PT  - JOURNAL ARTICLE
AU  - Sergio Davì
AU  - Alessandro Consolaro
AU  - Dinara Guseinova
AU  - Angela Pistorio
AU  - Nicolino Ruperto
AU  - Alberto Martini
AU  - Randy Q. Cron
AU  - Angelo Ravelli
TI  - An International Consensus Survey of Diagnostic Criteria for Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis
AID  - 10.3899/jrheum.100996
DP  - 2011 Feb 01
TA  - The Journal of Rheumatology
PG  - jrheum.100996
4099  - http://www.jrheum.org/content/early/2011/01/27/jrheum.100996.short
4100  - http://www.jrheum.org/content/early/2011/01/27/jrheum.100996.full
AB  - Objective To identify candidate diagnostic criteria for macrophage activation syndrome (MAS) complicating systemic juvenile idiopathic arthritis (sJIA) using international consensus formation through a Delphi questionnaire survey. Methods A questionnaire listing 28 clinical, laboratory, and histopathologic features of MAS elicited by literature review was sent to 505 pediatric rheumatologists worldwide. Respondents were asked to select the 10 features that they felt were most important and useful in the diagnosis of MAS, and to order the 10 selected features by assigning the number 10 to the most important, and ending with 1 as the least important. Results The response rate was 46% (232 physicians from 47 countries). The items selected by more than 50% of respondents were, in order of frequency, falling platelet count, hyperferritinemia, evidence of macrophage hemophagocytosis in the bone marrow, increased liver enzymes, falling leukocyte count, persistent continuous fever ≥ 38°C, falling erythrocyte sedimentation rate, hypofibrinogenemia, and hypertriglyceridemia. Conclusion Our process led to identification of features that were felt to be most important as candidate diagnostic criteria for MAS by a large sample of international pediatric rheumatologists.