Management of severe hyperinflammation in the COVID-19 era: the role of the rheumatologist.
Management of severe hyperinflammation in the COVID-19 era: the role of the rheumatologist.
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DOI：
10.1093/rheumatology/keaa652
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发表时间：
2021-02-01
期刊：
影响因子：
--
通讯作者：
Brogan P
中科院分区：
文献类型：
--
作者：
Papadopoulou C;Al Obaidi M;Moraitis E;Compeyrot-Lacassagne S;Eleftheriou D;Brogan P
本研究的目的是：（i）描述与SARS-CoV-2（PIMS-TS）暂时相关的儿童炎性多系统综合征的临床表现、治疗和结局;（ii）提出一个指导多学科团队（MDT）管理的框架;（iii）强调儿科风湿病学家在此背景下的作用。本研究涉及对转诊至单个儿科专科中心的疑似PIMS-TS患者的回顾性病例记录审查，重点关注MDT框架背景下的临床表现、实验室参数、治疗和结局。19例中位年龄为9.1岁的儿童符合PIMS-TS的定义，并在MDT框架内进行管理：5/19例为女性; 14/19例为黑人、亚洲人或少数民族; 9/19例还符合完全或不完全川崎（KD）的诊断标准。严重的全身炎症、休克和腹痛普遍存在。在MDT框架内对治疗进行分层，包括所有CS;所有静脉注射免疫球蛋白; 4/19例阿那白滞素; 1/19例英夫利西单抗; 4/19例抗病毒药物（阿昔洛韦）。我们观察到显著的诊断平衡使用PIMS-TS的当前定义，与KD重叠。在临床试验之外，MDT方法至关重要。儿科风湿病学家的作用是考虑鉴别诊断的炎症在年轻人，建议经验性免疫调节治疗，以确定现实的治疗目标，以衡量治疗的成功，监督及时降压的免疫调节，并有助于长期MDT随访的任何晚期炎症后遗症。
The objectives of this study were (i) to describe the clinical presentation, treatment and outcome of paediatric inflammatory multisystem syndrome temporally related to Sars-CoV-2 (PIMS-TS) in children; (ii) to propose a framework to guide multidisciplinary team (MDT) management; and (iii) to highlight the role of the paediatric rheumatologist in this context. This study involved a retrospective case notes review of patients referred to a single specialist paediatric centre with suspected PIMS-TS, with a focus on clinical presentation, laboratory parameters, treatment, and outcome in the context of an MDT framework. Nineteen children of median age 9.1 years fulfilled the definition of PIMS-TS and were managed within an MDT framework: 5/19 were female; 14/19 were of Black, Asian or minority ethnicity; 9/19 also fulfilled diagnostic criteria for complete or incomplete Kawasaki disease (KD). Severe systemic inflammation, shock, and abdominal pain were ubiquitous. Treatment was stratified within an MDT framework and included CSs in all; i.v. immunoglobulin in all; anakinra in 4/19; infliximab in 1/19; and antiviral (aciclovir) in 4/19. We observed significant diagnostic equipoise using a current definition of PIMS-TS, overlapping with KD. Outside of clinical trials, an MDT approach is vital. The role of the paediatric rheumatologist is to consider differential diagnoses of hyperinflammation in the young, to advise on empiric immunomodulatory therapy, to set realistic therapeutic targets, to gauge therapeutic success, to oversee timely step-down of immunomodulation, and to contribute to the longer-term MDT follow-up of any late inflammatory sequelae.
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评论：在翻译中发现：国际倡议追求白介素-1封锁治疗急性川崎病。
DOI：
10.1002/art.39975
发表时间：
2017-02
期刊：
Arthritis & rheumatology (Hoboken, N.J.)
影响因子：
--
作者：
Burns JC;Koné-Paut I;Kuijpers T;Shimizu C;Tremoulet A;Arditi M
通讯作者：
Arditi M
影响因子：
3.7
作者：
Manlhiot C;Mueller B;O'Shea S;Majeed H;Bernknopf B;Labelle M;Westcott KV;Bai H;Chahal N;Birken CS;Yeung RSM;McCrindle BW
通讯作者：
McCrindle BW
影响因子：
2
作者：
Hampson, Lisa V.;Whitehead, John;Eleftheriou, Despina;Brogan, Paul
通讯作者：
Brogan, Paul
影响因子：
5.1
作者：
Nicholson, George T.;Hsu, Daphne T.;Lopez, Leo
通讯作者：
Lopez, Leo
影响因子：
37.8
作者：
McCrindle, Brian W.;Rowley, Anne H.;Pahl, Elfriede
通讯作者：
Pahl, Elfriede