Back to Search
Start Over
Biologic disease-modifying antirheumatic drugs to treat multisystem inflammatory syndrome in children.
- Source :
-
Current opinion in rheumatology [Curr Opin Rheumatol] 2022 Sep 01; Vol. 34 (5), pp. 274-279. Date of Electronic Publication: 2022 Jul 05. - Publication Year :
- 2022
-
Abstract
- Purpose of Review: 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.<br />Recent Findings: 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.<br />Summary: 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.<br /> (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Child
Cytokine Release Syndrome
Cytokines
Humans
Immunoglobulins, Intravenous therapeutic use
Interleukin-1
Interleukin-6
SARS-CoV-2
Systemic Inflammatory Response Syndrome
Tumor Necrosis Factor-alpha
Antirheumatic Agents
Biological Products therapeutic use
COVID-19 complications
Mucocutaneous Lymph Node Syndrome complications
COVID-19 Drug Treatment
Subjects
Details
- Language :
- English
- ISSN :
- 1531-6963
- Volume :
- 34
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Current opinion in rheumatology
- Publication Type :
- Academic Journal
- Accession number :
- 35791863
- Full Text :
- https://doi.org/10.1097/BOR.0000000000000889