@medicalaxioms #covid4MDs I have been following the information on the cytokine storm related to #COVID19. This is similar to MAS that occurs in SJIA and SLE patients or HLH that occurs in malignancy and other infections. This was documented in MERS a few years ago.
@medicalaxioms #covid4MDs The difference in HLH related to malignancy is the HLH protocol with etoposide, decadron etc is meant for those who may get bone marrow transplants. Rheumatologists treat this differently. Unfortunately many hospitals do not have inpatient rheumatology!
@medicalaxioms #covid4MDs Pediatric rheumatologists are the ones who are experts in dealing with MAS and there are even less of them! If this virus goes viral hospitalists and intensivists will be dealing with the cytokine storm. China approved an IL6 agent (tocilizumab) to treat #COVID19
@medicalaxioms #covid4MDs Our favorite agent for this is an IL1 blocker (anakinra). We also use tocilizumab infusion. This is usually with methylprednisolone IV. We are now using JAK inhibitors as well. Patients do poorly with MAS because it is recognized too late. ncbi.nlm.nih.gov/pmc/articles/P…
@medicalaxioms #covid4MDs We don’t have stats on how many #COVID19 patients went into a cytokine storm but the fact that China approved use of TOC is interesting to this peds rheum! (If you know the stats, reply) If you are on the front line of this pandemic read the article on recognizing MAS
