressive therapeutic strategy may improve the outcome. The mainstay of mas treatment is glucocorticoid therapy. Most of the physicians start with an intravenous methylprednisolone 30 mgkgdose. May 05, 2020 macrophage activation syndrome in patients with systemic juvenile idiopathic arthritis is associated with munc4 polymorphisms. Nov 01, 2019 macrophage activation syndrome mas is a rare and severe complication of kawasaki disease kd. Macrophage activation syndrome in patients with systemic juvenile idiopathic arthritis is associated with munc4 polymorphisms. If you have questions about which treatment is right for you, talk to your healthcare professional. The resources below provide information about treatment options for this condition. Secondary hlh due to autoimmune disease is known as macrophage activation syndrome mas. Mas refers to reactive hemophagocytic lymphohistiocytosis hlh, which may be classified into primary, the genetic forms, and secondary, the. Prognostic factors of macrophage activation syndrome, at the. Macrophage activation syndrome mas is a serious complication of childhood systemic inflammatory disorders that is thought to be caused by excessive activation and proliferation of t lymphocytes and macrophages.
Macrophage activation syndrome mas is a pathological systemic. Apr 28, 2020 macrophage activation syndrome in patients with systemic juvenile idiopathic arthritis is associated with munc4 polymorphisms. In addition, mas has been described in association with systemic lupus erythematosus sle, kawasaki disease, and adult. Macrophage activation syndrome as an initial presentation. Common symptoms reported by people with macrophage activation syndrome. There are few reports of longterm outcomes of mas complicating csle. It occurs most commonly with systemiconset juvenile idiopathic arthritis sojia. Hemoglobin platelets x 109l neutrophils treatment available for macrophage activation syndrome. Adult macrophage activation syndrome mas, is a lifethreatening complication, developing during the clinical course of several inflammatory diseases such as adult onset stills disease aosd and systemic lupus erythematosus sle. Macrophage activation syndrome mas is the term used to describe a potentially lifethreatening complication of systemic inflammatory disorders, which occurs most commonly in systemic juvenile idiopathic arthritis jia and in its adult equivalent, adultonset stills disease 14, although its occurrence in patients. Mas is a lifethreatening complication of rheumatic disorders, including sjia, adultonset stills disease aosd and lupus.
This can occur in the setting of a number of different immune. Aug 22, 20 over the last few years, accumulating data have implicated a role for ferritin as a signaling molecule and direct mediator of the immune system. Macrophage activation syndrome treatment, symptoms, life. Macrophage activation syndrome mas is a rare and potentially fatal disorder, thought to result from uncontrolled activation and proliferation of t cells and excessive activation of macrophages. Macrophage activation syndrome as part of systemic. Haemophagocytic lymphohistiocytosis hlh is an underrecognized hyperinflammatory condition with a high mortality, characterized by inappropriate survival of histiocytes and cytotoxic t cells ctls, leading to a cytokine storm, haemophagocytosis and multiorgan damage. Predictive factors and prognosis of macrophage activation.
Macrophage activation syndrome is characterized by pancytopenia, liver insufficiency. Symptoms include fever, a painful mass or masses in the abdomen, easy bruising or bleeding, swollen lymph nodes, a rash, headache, confusion, vision changes, seizures andor coma as well as difficulty breathing. Pdf the clinical utility of splenic fluorodeoxyglucose. Treatment of macrophage activation syndrome mas with. The treatment of macrophage activation syndrome mas is traditionally based on the parenteral administration of high doses of corticosteroids. The clinical features include a persistent highgrade fever, hepatosplenomegaly, lymphadenopathy, hemorrhagic manifestations, and a sepsislike condition. Review macrophage activation syndrome as part of systemic juvenile idiopathic arthritis. Macrophage activation syndrome mas is an intriguing and potentially lifethreatening condition 1, 2, clinically characterized by nonremitting fever, hepatosplenomegaly, lymphadenopathy, encephalopathy, coagulopathy and even multi organ failure in severe cases. Macrophage activation syndrome mas is a lifethreatening complication of rheumatic. It remains a rare pathology, with a guarded prognosis, characterized by clinical and biological signs that are not very specific and whose association helps invoke. What is the prognosis of macrophage activation syndrome mas. A diagnosis of macrophage activation syndrome mas was made. Apart from these inflammatory disorders, different autoinflammatory dysfunctions like kawasaki disease, systemic lupus erythematosus, and periodic fever syndromes can trigger the onset of adult and childhood macrophage activation syndrome.
Macrophage activation syndrome mas is a phenomenon characterized by cytopenia, organ dysfunction, and coagulopathy associated with an inappropriate activation of macrophages 1. Kawasaki disease complicated with macrophage activation. Current focus has been on the development of novel therapeutics, including antivirals and vaccines. Soluble hemoglobinhaptoglobin scavenger receptor cd163 as a lineagespecific marker in. The clinical feature, early diagnosis and treatment options, and prognosis need to be further determined in patients with kd complicated with mas. Patients with infections and systemic inflammatory response syndrome were assigned to. Evidencebased diagnosis and treatment of macrophage activation syndrome in systemic juvenile idiopathic arthritis. Mas is a severe, potentially fatal disease characterized by severe systemic inflammation.
First line treatment for macrophage activation syndrome is considered as highdose corticosteroid therapy. Macrophage activation syndrome mas aboutkidshealth. Evidencebased diagnosis and treatment of macrophage activation. Macrophage activation syndrome, a rare complication of. Over the last few years, accumulating data have implicated a role for ferritin as a signaling molecule and direct mediator of the immune system. Macrophage activation syndrome causes, symptoms, diagnosis. Synonymous with secondary hemophagocytic lymphohistiocytosis, macrophage activation syndrome mas is a term used by rheumatologists to describe a potentially lifethreatening complication of systemic inflammatory disorders, most commonly systemic juvenile idiopathic arthritis sjia and systemic lupus erythematosus sle. The goal in treating mas is to reduce bodywide inflammation as quickly as possible and prevent organ damage. Actemra can mask macrophage activation syndrome in. Macrophage activation syndrome an overview sciencedirect. This study aimed to investigate the frequency of mals and to develop a biomarker of diagnosis and prognosis. Macrophage activation syndrome in adults with rheumatic disease.
Macrophages are a type of immune cell in the body that eats infectious organisms and damaged cells. Diagnosis is a challenge, treatment has to be started early and be aggressive to reduce the. It remains a rare pathology, with a guarded prognosis, characterized by clinical and biological signs that are not very specific and whose association helps invoke the diagnosis. Macrophage activation syndrome mas is a lifethreatening complication of rheumatic disease that, for unknown reasons, occurs much more frequently in individuals with systemic juvenile idiopathic. Macrophage activation syndrome, by definition, occurs in people who have an underlying rheumatic disorder, or an autoimmune disorder of the joints and connective tissues. Macrophage activation syndrome mas is a rare and severe complication of kawasaki disease kd. Hyperferritinemia is associated with a multitude of clinical conditions and with worse prognosis in critically ill patients. List of macrophage activation syndrome medications 1. Haemophagocytic lymphohistiocytosis hlh is an aberrant hyperinflammatory, hyperferritinemic immune response syndrome driven by macrophages and cytotoxic t cells. It is sometimes difficult to establish the diagnosis of hemophagocytic lymphohistiocytosis hlh, and the combination of the physical symptoms and certain laboratory tests is required. Macrophage activation syndrome mas is a lifethreatening condition, and it is a subset of hemophagocytic lymphohistiocytosis hlh.
Macrophage activation syndrome mas is address correspondence to dr wulffraat. Our aim is to compare longterm outcomes between mas and nonmas patients with csle seen at a single tertiary centre. Recent findings in hemophagocytic lymphohistiocytosis, a disease that. Hlh is classified into familial fhlh and into secondary shlh. The most common rheumatic disorder associated with macrophage activation syndrome is a condition called systemic juvenile idiopathic arthritis, which causes fever, rash, and. Apr 19, 2019 macrophage activation syndrome is a condition in which the bodys immune system activates excessively, leading to tissue and organ damage. Macrophage activation syndrome mas is a term used by rheumatologists to describe a potentially lifethreatening complication of systemic inflammatory disorders, most commonly systemic juvenile idiopathic arthritis sjia and its adult equivalent adult onset still disease and systemic lupus erythematosus sle 1. As of march 12, 2020, coronavirus disease 2019 covid19 has been confirmed in 125 048 people worldwide, carrying a mortality of approximately 37%,1 compared with a mortality rate of less than 1% from influenza. Macrophage activation syndrome is a serious complication of rheumatic disease, thought to be caused by excessive activation of macrophages and lymphocytes. The treatment and prognosis of patients with hlh and the macrophage activation syndrome mas, a form of hlh in patients with juvenile idiopathic arthritis and other rheumatologic conditions, will be discussed here. Prognosis depends on the severity of neurologic manifestations. In individuals with macrophage activation syndrome mas, the immune system is uncontrolled and works in overdrive, leading to too much inflammation in the entire body. Macrophage activation syndrome is the dysregulation of macrophage lymphocyte interactions leading to uncontrolled proliferation and activation of macrophages and t cells. A set of diagnostic criteria was recommended by the histiocyte society for use in the hlh2004 research protocol, and this was revised in 2007.
In adults, macrophage activation syndrome develops due to the complication of stills disease. The genetics, clinical features, and diagnosis of hlh are presented separately. Predictive factors and prognosis of macrophage activation syndrome. Type 2 has mutations in rab27a and haemophagocytic syndrome, with abnormal tcell and macrophage activation. Laboratory abnormalities of mas include pancytopenia, hyperferritinemia, hypertriglyceridemia and elevated serum.
Macrophage activation syndrome mas in adults is poorly studied. Macrophage activation syndrome is the dysregulation of macrophagelymphocyte interactions leading to uncontrolled proliferation and activation of macrophages and t cells. Treating systemic juvenile idiopathic arthritis sjia with actemra tocilizumab can modify the clinical and laboratory features of macrophage activation syndrome mas a severe, potentially lifethreatening complication of rheumatic diseases and complicate its diagnosis, a study found as such, the researchers said, it is not appropriate to use standard mas classification criteria. Nov 21, 2018 macrophage activation syndrome mas is a lifethreatening complication of rheumatic disease that, for unknown reasons, occurs much more frequently in individuals with systemic juvenile idiopathic arthritis sjia and in those with adultonset still disease. In the case of severe case, the intravenous route is usually chosen for administering the drug. Aug 31, 2018 macrophage activation syndrome mas is a lifethreatening condition, and it is a subset of hemophagocytic lymphohistiocytosis hlh. In macrophage activation syndrome, macrophages are excessively activated and cant be shut down. Predictive factors and prognosis of macrophage activation syndrome associated with adultonset stills disease.
Longterm outcomes of macrophage activation syndrome in. The recognition that mas belongs to the secondary or reactive hemophagocytic syndromes has led. Macrophage activation syndrome is characterized by pancytopenia, liver insufficiency, coagulopathy, and neurologic symptoms and is. Drugs used to treat macrophage activation syndrome. Macrophage activation syndrome genetic and rare diseases. Macrophage activation syndrome mas is a clinical syndrome caused by excessive activation and proliferation of well differentiated macrophages.