小儿系统性特发性关节炎与sars - cov -2相关多系统炎症综合征的重叠临床特征

IF 1.4 Q3 RHEUMATOLOGY Reumatologia Pub Date : 2023-01-01 DOI:10.5114/reum/161185
Oksana Boyarchuk, Tetiana Kovalchuk
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引用次数: 2

摘要

系统性青少年特发性关节炎(sJIA)的鉴别诊断往往是复杂的,因为临床表现的可变性和缺乏特异性体征。材料和方法:对2013-2022年PubMed/Medline和Scopus数据库的英文全文进行分析,使用以下关键词:“少年特发性关节炎”和“MIS-C”;“幼年特发性关节炎”和“川崎病”。作为问题的一个例子,病例描述的一个3岁的病人是提出。结果:第一步共识别167篇文献;然而,在排除重复文章和与主题无关的文章后,只有13篇被纳入分析。我们分析了描述sJIA和川崎病(KD)或儿童多系统炎症综合征(MIS-C)重叠临床特征的研究。我们讨论的主要问题是寻找将一种疾病与另一种疾病区分开来的具体特征。发热对静脉注射免疫球蛋白治疗的难治性是临床病程特征中最常见的指标。在其他临床症状中,长期反复发热、皮疹、不完全KD表型、高加索种族、脾肿大和复杂的巨噬细胞激活综合征也支持sJIA的诊断。在实验室测试中,高铁蛋白和血清白介素-18水平被发现对分化最有用。本病例表明,长时间的、不明原因的、具有特定模式的反复发热应是怀疑sJIA的原因。结论:新冠肺炎大流行时代sJIA与sars - cov -2相关MIS-C的重叠特征使诊断复杂化。我们的病例表现增加了长时间、尖峰、不明原因、反复发热的症状,具有支持系统性青少年特发性关节炎诊断的特定模式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Overlapping clinical features of systemic juvenile idiopathic arthritis and SARS-CoV-2-related multisystem inflammatory syndrome in children.

Introduction: Differential diagnosis of the systemic juvenile idiopathic arthritis (sJIA) is often complicated, because of the variability in clinical presentation and the absence of specific signs.

Material and methods: The PubMed/Medline and Scopus databases from the years 2013-2022 were analysed for full articles in English and the following key words were used: "juvenile idiopathic arthritis" and "MIS-C"; "juvenile idiopathic arthritis" and "Kawasaki disease". As an example of the problem the case description of a 3-year-old patient is presented.

Results: In the first step 167 publications were identified; however, after exclusion of duplicated articles and those not relevant to the topic, only 13 were included in the analysis. We analysed studies that describe overlapping clinical features of sJIA and Kawasaki disease (KD) or multisystem inflammatory syndrome in children (MIS-C). The main issues we discussed were the search for the specific features that would distinguish one disease from another. Fever refractory to intravenous immunoglobulin treatment was the most frequent indicator among the features of clinical courses. Among other clinical signs prolonged, recurrent fever, rash, an incomplete KD phenotype, Caucasian race, splenomegaly, and complicated macrophage activation syndrome also supported sJIA diagnosis. Among laboratory tests, high ferritin and serum interleukin-18 levels were found to be the most useful in differentiation. The present case demonstrates that prolonged, unexplained, recurrent fever with a specific pattern should be the reason to suspect sJIA.

Conclusions: Overlapping features of sJIA and SARS-CoV-2-related MIS-C complicates diagnosis in the era of the COVID-19 pandemic. Our case presentation adds symptoms of prolonged, spiking, unexplained, recurrent fever with a specific pattern for supporting systemic juvenile idiopathic arthritis diagnosis.

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来源期刊
Reumatologia
Reumatologia Medicine-Rheumatology
CiteScore
2.70
自引率
0.00%
发文量
44
审稿时长
10 weeks
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