Search

Background Previous studies including a systematic literature review revealed clinical manifestations and laboratory features of systemic juvenile idiopathic arthritis (s-JIA) associated macrophage activation syndrome (MAS) could be modified in patients treated with tocilizumab (TCZ) 1,2. Objectives To clarify whether TCZ modifies clinical manifestations and laboratory features of s-JIA associated MAS, and to assess performance of the 2016 MAS classification criteria for patients with s-JIA associated MAS while treated with TCZ in the real world. Methods A combination of expert consensus and analysis of real patient data was conducted by a panel of 15 pediatric rheumatologists. Clinical manifestations and laboratory features of s-JIA associated MAS at the MAS diagnosis in 12 patients while treated with TCZ and 18 patients not treated with TCZ were evaluated. Possible MAS was defined as having characteristic laboratory features but lack of clinical features of MAS, or atypical MAS, or early treatment that prevented fulminant MAS 3,4. Results Among 12 patients while treated with TCZ, only 2 patients were diagnosed with definite MAS, and other 10 patients were diagnosed with possible MAS. On the other hand, among 18 patients not treated with TCZ, 10 patients were diagnosed with definite MAS, and other 8 patients were diagnosed with possible MAS. MAS classification criteria could classify the patients diagnosed with definite MAS while treated with TCZ as having MAS as well as the patients not treated with TCZ (100% and 100%, respectively). However, this criteria were less likely to classify the patients diagnosed with possible MAS while treated with TCZ as well as the patients not treated with TCZ (60% and 75%, respectively). Furthermore, the patients with possible MAS while treated with TCZ were less likely febrile and significantly less often had rash, and had notably lower ferritin levels (587 versus 8518 ng/ml; P=0.0021), compared to the patients with possible MAS not treated with TCZ. Other laboratory features of MAS including lower platelet counts, lower fibrinogen were more pronounced in patients treated with TCZ. Conclusion These findings show TCZ could modify clinical manifestations and laboratory features of s-JIA associated MAS. When evaluating s-JIA patients while treated with TCZ, care must be taken to not underdiagnose MAS based on MAS classification criteria. References [1] Shimizu M, et al. Cytokine 2012;58:287-294. [2] Sculert GS, et al. Arthritis Care Res 2018;70:409-419 [3] Grom AA, et al. Arthritis Rheumatol 2016;68:218-228. [4] Yokota S, et al. J Rheumatol 2015;42:712-722. Disclosure of Interests Masaki Shimizu: None declared, Mao Mizuta: None declared, Takahiro Yasumi Shareholder of: Takeda, Speakers bureau: AbbVie, Novartis, CSL Behring, Naomi Iwata: None declared, Yuka Okura: None declared, Noriko Kinjo: None declared, Hiroaki Umebayashi Speakers bureau: AbbVie, Eisai, Novartis, Ono, Chugai, Tomohiro Kubota: None declared, Yasuo Nakagishi: None declared, Kenichi Nishimura: None declared, Masato Yashiro: None declared, Junko Yasumura: None declared, Hiroyuki Wakiguchi: None declared, Nami Okamoto: None declared, Masaaki Mori Grant/research support from: Tokyo Medical and Dental University (TMDU) received unrestricted research grants for Department of Lifetime Clinical Immunology from AbbVie GK, Ayumi Pharmaceutical Corporation, Chugai Pharmaceutical Co., Ltd., CSL Behring K.K., Japan Blood Products Organization, Mitsubishi Tanabe Pharma Corporation, Nippon Kayaku Co., Ltd., Ono Pharmaceutical Co., Ltd., Towa Pharmaceutical Co., Ltd., UCB Japan Co. Ltd.

Background The transition from pediatric to adult healthcare systems has recently received worldwide attention, and it is “the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented healthcare systems.” In Japan, 1,000 patients with childhood-onset chronic disease reach adulthood every year, and many of them survive without serious sequelae or disabilities. The Japan Pediatric Society convened a committee of healthcare transition, summarized their statements, and the working group launched its activities in 2013. Objectives A clinical practice guidance for the transitional care of young people with childhood-onset rheumatic disorders has been established in Japan. Methods The guidance was designed to support pediatric and non-pediatric rheumatologic health care professionals make decisions about appropriate transitional health care for childhood-onset rheumatic disorders. It offered statements and recommendations addressing key clinical questions regarding transitional care proposed by leading pediatric and non-pediatric rheumatology medical experts and consisted of general core and disease-specific guidance. Results Category of clinical questions in the general core guidance involved the following: (1) initial statement of transitional care in rheumatology; (2) management of social life environment and public funded health care; (3) issues specific to adolescence; (4) risk management in childhood-onset rheumatic disorders; and (5) decision-making, privacy and consent, access to information, adherence to care, and preferred methods of communication, including attending to health literacy needs. In the disease-specific guidance, issues focused on each rheumatic disorder such as juvenile idiopathic arthritis, childhood-onset systemic lupus erythematosus, juvenile dermatomyositis, and Sjogren’s syndrome were brought up. Conclusion The guidance informs policy and strategies to reach optimal outcomes in transitional care for both pediatric and non-pediatric rheumatologists based on available evidence and expert opinion. References [1] Miyamae T, et al. Survey of attitudes of non-pediatric rheumatologists among councilors of the Japan College of Rheumatology regarding transitional care. Mod Rheumatol. 2017;27(6):1047-1050. [2] Matsui T, et al. Survey of the awareness of adult rheumatologists regarding transitional care for patients with juvenile idiopathic arthritis in Japan. Mod Rheumatol. 2018;28(6):981-985. Disclosure of Interests Takako Miyamae Speakers bureau: AbbVie, Eisai, Bristol-Meyers, Novartis, Ayumi, Taisyo-Toyama, Chugai, Shinji Akioka Grant/research support from: Eli Lily, Speakers bureau: Pfizer, Maruho, CSL Behring, Astellas, Chugai, Toru Igarashi: None declared, Yuzaburo Inoue Grant/research support from: MSD, Speakers bureau: Novartis, CSL Behring, MSD, Taishotoyama, Ono, Motomu Hashimoto Grant/research support from: Astellas, Brystol-Meyers, Eisai, Employee of: M. H. is affiliated with the department (Department of Advanced Medicine for Rheumatic Diseases, Kyoto University), which is financially supported by four pharmaceutical companies (Tanabe-Mitsubishi, Chugai, Ayumi, UCB Japan), Speakers bureau: Tanabe Mitsubishi, Brystol-Meyers, Toshihiro Matsui Speakers bureau: Takeda, Chugai, Eisai, Pfizer, Astellas, Eli Lilly, Ono, AbbVie, Mitsubishi Tanabe, AsahiKASEI, UCB, Teijin, Susumu Nishiyama Paid instructor for: Kissei Pharmaceutical Co., Ltd, Takeda Pharmaceutical Company, Mitsubishi Tanabe Pharma, Astellas Pharma, Eisai Pharmaceutical company, AbbVie Inc., TEIJIN Pharma, Asahi Kasei Corporation, Bristol- Myers Squibb Company, Chugai Pharmaceutical Co., Ltd., Santen Pharmaceutical Co., Ltd., AYUMI Pharmaceutical Corporation, Speakers bureau: Kissei Pharmaceutical Co., Ltd, DAIICHI SANKYO COMPANY, LIMITED, Shiro Ohshima Grant/research support from: AbbVie, Eisai, Asahikasei, Speakers bureau: AbbVie, Eisai, Bristol-Meyers, Novartis, Astellas, Nippon-Kayaku, Pfizer, UCB, Ayumi, Daiichi-Sankyo, Takeda, Tanabe-Matsubishi, Chugai, Hiroaki Umebayashi Speakers bureau: AbbVie, Eisai, Novartis, Ono, Chugai, Takahiro Yasumi Shareholder of: Takeda, Speakers bureau: AbbVie, Novartis, CSL Behring, Masaaki Mori Grant/research support from: Tokyo Medical and Dental University (TMDU) received unrestricted research grants for Department of Lifetime Clinical Immunology from AbbVie GK, Ayumi Pharmaceutical Corporation, Chugai Pharmaceutical Co., Ltd., CSL Behring K.K., Japan Blood Products Organization, Mitsubishi Tanabe Pharma Corporation, Nippon Kayaku Co., Ltd., Ono Pharmaceutical Co., Ltd., Towa Pharmaceutical Co., Ltd., UCB Japan Co. Ltd.