{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:38:55Z","timestamp":1791545935224,"version":"4.3.4"},"reference-count":119,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,2,15]],"date-time":"2021-02-15T00:00:00Z","timestamp":1613347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To provide guidance on the management of Multisystem Inflammatory Syndrome in Children (MIS\u2010C), a condition characterized by fever, inflammation, and multiorgan dysfunction that manifests late in the course of severe acute respiratory syndrome coronavirus 2 (SARS\u2013CoV\u20102) infection. Recommendations are also provided for children with hyperinflammation during coronavirus disease 2019 (COVID\u201019), the acute, infectious phase of SARS\u2013CoV\u20102 infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Task Force was composed of 9 pediatric rheumatologists and 2 adult rheumatologists, 2 pediatric cardiologists, 2 pediatric infectious disease specialists, and 1 pediatric critical care physician. Preliminary statements addressing clinical questions related to MIS\u2010C and hyperinflammation in COVID\u201019 were developed based on evidence reports. Consensus was built through a modified Delphi process that involved anonymous voting and webinar discussion. A 9\u2010point scale was used to determine the appropriateness of each statement (median scores of 1\u20133 for inappropriate, 4\u20136 for uncertain, and 7\u20139 for appropriate). Consensus was rated as low, moderate, or high based on dispersion of the votes. Approved guidance statements were those that were classified as appropriate with moderate or high levels of consensus, which were prespecified before voting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The first version of the guidance was approved in June 2020, and consisted of 40 final guidance statements accompanied by a flow diagram depicting the diagnostic pathway for MIS\u2010C. The document was revised in November 2020, and a new flow diagram with recommendations for initial immunomodulatory treatment of MIS\u2010C was added.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our understanding of SARS\u2013CoV\u20102\u2013related syndromes in the pediatric population continues to evolve. This guidance document reflects currently available evidence coupled with expert opinion, and will be revised as further evidence becomes available.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/art.41616","type":"journal-article","created":{"date-parts":[[2020,12,5]],"date-time":"2020-12-05T05:15:23Z","timestamp":1607145323000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":305,"title":["American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS\u2013CoV\u20102 and Hyperinflammation in Pediatric COVID\u201019: Version 2"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0242-4029","authenticated-orcid":false,"given":"Lauren A.","family":"Henderson","sequence":"first","affiliation":[{"name":"Boston Children\u2019s Hospital and Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott W.","family":"Canna","sequence":"additional","affiliation":[{"name":"UPMC Children\u2019s Hospital of Pittsburgh and University of Pittsburgh  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin G.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Boston Children\u2019s Hospital and Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Gorelik","sequence":"additional","affiliation":[{"name":"Morgan Stanley Children\u2019s Hospital and Columbia University  New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8452-9937","authenticated-orcid":false,"given":"Sivia K.","family":"Lapidus","sequence":"additional","affiliation":[{"name":"Joseph M. 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