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Our research team read Ruscitti et al’s article regarding lung involvement in coronavirus disease 2019 (COVID-19) and macrophage activation syndrome (MAS) with great interest.1 This topic not only addresses the current pandemic, but also is of concern in our team’s expertise—rheumatology. As we thoroughly examined the details of this research study, we noticed a few points we would like to address and discuss: the definition of patient selection criteria, the necessity of differentiating among COVID-19 CT patterns, the pathogenic mechanism differences between MAS and COVID-19, and the potential relationship between COVID-19 and vasculopathy.
First of all, this article states that age matching is not reliable. However, we contemplate that age is crucial in disease pathogenesis, such as immunosenescence, age-related inflammatory disease and periodontal disease, all of which could contribute to COVID-19 and MAS. Thus, “age” should still be an important factor to be considered and controlled as a confounding variable.2 3 In addition, we doubt about the accuracy of diagnosis based on Yamaguchi criteria, as they simply serve as preliminary criteria for adult-onset Still’s disease (AOSD),4 which may led to misclassification. …
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