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Concurrent use of tumor necrosis factor inhibitor and tyrosine kinase inhibitor in ankylosing spondylitis and myeloid neoplasm. 肿瘤坏死因子抑制剂和酪氨酸激酶抑制剂在强直性脊柱炎和髓系肿瘤中的同时应用。
IF 1.9 Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.21097
Akash Gupta, Yuliya Afinogenova, Nikolai A Podoltsev, Abhijeet Danve

Biologic disease-modifying agents (bDMARDs) are highly effective in controlling the symptoms of autoimmune rheumatic diseases. The decision on whether to continue bDMARDs following a cancer diagnosis can be challenging for patients and physicians. Here, we describe a case of a middle-aged male with ankylosing spondylitis who was controlled on infliximab (IFX) and found to have a myeloid neoplasm with Platelet-Derived Growth Factor Receptor Beta rearrangement. The patient was started on a tyrosine kinase inhibitor imatinib. Given its significant positive effect on patient's quality of life, IFX was continued with a favorable outcome. This case highlights the importance of shared decisionmaking in balancing risks and benefits of immunosuppressants in appropriate cases of hematologic malignancy.

生物疾病调节剂(bDMARDs)在控制自身免疫性风湿病症状方面非常有效。癌症诊断后是否继续使用bdmard对患者和医生来说都是一个挑战。在这里,我们描述了一个中年男性强直性脊柱炎的病例,他被控制在英夫利昔单抗(IFX),发现有一个髓系肿瘤与血小板衍生生长因子受体β重排。患者开始使用酪氨酸激酶抑制剂伊马替尼。鉴于其对患者生活质量的显著积极影响,IFX继续治疗并取得了良好的结果。本病例强调了在适当的血液恶性肿瘤病例中,在平衡免疫抑制剂的风险和益处方面共同决策的重要性。
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引用次数: 0
An Unusual Case of Extrapulmonary Tuberculosis in Rheumatology Consultation. 风湿病会诊一例罕见的肺外结核。
IF 1.9 Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.21207
Kayra Somay, İlker Eren, Mahir Kapmaz, Benan Çağlayan, Afak Durur Karakaya, Nilüfer Alpay Kanıtez
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引用次数: 0
Overview of Thigh and Leg Anatomical and Sonographic Landmarks in Rheumatic Patients. 风湿病患者大腿和腿部解剖及超声标志物概述
IF 1.3 Q4 RHEUMATOLOGY Pub Date : 2022-09-01 DOI: 10.5152/eurjrheum.2022.21131
Ramon Balius, Carles Pedret, Paula Estrada-Alarcón, Hèctor Corominas

Musculoskeletal ultrasound has become a practical and accessible diagnostic tool for musculoskeletal diseases. It is used to examine joints, tendons, vessels, and nerves due to its wide availability in rheumatology practice. Ultrasound has also been applied for years in other areas such as muscular injuries in sports activities and rheumatic diseases with inflammation such as myositis. The knowledge among rheumatologists about muscle ultrasound is increasingly growing taking into account it is not the main target of their ultrasound activity but mainly based on the evaluation of joint, synovitis, tenosynovitis, vasculitis in giant cell arteritis, and parotid gland evaluation in Sjögren´s syndrome. Thus, the present review describes anatomical and ultrasound findings including all muscles of the thigh (anterior, posterior, medial aspects) and leg (anterior, lateral, posterior superficial, deep posterior compartments) of lower limb structures to ease a comprehensive clinical and sonographic evaluation.

肌肉骨骼超声波已成为一种实用、便捷的肌肉骨骼疾病诊断工具。由于其在风湿病学实践中的广泛应用,它可用于检查关节、肌腱、血管和神经。多年来,超声波还被应用于其他领域,如体育活动中的肌肉损伤和肌炎等伴有炎症的风湿性疾病。考虑到肌肉超声并不是风湿病学家超声活动的主要目标,而主要是基于关节、滑膜炎、腱鞘炎、巨细胞动脉炎中的血管炎以及斯约格伦综合征中的腮腺评估,风湿病学家对肌肉超声的了解正日益增多。因此,本综述描述了包括下肢结构的大腿(前方、后方、内侧)和腿部(前方、外侧、后方浅区、后方深区)所有肌肉的解剖和超声检查结果,以便于进行全面的临床和超声评估。
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引用次数: 0
Ultrasound evaluation of interstitial lung disease in rheumatoid arthritis and autoimmune diseases. 类风湿性关节炎和自身免疫性疾病间质性肺病的超声评估。
IF 1.9 Pub Date : 2022-08-09 DOI: 10.5152/eujrheum.2022.20120
Esther F Vicente-Rabaneda, David A Bong, Noemí Busquets-Pérez, Ingrid Möller

The interpretation of lung ultrasound (US) is the result of the analysis of artifacts, rather than exact representations of anatomical structures, which appear when changes in the physical properties of the lung occur. Its application to the study of interstitial lung disease (ILD) associated with autoimmune diseases has aroused great interest in the last 10 years, as evidenced by a growing number of publications studying its usefulness in the diagnostic process, as a prognostic marker, and as an aid in monitoring of patients. The main elements in lung US interpretation in ILD are the B lines and the changes in the pleural line. B lines are vertical artifacts that are generated when there is a partial decrease in the air content of the lung parenchyma and/or the volume of the interstitial area expands. Pleural line alterations that can be seen are irregularities, thickening, fragmentation, or subpleural nodules. Both the B lines and the changes in the pleural line have shown a significant positive correlation with the evidence on chest computed tomography (high-resolution computed tomography [HRCT]) of ILD associated with autoimmune diseases, with sensitivity and negative predictive values of up to 100%. These results, together with the safety, accessibility, and low cost of lung US, support this imaging technique as a promising screening method for optimizing the indication for HRCT. The role of lung US regarding sensitivity to change needs further investigation with multicenter prospective studies.

肺部超声波(US)的解释是对伪影分析的结果,而不是对解剖结构的准确描述,伪影是在肺部物理特性发生变化时出现的。在过去十年中,该技术在与自身免疫性疾病相关的间质性肺病(ILD)研究中的应用引起了人们的极大兴趣,越来越多的出版物研究了该技术在诊断过程中的作用、作为预后标记的作用以及作为监测患者的辅助手段的作用。B 线和胸膜线的变化是肺部 US 对 ILD 进行解释的主要因素。B 线是垂直伪影,当肺实质含气量部分减少和/或肺间质体积增大时产生。胸膜线的改变可表现为不规则、增厚、破碎或胸膜下结节。B 线和胸膜线的变化与胸部计算机断层扫描(高分辨率计算机断层扫描 [HRCT])显示的与自身免疫性疾病相关的 ILD 的证据有显著的正相关性,灵敏度和阴性预测值高达 100%。这些结果,加上肺部 US 的安全性、可及性和低成本,都支持将这种成像技术作为一种有前途的筛查方法,以优化 HRCT 的适应症。关于肺部 US 在敏感性变化方面的作用,还需要通过多中心前瞻性研究进行进一步调查。
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引用次数: 0
Walking, running, and recreational sports for knee osteoarthritis: An overview of the evidence. 步行、跑步和休闲运动治疗膝关节骨关节炎:证据概述。
IF 1.9 Pub Date : 2022-08-09 DOI: 10.5152/eurjrheum.2022.21046
Dana Voinier, Daniel K White

Objective: We provided an overview of narrative reviews, systematic reviews, and meta-analyses that summarize primary evidence of how physical activity (PA) relates to structural progression of knee osteoarthritis (OA). This overview can serve as a resource for healthcare providers when recommending PA to patients with, or at risk, for knee OA.

Methods: We searched the PubMED database for publications on "exercise" [MeSH Terms] and "knee osteoarthritis" [MeSH Terms]. We restricted our search to review articles, originally published in English, from 2005 to 2020. We then added several original studies to provide more detailed support of the findings of the review articles, based on the authors familiarity with the literature.

Results: We summarized the findings of 20 reviews and an additional 12 original studies. We found consistent evidence that common forms of PA (walking, running, and certain recreational sports) are not related to structural progression of knee OA, and can be safely recommended to patients with, or at risk, for knee OA.

Conclusion: Healthcare providers can refer to this overview of the evidence, as well as current PA guidelines, when recommending PA to their patients with, or at risk for, knee OA. Future studies can support PA guidelines that target preserving the structural integrity of the knees.

目的:我们概述了叙述性综述、系统性综述和荟萃分析,这些综述总结了体育锻炼(PA)与膝关节骨性关节炎(OA)结构进展关系的主要证据。该综述可作为医疗服务提供者在向膝关节OA患者或高危患者推荐体育锻炼时的参考资料:我们在 PubMED 数据库中搜索了有关 "运动"[MeSH 词条] 和 "膝骨关节炎"[MeSH 词条] 的出版物。我们将搜索范围限制在 2005 年至 2020 年间以英文发表的综述文章。然后,我们根据作者对文献的熟悉程度,添加了几项原创研究,为综述文章的研究结果提供更详细的支持:我们总结了 20 篇综述文章和另外 12 项原创研究的结果。我们发现,有一致的证据表明,常见形式的体育锻炼(步行、跑步和某些休闲运动)与膝关节 OA 的结构性进展无关,可以安全地推荐给膝关节 OA 患者或有此风险的患者:结论:医疗保健提供者在向膝关节 OA 患者或有膝关节 OA 风险的患者推荐 PA 时,可参考本证据概述以及当前的 PA 指南。未来的研究将支持以保护膝关节结构完整性为目标的运动疗法指南。
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引用次数: 0
What are the main factors affecting the outcome of tocilizumab therapy in COVID-19-induced cytokine release syndrome? 在COVID-19诱导的细胞因子释放综合征中,影响tocilizumab治疗结果的主要因素是什么?
IF 1.9 Pub Date : 2022-07-01 DOI: 10.5152/eurjrheum.2022.21010
Cansu Akleylek, Seray Gizem Gür, İbrahim Halil Sever, Safiye Koçulu Demir, Esin Çevik, Egemen Eken, Zafer Gökkaya, Yonca Çağatay, Neslihan Yılmaz

Objective: Recommendations for the treatment of cytokine release syndrome/macrophage activation syndrome (MAS) associated with coronavirus disease-2019 (COVID-19) are still of poor quality. IL-6 is an important therapeutic target as a main mediator of cytokine storm. The aim of our study was to evaluate the tocilizumab (TCZ) efficacy and factors affecting the therapy outcome.

Methods: This retrospective study included 27 patients treated with TCZ for COVID-19-MAS. All patients in this study were treated with TCZ (intravenously, at a dose of 8 mg kg1 ) in addition to standard therapy. Clinical improvement (survival and decreased oxygen demand) on the 10-14th days and secondary infection rate were assessed.

Results: In our 27 treated patients, 14 (51.8%) received TCZ in the intensive care unit (ICU) and seven (25.9%) were need to invasive mechanical ventilation (IMV). Fifteen (55.6%) of these patients revealed a good clinical response (four patients discharge from the ICU and 11 patients who followed-up in nonICU beds showed a decrease in oxygen demand). TCZ was significantly less effective in patients having high Murray lung injury score, low PO2/FiO2 ratio, IMV, and ICU admission (P < .05). Severity of hypoxemia was found as a single independent risk factor in the multivariable analysis (P < .05). Secondary bacterial infections rate was significantly higher in intubated patients (P < .01) or treated in the ICU (P ¼ .01).

Conclusion: TCZ was showed limited efficacy for COVID-19-related MAS. The most important predictive indicator for therapy outcome was found as the severity of hypoxemia. In addition, IMV and/or ICU was associated with the poor outcome and high side effect. So, controlled trials are still needed to confirm the indications and timing of TCZ therapy.

目的:新冠病毒病-2019 (COVID-19)相关细胞因子释放综合征/巨噬细胞激活综合征(MAS)的治疗建议质量仍然较差。IL-6作为细胞因子风暴的主要介质是重要的治疗靶点。本研究的目的是评估托珠单抗(TCZ)的疗效和影响治疗结果的因素。方法:回顾性研究27例经中西医结合治疗的新冠肺炎患者。本研究中的所有患者在标准治疗的基础上接受TCZ(静脉注射,剂量为8mg kg1)治疗。观察10 ~ 14天的临床改善情况(生存和耗氧量下降)及继发感染率。结果:27例患者中,重症监护病房(ICU)接受TCZ治疗的14例(51.8%),需要有创机械通气(IMV)治疗的7例(25.9%)。15例(55.6%)患者表现出良好的临床反应(4例从ICU出院,11例在非ICU床位随访的患者出现需氧量下降)。在Murray肺损伤评分高、PO2/FiO2比低、IMV低、入住ICU的患者中,TCZ的疗效明显较差(P < 0.05)。在多变量分析中发现低氧血症的严重程度是一个独立的危险因素(P < 0.05)。继发细菌感染率明显高于插管组(P < 0.01)和ICU组(P < 0.01)。结论:TCZ对新型冠状病毒相关MAS疗效有限。治疗结果最重要的预测指标是低氧血症的严重程度。此外,IMV和/或ICU与预后差和高副作用相关。因此,还需要进行对照试验来确定TCZ的适应症和治疗时机。
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引用次数: 2
Identifying physician-perceived barriers to a pragmatic treatment trial in rheumatoid arthritis. 确定医生感知的障碍,以实际治疗类风湿关节炎试验。
IF 1.9 Pub Date : 2022-07-01 DOI: 10.5152/eujrheum.2022.21038
Haiyan Qu, Shamly Austin, Jasvinder A Singh

Objective: The aim of this qualitative research was to identify physician-perceived patient and clinic barriers to patient recruitment in a rheumatoid arthritis (RA) pragmatic trial of anti-tumor necrosis factor (TNF) biologic versus non-TNF biologic/Janus-Kinase inhibitor initiation after an inadequate response to methotrexate.

Methods: Semistructured telephone interviews were conducted with 26 rheumatologists in March 2019. An exploratory thematic analysis approach was used to analyze the interview data.

Results: Physician perceived patient barriers to the implementation of an RA pragmatic trial. This theme covers three subthemes: (1) patients' personal barriers, (2) patients' treatment-related factors, and (3) trial-related factors (eg, patient recruitment, side effects, mode of use, etc). Physicians perceived clinic barriers interfered with the pragmatic trial enrollment from the clinic or the healthcare system perspective. This theme covered four subthemes: (1) clinic-related factors, (2) patient-related factors, (3) research personnel, and (4) facilitators (positive factors of the clinic).

Conclusion: Our results from the inductive thematic analysis will help researchers understand the key patient and clinic/system factors/barriers that may influence pragmatic RA trial implementation. The themes suggest there are factors that can be modified (eg, coordinator effort needed, effective patient recruitment during clinic visits, provider engagement) and challenges to overcome (patient insurance status, busy clinic flow, and space issues including limited number of patient rooms). In summary, these themes provide a basis for our and other research teams to develop clinic-centered and patientcentered strategies to implement a pragmatic RA trial.

目的:本定性研究的目的是确定在对甲氨蝶呤反应不充分后,抗肿瘤坏死因子(TNF)生物制剂与非TNF生物制剂/ janus -激酶抑制剂启动的类风湿性关节炎(RA)实用试验中,医生感知的患者和临床招募患者的障碍。方法:于2019年3月对26名风湿病专家进行半结构化电话访谈。采用探索性专题分析方法对访谈数据进行分析。结果:医生认为患者对实施RA实用试验存在障碍。该主题包括三个子主题:(1)患者的个人障碍;(2)患者的治疗相关因素;(3)试验相关因素(如患者招募、副作用、使用方式等)。从临床或医疗系统的角度来看,医生认为临床障碍干扰了实用的试验登记。该主题包括四个子主题:(1)临床相关因素,(2)患者相关因素,(3)研究人员,(4)促进者(临床积极因素)。结论:我们的归纳专题分析结果将有助于研究人员了解可能影响实际RA试验实施的关键患者和临床/系统因素/障碍。这些主题表明,有一些因素可以修改(例如,需要协调员的努力,在诊所就诊期间有效的患者招募,提供者的参与)和需要克服的挑战(患者保险状况,繁忙的诊所流量和空间问题,包括有限的病房数量)。总之,这些主题为我们和其他研究团队制定以临床为中心和以患者为中心的策略来实施实用的RA试验提供了基础。
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引用次数: 0
Physical activity and psychosomatic status in patients with Behçet's disease during coronavirus disease pandem. 冠状病毒大流行期间behaperet病患者的身体活动和心身状况
IF 1.9 Pub Date : 2022-07-01 DOI: 10.5152/eurjrheum.2021.20166
Songül Bağlan Yentür, Furkan Bilek, Süleyman Serdar Koca

Objective: The aim of this study is to examine the changes in physical activity level, fatigue, depression, and sleep quality in patients with Behçet's disease during the COVID-19 pandemic.

Methods: The study was designed as an online questionnaire applied to individuals who are being followed up with the diagnosis of Behçet's disease in the rheumatology department. Data were collected using multiple scales including International Physical Activity Questionnaire (IPAQ), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Pittsburg Sleep Quality Index (PSQI), and Visual Analogue Scale (VAS) to evaluate physical activity level, fatigue, depression, sleep quality, and pain, respectively.

Results: Sixteen patients diagnosed with Behçet's disease were included in the study. No statistically significant difference was observed between the IPAQ, FSS, BDI, PSQI, and VAS assessment scores before COVID-19 and during COVID-19 period (P > .05 for all).

Conclusion: Thinking of the negative effects of aggressive clinical symptoms, Behçet's disease patients should be supported in physical activity and psychosocial status.

目的:探讨2019冠状病毒病(COVID-19)大流行期间behaperet病患者身体活动水平、疲劳、抑郁和睡眠质量的变化。方法:本研究设计为一份在线问卷,适用于风湿病科随访诊断为behaperet病的个体。采用国际体力活动问卷(IPAQ)、疲劳严重程度量表(FSS)、贝克抑郁量表(BDI)、匹兹堡睡眠质量指数(PSQI)和视觉模拟量表(VAS)等量表,分别评价受试者的体力活动水平、疲劳程度、抑郁程度、睡眠质量和疼痛程度。结果:16例诊断为behaperet病的患者纳入研究。IPAQ、FSS、BDI、PSQI、VAS评分在新冠肺炎前与新冠肺炎期间比较,差异均无统计学意义(P > 0.05)。结论:考虑到侵袭性临床症状对患者的负面影响,应在身体活动和心理社会状况方面给予支持。
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引用次数: 0
Updates in ANCA-associated vasculitis. anca相关血管炎的最新进展。
IF 1.9 Pub Date : 2022-07-01 DOI: 10.5152/eujrheum.2022.20248
Carolyn Ross, Jean-Paul Makhzoum, Christian Pagnoux

Antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) are small-vessel vasculitides that include granulomatosis with polyangiitis (formerly Wegener's granulomatosis), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (Churg - Strauss syndrome). Renal-limited AAV can be considered a fourth entity. Despite their rarity and still unknown cause(s), research into AAV has been very active over the past decades and has allowed for the development of new therapeutic regimens. The pathogenesis is a complex process of immune dysregulations with genetic and environmental influences. Recent genome-wide association studies have identified multiple genetic predisposing variants, especially at the major histocompatibility complex region. The pathogenic role of antimyeloperoxidase ANCA (MPO-ANCA) is well supported by several animal models, but that of antiproteinase 3 ANCA (PR3-ANCA) is not as strongly demonstrated. B cells likely play a major role in the pathogenesis because they produce ANCAs, as do neutrophil abnormalities, imbalances in T-cell subtypes, and/or cytokine - chemokine networks. The role of the alternative complement pathway was established more recently, and studies of the antagonist of human C5a receptor (avacopan) in AAV have just been completed, with promising results. The current standard management of severe AAV still consists of remission induction therapy with glucocorticoids combined with rituximab or, less often now, cyclophosphamide. Several studies showed that reduced-dose regimens of glucocorticoids are noninferior to the previously used heavier regimens, for therefore less cumulative exposure to glucocorticoids. Avacopan use may even lead to new steroid-free therapeutic approaches, at least for some selected patients. Several trials and studies have now shown the superiority of rituximab over azathioprine or methotrexate as maintenance therapy. However, the optimal dosing regimen and duration for maintenance remain to be better defined, at the individual patient level. Many changes have occurred in the standard of care for AAV over the past decades, and more are expected soon, including with use of avacopan, but also, likely, a few other agents under investigation or development.

抗中性粒细胞细胞质抗体(ANCA)相关血管炎(AAV)是小血管血管炎,包括肉芽肿病合并多血管炎(原Wegener肉芽肿病)、显微镜下的多血管炎和嗜酸性肉芽肿病合并多血管炎(Churg - Strauss综合征)。肾受限型AAV可被视为第四个实体。尽管AAV罕见且病因不明,但在过去的几十年里,对AAV的研究一直非常活跃,并为新的治疗方案的开发提供了条件。其发病机制是一个复杂的免疫失调过程,受遗传和环境的影响。最近的全基因组关联研究已经确定了多种遗传易感变异,特别是在主要组织相容性复合体区域。抗髓过氧化物酶ANCA (MPO-ANCA)的致病作用已得到多种动物模型的支持,但抗蛋白酶3 ANCA (PR3-ANCA)的致病作用尚未得到充分证实。B细胞可能在发病机制中起主要作用,因为它们产生anca,中性粒细胞异常、t细胞亚型失衡和/或细胞因子-趋化因子网络也会产生anca。替代补体途径的作用是最近才确立的,而人类C5a受体拮抗剂(avacopan)在AAV中的研究刚刚完成,结果很有希望。目前严重AAV的标准治疗仍然包括糖皮质激素联合利妥昔单抗或环磷酰胺(现在较少使用)的缓解诱导治疗。几项研究表明,减少糖皮质激素剂量的方案并不逊于以前使用的更大剂量方案,因此减少了糖皮质激素的累积暴露。Avacopan的使用甚至可能导致新的无类固醇治疗方法,至少对于一些选定的患者。一些试验和研究表明,作为维持治疗,利妥昔单抗优于硫唑嘌呤或甲氨蝶呤。然而,在个体患者水平上,最佳给药方案和维持时间仍有待更好地确定。在过去的几十年里,AAV的治疗标准发生了许多变化,预计很快会有更多的变化,包括使用avacopan,但也可能有其他一些正在研究或开发的药物。
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引用次数: 5
Multisystem Inflammatory Syndrome in Children: A Year in Review. 儿童多系统炎症综合征:一年回顾。
IF 1.9 Pub Date : 2022-07-01 DOI: 10.5152/eurjrheum.2022.21114
Vivekanand Tiwari, Albert A Daniel

Centers for Disease Control and Prevention published a case definition for the multisystem inflammatory syndrome in children in May 2020 when reports started pouring in about a clinical syndrome in children which was temporally associated with coronavirus disease 2019 infection. It has also been referred to as pediatric inflammatory multisystemic syndrome temporally associated with severe acute respiratory syndrome coronavirus 2. Most of these patients test positive for severe acute respiratory syndrome coronavirus 2 serology or reverse transcription-polymerase chain reaction, although a small number of patients could test negative which would require an epidemiological link to the coronavirus disease 2019 infection. The initial clinical presentation could overlap with Kawasaki disease, severe coronavirus disease 2019 infection, toxic shock syndrome, and macrophage activation syndrome. While multisystem inflammatory syndrome in children is characterized by multisystem involvement with hyper inflammation and severe clinical presentation initially, the prognosis is generally good. Since it was first described, there have been multiple studies describing the demographic characteristics, laboratory features, and treatment paradigm.

美国疾病控制和预防中心于2020年5月发布了儿童多系统炎症综合征的病例定义,当时有关儿童临床综合征的报道开始大量涌入,该综合征与2019年冠状病毒感染暂时相关。它也被称为小儿炎症性多系统综合征,与严重急性呼吸综合征冠状病毒2暂时相关。这些患者中的大多数对严重急性呼吸综合征冠状病毒2型血清学或逆转录聚合酶链反应检测呈阳性,尽管少数患者可能检测呈阴性,这需要与2019年冠状病毒感染存在流行病学联系。最初的临床表现可能与川崎病、2019年严重冠状病毒病感染、中毒性休克综合征和巨噬细胞激活综合征重叠。虽然儿童多系统炎症综合征的特点是多系统受累,初始表现为高度炎症,临床表现严重,但预后一般较好。自首次描述以来,已有多项研究描述了人口统计学特征,实验室特征和治疗范例。
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引用次数: 3
期刊
European journal of rheumatology
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