Abstract

Objective: Systemic juvenile idiopathic arthritis (JIA) is a subgroup of JIA that can involve multiple systems other than the joints. Macrophage activation syndrome (MAS) is a life-threatening condition that can be observed in patients with systemic JIA. The aim of this study was to evaluate the performance of the ferritin/erythrocyte sedimentation rate (ESR) ratio, a diagnostic parameter for MAS, in our cohort.

Materials and Methods: Children with systemic JIA who were followed in our hospital’s pediatric rheumatology department and diagnosed with MAS were retrospectively recorded for the presence or absence of MAS. The performance of the ferritin/ESR ratio between these patient groups was analyzed.

Results: The study included 45 patients with systemic JIA without MAS and 11 patients with systemic JIA with MAS. No differences were observed between the two groups in terms of age, gender, and follow-up duration (p =0.121, p = 0.547, and p = 0.495, respectively). The JADAS-27 score, which includes rash, hepatomegaly, splenomegaly, and disease activity score, was significantly higher in the systemic JIA group with MAS (all p<0.050). The ferritin/ESR ratio was significantly higher in systemic JIA patients who developed MAS [247.71 (36.23-886.66) vs. 31.47 (0.39-555.55); p<0.001]. A ferritin/ESR ratio of >38.84 had 100% sensitivity and 73.3% specificity for the development of MAS in patients with systemic JIA.

Conclusion:
A ferritin/ESR ratio of (>)38.84 had high sensitivity and specificity for predicting the development of MAS in patients with systemic JIA in our cohort.

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Copyright © 2026 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Ertem Ş, Uğur Eş Y, Erdem Torun Ş, Özçelik E, Esen E, Karagöl C, et al. Ferritin/erythrocyte sedimentation rate ratio in macrophage activation syndrome in patients with systemic juvenile idiopathic arthritis: A single center experience. Turk J Pediatr Dis. 2026;Early View:1-6. https://doi.org/10.12956/TJPD.2026.1292