Consumption coagulopathy after gold therapy for JRA

Macrophage activation syndrome: a potentially fatal complication of rheumatic disorders

“…20 In the 1980s gold (sodium aurothiomalate) was used as a second line agent for JIA. Reports appeared of “consumptive coagulopathy”, resulting in some fatalities when these children received the second dose of gold 21. The clinical features were in fact similar to MAS and four of the five patients in this report had SOJIA.…”

Natural killer cell dysfunction: A common pathway in systemic‐onset juvenile rheumatoid arthritis, macrophage activation syndrome, and hemophagocytic lymphohistiocytosis?

“…Although it is now evident that development of MAS can be precipitated by virtually any infectious agent (bacterial, fungal, and even parasitic) (20), viral illnesses, particularly EBV and infections caused by other members of the herpesvirus family, appear to be most commonly described (7, 13–15). In several reports, the triggering of MAS coincided with modifications in drug therapy, most notably administration of gold preparations (5, 6, 29), methotrexate (30, 31), sulfasalazine (32), and tumor necrosis factor (TNF)–blocking agents (33). These associations, however, should be interpreted cautiously, because many of the described patients had very active underlying rheumatic disease, and MAS might have been developing when therapy with the drugs was started.…”

Use of Rituximab in Conjunction With Immunosuppressive Chemotherapy as a Novel Therapy for Epstein Barr Virus-associated Hemophagocytic Lymphohistiocytosis

“…Среди вирусных заболеваний наиболее частой причи-ной являются вирус Эпштейна-Барр (ВЭБ) и другие гер-песвирусные инфекции [2, 6,11,14]. В ряде наблюдений развитие САМ совпало с назначением препаратов золота [6,15], метотрексата [11,[16][17][18], сульфасалазина [19]. Вме-сте с тем авторы считают, что данные лекарственные сред-ства следует с осторожностью интерпретировать как триг-гер, поскольку у большинства пациентов риск развития САМ имелся и до назначения терапии перечисленными препаратами.…”