Macrophage activation syndrome in children with systemic juvenile idiopathic arthritis and systemic lupus erythematosus.

Abstract

Macrophage activation syndrome (MAS) is a hyper-inflammatory disorder secondary to a rheumatic disease such as systemic juvenile idiopathic arthritis (SJIA) and systemic lupus erythematosus (SLE). We aimed to present the characteristics of our pediatric MAS patients. Clinical features, laboratory parameters, treatment, and outcome of 34 patients (28 SJIA; six SLE; 37 MAS episodes) followed at a tertiary health center between 2009 and 2015 were retrospectively reviewed. The median age at MAS onset was 11years. More SJIA patients had MAS at disease onset than SLE patients (53.6 vs. 16.7%). Fever, high C-reactive protein and hyperferritinemia were present in all MAS episodes. Rash was less (p=0.03), and fatigue was more frequent (p=0.042) in SLE than SJIA patients. All received corticosteroids. Cyclosporine was given in 74.2% of SJIA-MAS; 66.7% of SLE-MAS episodes. Intravenous immunoglobulin, anakinra, or etoposide was administered during 67.7; 41.9; 32.3% of SJIA-MAS and 33.3; 33.3; 50% of SLE-MAS episodes, respectively. Plasmapheresis was performed during 41.9% of SJIA-MAS and 33.3% of SLE-MAS episodes. The mortality rate was 11.8% (n=4;3 SJIA, 1 SLE). Hepatosplenomegaly was more frequent (p=0.005), and plasmapheresis was performed more frequently (p=0.021) in the patients who died compared to the cured patients. The median duration between symptom onset and admission to our hospital was longer among the patients who died (16.5 vs. 7days; p=0.049). Our patients' characteristics were similar to the reported cases, but our mortality rate is slightly higher probably due to late referral to our center. Early diagnosis and effective treatment are crucial to prevent mortality.