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Macrophage activation syndrome in juvenile systemic lupus erythematosus: an under-recognized complication?
1Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini, Genova, Italy, Hospital Pedro de Elizalde, Buenos Aires, Argentina.
Abstract:
Macrophage activation syndrome (MAS) is a life-threatening complication of rheumatic diseases that is thought to be caused by the activation and uncontrolled proliferation of T lymphocytes and macrophages, leading to widespread haemophagocytosis and cytokine overproduction. It is seen most commonly in systemic juvenile idiopathic arthritis, but is increasingly recognized also in juvenile systemic lupus erythematosus (J-SLE). Recognition of MAS in patients with J-SLE is often challenging because it may mimic the clinical features of the underlying disease or be confused with an infectious complication. This review summarizes the characteristics of patients with J-SLE-associated MAS reported in the literature or seen by the authors and analyses the distinctive clinical, diagnostic and therapeutic issues that the occurrence of MAS may raise in patients with J-SLE.
Insights
Macrophage activation syndrome (MAS) is a severe complication in rheumatic diseases, particularly juvenile systemic lupus erythematosus (J-SLE). This review highlights its challenging diagnosis and management in J-SLE patients.
Area of Science:
- Rheumatology
- Immunology
- Pediatrics
Background:
- Macrophage activation syndrome (MAS) is a life-threatening condition associated with rheumatic diseases.
- It involves uncontrolled immune cell activation, leading to cytokine storms and organ damage.
- While common in systemic juvenile idiopathic arthritis, MAS is increasingly recognized in juvenile systemic lupus erythematosus (J-SLE).
Purpose of the Study:
- To summarize characteristics of J-SLE patients with MAS.
- To analyze clinical, diagnostic, and therapeutic challenges of MAS in J-SLE.
- To provide insights for better management of this complication.
Main Methods:
- Literature review of J-SLE-associated MAS cases.
- Analysis of reported clinical presentations.
- Synthesis of diagnostic criteria and treatment strategies.
Main Results:
- MAS in J-SLE can mimic disease flares or infections, complicating diagnosis.
- Early recognition and prompt treatment are crucial for favorable outcomes.
- Distinctive clinical and laboratory features may aid in differentiating MAS from other conditions in J-SLE.
Conclusions:
- MAS is a significant and challenging complication in J-SLE.
- Awareness and understanding of its nuances are vital for timely diagnosis and effective management.
- Further research is needed to refine diagnostic and therapeutic approaches for MAS in J-SLE.
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