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Campbell JA, Shenoi S. Features and Clinical Course of Infantile Juvenile Idiopathic Arthritis. J Clin Rheumatol 2022; 28:e609-e611. [PMID: 33843769 DOI: 10.1097/rhu.0000000000001737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a heterogeneous group of 7 chronic arthritides categories that affects children younger than 16 years. This case series elucidates the characteristics of patients from a single center diagnosed with JIA at younger than 12 months. METHODS We included patients who presented to the rheumatology clinic for JIA with symptom onset at younger than 1 year. Chart review was conducted to complete case report forms that included demographics, historical features, examination features, laboratory results, imaging results, and treatment courses. RESULTS We identified 12 patients who met our inclusion criteria. Eight of our patients were diagnosed with oligoarticular JIA, 3 had polyarticular JIA, and 1 was diagnosed with systemic JIA. Overall, 58% (7/12) of patients had joint contractures at their initial visit. Of the patients with oligoarticular JIA, 50% (4/8) required a disease-modifying antirheumatic drug to achieve disease remission; 12.5% (1/8) required biologic therapy. All of the polyarticular JIA patients had highly positive antinuclear antibodies, as well as elevated inflammatory markers. CONCLUSIONS Children with infantile JIA are overall similar to the larger population of patients with JIA. Disease severity may not be different compared with that of older children with JIA; however, there is likely a larger delay in diagnosis and the presence of contractures, which occurred in more than half of our patients.
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Affiliation(s)
- Julie A Campbell
- From the Pediatric Rheumatology Division, Seattle Children's Hospital and Research Center, University of Washington, Seattle, WA
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2
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Fung SG, Webster R, Kuenzig ME, Knight B, Batthish M, Robinson C, Chanchlani R, Benchimol EI, Jimenez-Rivera C. Incidence of Chronic Immune-Mediated Inflammatory Diseases After Diagnosis with Kawasaki Disease: A Population-Based Cohort Study. Rheumatology (Oxford) 2021; 61:2095-2103. [PMID: 34498025 DOI: 10.1093/rheumatology/keab680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/01/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Kawasaki disease (kDa) is an immune-mediated vasculitis of childhood with multi-organ inflammation. We determined the risk of subsequent immune-mediated inflammatory disease (IMID), including arthritis, type 1 diabetes, inflammatory bowel disease (IBD), autoimmune liver disease (ALD), primary sclerosing cholangitis (PSC) and multiple sclerosis (MS). METHODS We conducted a matched population-based cohort study using health administrative data from Ontario, Canada. Children aged <18 years born between 1991-2016 diagnosed with kDa (n = 3,753) were matched to 5 non-kDa controls from the general population (n = 18 749). We determined the incidence of IMIDs after resolution of kDa. Three- and 12-month washout periods were used to exclude kDa-related symptoms. RESULTS There was an elevated risk of arthritis in kDa patients compared with non-kDa controls starting three months after index date (103.0 vs 12.7 per 100 000 person-years (PYs); incidence rate ratio (IRR) 8.07 (95% CI 4.95-13.2); hazard ratio (HR) 8.08 (95% CI 4.95-13.2), resulting in the overall incidence of IMIDs being elevated in kDa patients (175.1 vs 68.0 per 100 000 PYs; IRR 2.58 (95% CI 1.93-3.43); HR 2.58, 95% CI 1.94-3.43). However, there was no increased risk for diabetes, IBD, ALD, PSC or MS in kDa patients. Similar results were observed using a 12-month washout period. CONCLUSIONS Children diagnosed with kDa were at increased risk of arthritis following the acute kDa event, but not other IMIDs. Health care providers should monitor for arthritis in children following a diagnosis of kDa.
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Affiliation(s)
- Stephen G Fung
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,ICES, Ontario, Canada
| | - Richard Webster
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - M Ellen Kuenzig
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,ICES, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Braden Knight
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,ICES, Ontario, Canada.,Ontario Child Health SUPPORT Unit, Ottawa, Ontario, Canada
| | - Michelle Batthish
- Division of Rheumatology, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Cal Robinson
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rahul Chanchlani
- ICES, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Pediatric Nephrology, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute (PHRI), McMaster University, Hamilton, ON, Canada
| | - Eric I Benchimol
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,ICES, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Carolina Jimenez-Rivera
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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3
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Saez-de-Ocariz M, Gámez-González LB, Rivas-Larrauri F, Castaño-Jaramillo LM, Toledo-Salinas C, Garrido-García LM, Ulloa-Gutierrez R, Santamaría-Piedra M, Orozco-Covarrubias MDLL, Scheffler-Mendoza S, Yamazaki-Nakashimada MA. Kawasaki disease mimickers. Pediatr Int 2021; 63:880-888. [PMID: 33249696 DOI: 10.1111/ped.14561] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/14/2020] [Accepted: 11/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis that predominantly affects patients younger than 5 years. In the absence of an available, affordable diagnostic test, detailed clinical history and physical examination are still fundamental to make a diagnosis. METHODS We present five representative cases with KD-like presentations: systemic onset juvenile idiopathic arthritis, mycoplasma-induced rash and mucositis, staphylococcal scalded skin syndrome, BCGosis, and the recently described multisystemic inflammatory syndrome in children (MIS-C) associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus. RESULTS Rash, fever, and laboratory markers of inflammation can be present in several childhood diseases that may mimic KD. CONCLUSION The term 'Kawasaki syndrome' instead of 'Kawasaki disease' may be more appropriate. Physicians should consider an alternative diagnosis that may mimic KD, particularly considering MIS-C during the present pandemic, as an aggressive diagnostic and therapeutic approach is needed.
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Affiliation(s)
| | | | | | | | - Carla Toledo-Salinas
- Clinical Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáez Herrera", San José, Costa Rica
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4
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Kanemasa H, Nanishi E, Takada H, Ishimura M, Nishio H, Honjo S, Masuda H, Nagai N, Nishihara T, Ishii T, Adachi T, Hara S, Lin L, Tomita Y, Kamizono J, Komiyama O, Kohdera U, Tanabe S, Sato A, Hida S, Yashiro M, Makino N, Nakamura Y, Hara T, Ohga S. Overlapping Features in Kawasaki Disease-Related Arthritis and Systemic-Onset Juvenile Idiopathic Arthritis: A Nationwide Study in Japan. Front Pediatr 2021; 9:597458. [PMID: 34354966 PMCID: PMC8329333 DOI: 10.3389/fped.2021.597458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 06/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Arthritis may occur after the diagnosis of Kawasaki disease (KD). Most cases are self-limiting; however, some patients require prolonged treatment. Method: To characterize KD-related arthritis, 14 patients who required arthritis treatment within 30 days after the diagnosis of KD were recruited from the 23rd KD survey in Japan. Twenty-six additional patients were included from our tertiary center and literature review cohorts. Results: The estimated prevalence of KD-related arthritis in Japan was 48 per 100,000 KD patients. Patients with KD-related arthritis had an older age at onset (52 vs. 28 months, P = 0.002) and higher rate of intravenous immunoglobulin (IVIG) resistance in comparison to those without arthritis (86 vs. 17%, P < 0.001). Among 40 patients, 18 had arthritis in the acute phase KD (continued fever-onset type) and 22 did in the convalescent phase (interval fever-onset type). Both showed a similar rate of complete KD or IVIG response. Interval-type patients required biologics for arthritis control less frequently (5 vs. 39%, P = 0.02) and had a higher 2-year off-treatment rate (100 vs. 43%, P = 0.009) than continued-type ones. Interval-types showed lower serum ferritin and interleukin-18 levels than continued-types. When continued-types were grouped according to whether or not they required biologics (n = 7 and n = 11, respectively), the former subgroup had higher ferritin and interleukin-18 levels (P = 0.01 and 0.02, respectively). A canonical discriminant analysis differentiated interval-type from continued-type with the combination of age, time to arthritis, and the ferritin and matrix metalloproteinase-3 levels. Conclusion: Arthritis requiring treatment is a rare complication of KD. KD-associated arthritis includes interval-type (KD-reactive) and continued-type (true systemic-onset juvenile idiopathic arthritis [JIA] requiring biologics), and overlapping arthritis, suggesting the pathophysiological continuity of autoinflammation between KD and JIA.
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Affiliation(s)
- Hikaru Kanemasa
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Etsuro Nanishi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetoshi Takada
- Department of Perinatal and Pediatric Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisanori Nishio
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Honjo
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Hiroshi Masuda
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Noriko Nagai
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Japan
| | - Takahiro Nishihara
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Tohru Ishii
- Department of Pediatrics, National Hospital Organization Tochigi Medical Center, Utsunomiya, Japan
| | - Takenori Adachi
- Department of Pediatrics, Tosei General Hospital, Seto, Japan
| | - Satoshi Hara
- Department of Pediatrics, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Lisheng Lin
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshie Tomita
- Department of Pediatrics, Kitakyusyu Municipal Yahata Hospital, Kitakyushu, Japan
| | - Junji Kamizono
- Department of Pediatrics, Kitakyusyu Municipal Yahata Hospital, Kitakyushu, Japan
| | - Osamu Komiyama
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Urara Kohdera
- Department of Pediatrics, Nakano Children's Hospital, Osaka, Japan
| | - Saori Tanabe
- Department of Pediatrics, Nihonkai General Hospital, Sakata, Japan
| | - Atsuo Sato
- Department of Pediatrics, Yokohama Rosai Hospital, Yokohama, Japan
| | - Shinya Hida
- Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan
| | - Mayumi Yashiro
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Nobuko Makino
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | | | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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5
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Jindal AK, Pilania RK, Prithvi A, Guleria S, Singh S. Kawasaki disease: characteristics, diagnosis, and unusual presentations. Expert Rev Clin Immunol 2019; 15:1089-1104. [PMID: 31456443 DOI: 10.1080/1744666x.2019.1659726] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Kawasaki disease (KD) is one of the commonest pediatric vasculitides and is associated with a significant risk of development of coronary artery abnormalities if left untreated. Areas covered: In this review, we have highlighted the incomplete and unusual presentations of KD and also emphasize the controversies pertaining to 2D echocardiography in KD. A PubMed search was performed regarding diagnosis and unusual presentations of KD. Expert opinion: Diagnosis of KD is essentially clinical and based on recognition of typical clinical features that may appear sequentially and all signs and symptoms may not be present at one point of time. There is no confirmatory laboratory test for diagnosis of this condition. Further complicating the picture is the fact that incomplete and atypical forms KD may be seen in up to 50% patients. Although 2D echocardiography continues to be the preferred imaging modality for cardiac assessment in patients with KD, it has its limitations.
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Affiliation(s)
- Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Ashwini Prithvi
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Sandesh Guleria
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
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Abstract
Rheumatologic diseases are uncommon in children but have the potential for significant morbidity, mortality, and disability. This article reviews the most common rheumatologic diseases in children, their diagnostic evaluations, and the NP's role in the management and coordination of these conditions.
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7
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Noto T, Seto H, Fukuhara J, Murabayashi M, Yachie A, Ayusawa M, Morioka I. A case of incomplete Kawasaki disease with extremely high serum ferritin and interleukin-18 levels. BMC Pediatr 2018; 18:386. [PMID: 30541507 PMCID: PMC6291954 DOI: 10.1186/s12887-018-1365-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/04/2018] [Indexed: 01/17/2023] Open
Abstract
Background The clinical features and laboratory parameters of patients with Kawasaki disease (KD) and systemic juvenile idiopathic arthritis (sJIA) occasionally overlap. Therefore, serum levels of cytokine and ferritin are used as markers to distinguish between KD and sJIA. KD patients have a high level of interleukin (IL)-6, low level of IL-18, and no elevation of the level of serum ferritin. Conversely, sJIA patients have a low level of IL-6 and high levels of IL-18 and ferritin in the serum. However, to the best of our knowledge, no case report of KD with a low serum level of IL-6 and extremely high levels of IL-18 and ferritin is found. Case presentation A 6-year-old boy presented with a history of fever for 9 days and a rash that appeared 7 days from the onset. He was diagnosed with incomplete KD because of fever, skin rash, oral cavity erythematous changes, and erythema and edema of the hands with laboratory findings of serum albumin level < 3.0 g/dL, elevated alanine aminotransferase level and leukocyturia. Intravenous immunoglobulin and prednisolone and oral aspirin were introduced on the 10th day. Fever subsided 1 day after initiating the treatment, but arthritis of both knees appeared in addition to hepatosplenomegaly. We suspected sJIA, as the serum level of ferritin was 19,740 ng/mL, IL-6 was < 3 pg/mL, and IL-18 was 132,000 pg/mL. Skin desquamation of the fingertips was observed 18 days from the onset; thus, he was finally diagnosed with incomplete KD with arthritis. At 32 days from the onset, we stopped the prednisolone therapy and no symptoms of relapse were observed afterwards. In the follow-up at 16 months from the onset, he had neither signs of active joint or skin involvement, nor cardiac involvement. Conclusions Although patients with sJIA generally have high serum levels of IL-18 and ferritin, this was a case of incomplete KD with extremely high serum levels of IL-18 and ferritin. Serum cytokine and ferritin are often used for the differential diagnosis of KD and sJIA. We need to recognize the existence of KD with high serum levels of IL-18 and ferritin.
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Affiliation(s)
- Takanori Noto
- Department of Pediatrics, Numazu City Hospital, 550, Harunoki, Higashi-Shiroji, Numazu, 4100302, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1, Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hiroki Seto
- Department of Pediatrics, Numazu City Hospital, 550, Harunoki, Higashi-Shiroji, Numazu, 4100302, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1, Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Junji Fukuhara
- Department of Pediatrics, Numazu City Hospital, 550, Harunoki, Higashi-Shiroji, Numazu, 4100302, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1, Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masao Murabayashi
- Department of Pediatrics, Numazu City Hospital, 550, Harunoki, Higashi-Shiroji, Numazu, 4100302, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1, Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Akihiro Yachie
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1, Takaramachi, Kanazawa, 9208641, Japan
| | - Mamoru Ayusawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1, Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1, Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
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8
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Martins A, Conde M, Brito M, Gouveia C. Arthritis in Kawasaki disease: A poorly recognised manifestation. J Paediatr Child Health 2018; 54:1371-1374. [PMID: 29943869 DOI: 10.1111/jpc.14102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 05/13/2018] [Accepted: 05/22/2018] [Indexed: 11/27/2022]
Abstract
AIM To determine the prevalence of arthritis in Kawasaki disease (KD) and the clinical characteristics of children with KD and arthritis. METHODS This was a single-centre, 15-year, retrospective study of children admitted with KD. Clinical features (including coronary involvement), laboratory results and treatment response were evaluated. RESULTS Of 63 children with KD, 60.3% were male, with a median of age of 2.0 years. Complete KD was found in 68.3%. The time from symptom onset to treatment was 7.0 days (median); 30.7% had coronary artery aneurysms, from which 82.5% responded to intravenous immunoglobulin. During the course of their illness, eight children developed arthritis (12.7%), which was early onset in six (75%) and oligoarticular in five (62.5%). The median number of joints was 3.5 (P25 = 1.3, P75 = 17.0), and at least one large joint was affected. In all cases, the arthritis was self-limited and left no sequelae, lasting a median of 14 days and no longer than 22 days. KD children with arthritis were older (P = 0.025), and those with early-onset arthritis responded to first-line therapy, unlike the late-onset group (P = 0.018). CONCLUSIONS This study emphasises the value of a systematic articular examination of joints in KD. Refractory KD was observed in children with late-onset arthritis.
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Affiliation(s)
- Andreia Martins
- Paediatric Infectious Diseases Unit, Dona Estefania Hospital, Lisbon, Portugal
| | - Marta Conde
- Paediatric Rheumatology Unit, Dona Estefania Hospital, Lisbon, Portugal
| | - Maria Brito
- Paediatric Infectious Diseases Unit, Dona Estefania Hospital, Lisbon, Portugal
| | - Catarina Gouveia
- Paediatric Infectious Diseases Unit, Dona Estefania Hospital, Lisbon, Portugal
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9
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Lynch J, Patra KP, Vijay C, Mitchell M, Moffett-Bradford K. A Case of Fever of Unknown Origin. Hosp Pediatr 2015; 5:452-5. [PMID: 26231636 DOI: 10.1542/hpeds.2014-0238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | | | - Michelle Mitchell
- Section of Infectious Diseases, Department of Pediatrics, West Virginia University Children's Hospital, Morgantown, West Virginia
| | - Kathryn Moffett-Bradford
- Section of Infectious Diseases, Department of Pediatrics, West Virginia University Children's Hospital, Morgantown, West Virginia
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10
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Dong S, Bout-Tabaku S, Texter K, Jaggi P. Diagnosis of systemic-onset juvenile idiopathic arthritis after treatment for presumed Kawasaki disease. J Pediatr 2015; 166:1283-8. [PMID: 25771391 DOI: 10.1016/j.jpeds.2015.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 01/02/2015] [Accepted: 02/03/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To estimate the incidence of systemic-onset juvenile idiopathic arthritis (SoJIA) within 6 months after treatment for presumed Kawasaki disease (KD) (presumed patients with KD with subsequent diagnosis of SoJIA [pKD/SoJIA]) and describe presentation differences from sole KD. STUDY DESIGN We identified patients treated for KD at Nationwide Children's Hospital and from the Pediatric Health Information System from 2009-2013. We then identified the subset of children, pKD/SoJIA, who received an International Classification of Diseases, Ninth Revision code for SoJIA and had it listed at least once 3 months after and within 6 months after KD diagnosis. Demographic characteristics, readmission rates, treatments, and complications were noted. A literature review was also performed to identify clinical, laboratory, and echocardiographic data of previously documented patients with KD later diagnosed with SoJIA. RESULTS There were 6745 total treated patients with KD in the Pediatric Health Information System database during the study period; 10 patients were identified to have pKD/SoJIA (0.2% of cohort). Those with pKD/SoJIA were predominantly Caucasian compared with patients with KD (90% and 46.8%, respectively; P=.003). Macrophage activation syndrome was more common in patients with pKD/SoJIA than in sole patients with KD (30% and 0.30%, respectively; P<.001). Fifteen cases of pKD/SoJIA were identified by literature and chart review, 12 of whom were initially diagnosed with incomplete KD. CONCLUSIONS We reported a 0.2% incidence of pKD/SoJIA, which was associated with Caucasian race, macrophage activation syndrome, and an incomplete KD phenotype.
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Affiliation(s)
- Siwen Dong
- The Ohio State University College of Medicine, Columbus, OH
| | - Sharon Bout-Tabaku
- Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Karen Texter
- Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Preeti Jaggi
- Nationwide Children's Hospital and The Ohio State University, Columbus, OH.
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11
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Sotelo-Cruz N. [A review of Kawasaki disease, a perspective from the articles published in Mexico since January 1977 to May 2012]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 83:214-22. [PMID: 23663892 DOI: 10.1016/j.acmx.2013.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 01/23/2013] [Accepted: 02/01/2013] [Indexed: 11/24/2022] Open
Abstract
Kawasaki disease was described in 1967 by Tomisu Kawasaki. It affects children aged between one and 5 years, and it evolves with fever and small vessel vasculitis, which leads to cardiovascular complications, including coronary aneurisms, myocarditis, valve injuries, pericardial effusion and myocardial infarction; eventually involving many others organs. The etiology actually is not well known, as the exactly pathogenic mechanisms; however, now there are important advances. If the clinical signs and symptoms are identify early and the children received treatment with aspirin and intravenous immunoglobulin, the patients evolves without sequels. The Kawasaki disease is an infrequent disease in Mexico.
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Affiliation(s)
- Norberto Sotelo-Cruz
- Departamento de Medicina y Ciencias de la Salud, Universidad de Sonora, Hermosillo, Sonora, México.
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12
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Serum IL-18 as a potential specific marker for differentiating systemic juvenile idiopathic arthritis from incomplete Kawasaki disease. Rheumatol Int 2014; 35:81-4. [DOI: 10.1007/s00296-014-3059-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
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13
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Incomplete Kawasaki disease followed by systemic onset juvenile idiopathic arthritis- the diagnostic dilemma. Indian J Pediatr 2013; 80:783-5. [PMID: 23054859 DOI: 10.1007/s12098-012-0893-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
Abstract
The authors report an 18-mo-old girl who presented with features of incomplete Kawasaki disease and was refractory to intravenous immunoglobulin and infliximab treatment. She subsequently responded to pulse intravenous methylprednisolone therapy. The diagnostic dilemma arose after 2 mo when she developed clinical features suggestive of systemic onset juvenile idiopathic arthritis. Since both diseases have overlapping clinical features and no specific diagnostic laboratory tests, it is difficult for the clinicians even in the best of centers to reach a definitive diagnosis as illustrated by the index case.
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14
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A girl with extremely refractory Kawasaki disease: an instructive case with unusual course and outcome. Cardiol Young 2012; 22:461-5. [PMID: 21933460 DOI: 10.1017/s1047951111001260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Kawasaki disease constitutes an acute febrile vasculitis of unknown aetiology. It is considered the most common cause of acquired cardiac failure in children. Although standard treatment comprises intravenous immunoglobulin and aspirin, some children exhibit refractory disease, necessitating the use of alternative therapies such as corticosteroids and anti-tumour necrosis factor-alpha. For these cases, few controlled data are available. This report focuses on an extremely refractory classical Kawasaki disease with coronary artery aneurysms and ongoing inflammation. We discuss the therapeutic approaches and the potential pitfalls undertaken, which led to an unfavourable clinical outcome.
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Izumi G, Narugami M, Saita Y, Matsuzawa T, Sugawara O, Kawamura N, Kobayashi I. Arthritis associated with Kawasaki disease: MRI findings and serum matrix metalloproteinase-3 profiles. Pediatr Int 2011; 53:1087-9. [PMID: 22181570 DOI: 10.1111/j.1442-200x.2011.03393.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gaku Izumi
- Department of Pediatrics, Kitami Red Cross Hospital, Kitami, Japan
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Delayed diagnosis of Kawasaki syndrome and thrombosis of a medium-sized aneurysm of the anterior descending coronary artery: case report and literature review. Rheumatol Int 2011; 32:809-14. [PMID: 21327430 DOI: 10.1007/s00296-011-1814-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 01/22/2011] [Indexed: 11/26/2022]
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