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Cure Arthritis Naturally

Cure Arthritis Naturally

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aAge unknown from records reviewed.

From Janka G, Imashuku S, Elinder G, Schneider M, Henter JJ. Infection and malignancy associated hemophagocytic syndromes. Hematol Oncol Clin North Am 1998;12:435-43.

aAge unknown from records reviewed.

From Janka G, Imashuku S, Elinder G, Schneider M, Henter JJ. Infection and malignancy associated hemophagocytic syndromes. Hematol Oncol Clin North Am 1998;12:435-43.

Table 22-16. Malignancies Associated with the Development of Hemophagocytic Syndromes

1. Development of a hemophagocytic syndrome before and/or during the treatment for malignancy, such as

Acute lymphoblastic leukemia

Multiple myeloma

Germ cell tumor

Thymoma

Carcinoma

2. Development of a hemophagocytic syndrome with a masked hematolymphoid malignancy in the background, such as

T/NK-cell leukemia Lymphomas

Angiocentric immunoproliferative lesion-like Large cell anaplastic lymphoma Adult B-cell lymphoma

From Janka G, Imashuku S, Elinder G, Schneider M, Henter JJ. Infection and malignancy associated hemophagocytic syndromes. Hematol Oncol Clin North Am 1998;12:435-43.

Treatment

If the malignancy-associated hemophagocytic syndrome (MAHS) occurs in an immunocompromised host before treatment, therapy of malignancy and infection is suggested. If it develops in association with an infection during chemotherapy, cessation of chemotherapy may be considered if the malignancy is under control. In addition, treatment for infectious agents, corticosteroids, and etoposide should be administered. Rapidly progressive MAHS may also need to be treated according to the HLH-2004 protocol (see page 622).

Macrophage Activation Syndrome in Systemic Juvenile Rheumatoid Arthritis and Other Chronic Conditions (Reactive Hemophagocytic Lymphohistiocytosis)

Macrophage activation syndrome (MAS) is caused by an excessive activation and proliferation of mature macrophages. It is observed in a number of conditions, including infections, neoplasms, and rheumatologic diseases. Triggers for MAS in juvenile rheumatoid arthritis (JRA) include gold therapy, aspirin, other nonsteroidal anti-inflammatory drugs, and viral infections. Typically, patients with such chronic conditions present with the following features of acute illness:

• Persistent fever

• Hepatosplenomegaly

• Pancytopenia

• Low erythrocyte sedimentation rate (ESR)

• Elevated liver enzymes

• Prolonged prothrombin time, prolonged partial thromboplastin time, hypofib-rinogemia, and low levels of vitamin K-dependent clotting factors

• Easy bruisability and mucosal bleeding

• Fibrin degradation products (may be present)

• Elevated serum liver enzyme values

• Numerous, well-differentiated hemophagocytic histiocytes are a pathognomonic feature of this condition and are found in various organs.

In patients with systemic JRA, the acute deterioration is preceded by either a viral infection or major changes in therapy (e.g., administration of gold therapy or non-steroidal anti-inflammatory drugs).

Macrophage activation syndrome as a complication of JRA is associated with considerable morbidity and death. Table 22-17 shows the clinical differentiation of macrophage activation syndrome associated with JRA from a typical acute exacerbation of systemic JRA. The presence of hemophagocytic histiocytes in the bone marrow and lymph nodes confirms the diagnosis.

Treatment

Because of its seriousness, this syndrome should be recognized promptly on the basis of the previously mentioned findings. Early treatment, consisting of the use of corticosteroids (after performing a bone marrow examination), should be instituted. This treatment usually results in a rapid resolution of symptoms. The dose should be tapered slowly to prevent relapse. If corticosteroids fail to improve this condition, cyclosporine A has been shown to be successful.

Table 22-17. Features That Differentiate Acute Exacerbation of Juvenile Rheumatoid Arthritis from Macrophage Activation Syndrome Complicating Juvenile Rheumatoid Arthritis

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Arthritis Joint Pain

Arthritis Joint Pain

Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.

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