Biologic disease-modifying antirheumatic drugs to treat multisystem inflammatory syndrome in children.
Antirheumatic Agents
Biological Products
/ therapeutic use
COVID-19
/ complications
Child
Cytokine Release Syndrome
Cytokines
Humans
Immunoglobulins, Intravenous
/ therapeutic use
Interleukin-1
Interleukin-6
Mucocutaneous Lymph Node Syndrome
/ complications
SARS-CoV-2
Systemic Inflammatory Response Syndrome
Tumor Necrosis Factor-alpha
COVID-19 Drug Treatment
Journal
Current opinion in rheumatology
ISSN: 1531-6963
Titre abrégé: Curr Opin Rheumatol
Pays: United States
ID NLM: 9000851
Informations de publication
Date de publication:
01 09 2022
01 09 2022
Historique:
pubmed:
7
7
2022
medline:
28
7
2022
entrez:
6
7
2022
Statut:
ppublish
Résumé
Multisystem inflammatory syndrome in children (MIS-C) is a postinfectious complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection primarily affecting children. MIS-C shares features with Kawasaki disease (KD) and cytokine storm syndrome (CSS) frequently requiring intensive care support. Although intravenous immunoglobulin (IVIg) and glucocorticoids (GCs) are effective therapeutics for most, refractory MIS-C is treated with various biologic disease-modifying antirheumatic drugs (bDMARDs). Understanding the clinical features, inflammatory cytokines, and genetic associations provides rationale for bDMARD in treating severe MIS-C. Children with MIS-C have clinical KD features and often present in hypovolemic and cardiogenic shock requiring volume repletion (gastrointestinaI losses) and cardiac pressor support (epinephrine). Investigation of MIS-C serum reveals elevated pro-inflammatory cytokines [interleukin (IL)-1, IL-6, IL-18, interferon gamma (IFNγ), tumor necrosis factor (TNF)], but to a lesser extent than other established CSS. Gene sequencing of MIS-C children identifies heterozygous mutations in CSS associated genes. Treatment of refractory (IVIg and GC) MIS-C with bDMARDs to IL-1, IL-6, and TNF is efficacious for survival as well as resolving cardiac and coronary artery inflammation. MIS-C is a postinfectious complication of SARS-CoV-2 resembling KD and CSS, both genetically and by pro-inflammatory cytokines. MIS-C that is refractory to IVIg and GC is routinely responsive to bDMARDs targeting IL-1, IL-6, and TNF.
Identifiants
pubmed: 35791863
doi: 10.1097/BOR.0000000000000889
pii: 00002281-202209000-00006
doi:
Substances chimiques
Antirheumatic Agents
0
Biological Products
0
Cytokines
0
Immunoglobulins, Intravenous
0
Interleukin-1
0
Interleukin-6
0
Tumor Necrosis Factor-alpha
0
Types de publication
Journal Article
Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
274-279Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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