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Evaluating diagnostic criteria for macrophage activation syndrome in patients with adult onset Still’s disease. Response to: ‘Comparison of MS score and HScore for the diagnosis of adult-onset Still’s disease associated macrophage activation syndrome’ by Zhang et al
  1. Francesca Minoia1,
  2. Angelo Ravelli2,3
  1. 1Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
  2. 2IRCCS Istituto Giannina Gaslini, Genova, Italy
  3. 3Università degli Studi di Genova, Genova, Italy
  1. Correspondence to Dr Francesca Minoia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; francesca.minoia{at}

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We thank Zhang et al1 for their interest in our MAS/sJIA (MS) score for diagnosis of macrophage activation syndrome (MAS) in systemic juvenile idiopathic arthritis (sJIA).2 Considering that sJIA and adult-onset Still’s disease (AOSD) are nowadays thought to constitute a continuum of a single disease entity3 4 and that they share a similar risk for MAS, it is worth evaluating whether the proposed diagnostic tools are suitable to detect MAS in both illnesses.

Zhang et al1 compared the diagnostic performance of the MS score with that of the HScore5 in their retrospective series of 209 patients with AOSD, 35 of whom had MAS. The HScore is aimed at identifying a broad range of reactive haemophagocytic syndromes and has been developed in a cohort …

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