1
|
Oni L, Platt C, Marlais M, McCann L, Barakat F, Hesseling M, Cottis H, Protheroe S, Haigh G, Nott K, Marro J, King E, Kelly J, Sussens J, Mulvaney S, Whitby T, Morgan I, Sharma A, Al-Jayyousi R, Cheung CK, Ng C, Lander AD, Simmons W, Melling C, Grandison R, Treitl L, Salama AD, Dudley J. National recommendations for the management of children and young people with IgA vasculitis: a best available evidence, group agreement-based approach. Arch Dis Child 2024:archdischild-2024-327364. [PMID: 39379139 DOI: 10.1136/archdischild-2024-327364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 09/18/2024] [Indexed: 10/10/2024]
Abstract
OBJECTIVE IgA vasculitis (IgAV) is the most frequently experienced subtype of vasculitis seen in children. Most children fully recover, however, complications including chronic kidney disease are recognised. The aim of this project was to use a best available evidence, group agreement, based approach to develop national recommendations for the initial management of IgAV and its associated complications. METHODS A fully representative multiprofessional guideline development group (GDG), consisting of 28 members, was formed and met monthly. Graded recommendations were generated using nationally accredited methods, which included a predefined scope, open consultation, systematic literature review, evidence appraisal, review of national or international guidelines and a period of open consultation. Audit measures and research priorities were incorporated. RESULTS The IgAV GDG met over a 14-month period. A total of 82 papers were relevant for evidence synthesis. For the initial management, four topic areas were identified with five key questions generating six graded recommendations related to classification, specialist referral and musculoskeletal involvement. For the associated complications, five topic areas with 12 key questions generated 15 graded recommendations covering nephritis, gastrointestinal and testicular involvement, atypical disease and follow-up. Open consultation feedback was incorporated. The guidelines were endorsed by the UK Kidney Association and Royal College of Paediatrics and Child Health and are available online. CONCLUSION Despite IgAV being a rare disease with limited evidence, a national standardised approach to the clinical management for children and young people has been achieved. This should unite approaches to care and act as a foundation for improvement.
Collapse
Affiliation(s)
- Louise Oni
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Department of Paediatric Nephrology, Alder Hey Children's Hospital, Liverpool
| | - Caroline Platt
- Bristol Renal Unit, Bristol Royal Hospital for Children, Bristol, UK
| | - Matko Marlais
- Department of Paediatric Nephrology, Great Ormond Street Hospital, London, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Farah Barakat
- Kings College Hospital NHS Foundation Trust, London, UK
| | - Markus Hesseling
- Department of Paediatrics, Children's health Ireland, Dublin, Ireland
| | - Hannah Cottis
- Department of Paediatrics, Royal Devon University Hospital, Devon, UK
| | - Sue Protheroe
- Department of Paediatric Gastroenterology, Birmingham Children's Hospital, Birmingham, UK
| | - Gabrielle Haigh
- Department of Paediatrics, Betsi Cadwaladr Health Board, Wales, UK
| | - Kerstin Nott
- Department of Paediatric Rheumatology, Southampton Children's Hospital, Southampton, UK
| | - Julien Marro
- University of Liverpool Medical School, Liverpool, UK
| | | | - Jane Kelly
- General Practice, Minchinhampton Surgery, Gloucestershire, UK
| | - Jill Sussens
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Shirley Mulvaney
- Department of Paediatric Emergency Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Thomas Whitby
- General Paediatrics, Alder Hey Children's Hospital, Liverpool, Merseyside, UK
| | - Iona Morgan
- Department of Paediatrics, Royal Hospital for Children, Glasgow, UK
| | - Amita Sharma
- Department of Paediatrics, Royal Hospital for Children, Glasgow, UK
| | | | | | | | | | - William Simmons
- Department of Paediatric Pathology, Alder Hey Children's Hospital, Liverpool, UK
| | - Charlotte Melling
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | | | | | - Alan D Salama
- Department of Renal Medicine, UCL Centre for Kidney and Bladder Health, London, UK
| | - Jan Dudley
- Bristol Renal Unit, Bristol Royal Hospital for Children, Bristol, UK
| |
Collapse
|
2
|
Rosmaninho I, Simão-Parreira B, Leal C, Cardoso L, Almeida J. Exploring the Diagnostic Odyssey of IgA Vasculitis. Cureus 2024; 16:e68170. [PMID: 39347365 PMCID: PMC11439127 DOI: 10.7759/cureus.68170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 10/01/2024] Open
Abstract
IgA vasculitis is a form of small vessel vasculitis characterized by IgA immune complex deposition. Although primarily affecting children, it can also occur in adults, often with more severe manifestations and a higher risk of chronic kidney disease (CKD). The authors present the case of a 77-year-old man with significant cardiovascular risk and atrial fibrillation who was admitted to the emergency department (ED) with pruritic and painful palpable purpuric rash, weight loss, and asthenia persisting for approximately one month prior to presentation. Laboratory findings revealed normocytic normochromic anemia, worsening renal function, elevated inflammatory markers, and leukoerythrocyturia. Initially diagnosed as infectious purpura associated with urinary tract infection, the patient was discharged with a prescription for antibiotics (cefixime). Subsequent worsening of the skin lesions, constitutional symptoms, and gross hematuria prompted a second visit to the ED, and the persistent deterioration of kidney function and inflammatory parameters led to admission for further investigation and consideration of a kidney biopsy. This case report describes the etiological investigation, providing a brief review of the typical characteristics of this disease and highlighting the importance of certain factors in establishing the diagnosis, notably the need and timing of a biopsy of the affected organ for a definitive diagnosis. Additionally, the clinical case underscores the diagnostic challenge, particularly when histological confirmation is elusive.
Collapse
Affiliation(s)
- Irene Rosmaninho
- Internal Medicine Department, Unidade Local de Saúde de São João, Porto, PRT
| | | | - Carolina Leal
- Anatomopathology Department, Unidade Local de Saúde de São João, Porto, PRT
| | - Leila Cardoso
- Internal Medicine Department, Unidade Local de Saúde de São João, Porto, PRT
| | - Jorge Almeida
- Internal Medicine Department, Unidade Local de Saúde de São João, Porto, PRT
| |
Collapse
|
3
|
Vasileva AV, Chakarov I, Chakarova P. Modern diagnostic methods for early assessment of the abdominal involvement in Schönlein-Henoch disease. Folia Med (Plovdiv) 2024; 66:73-79. [PMID: 38426468 DOI: 10.3897/folmed.66.e113993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/23/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Schönlein-Henoch disease is a small vessel vasculitis resulting from IgA-mediated inflammation. It is the most common acute systemic vasculitis in childhood, mainly affecting the skin, gastrointestinal tract, joints, and kidneys. Although the prognosis of Schönlein-Henoch is generally good, gastrointestinal tract involvement is a potential complication, presenting as massive gastrointestinal bleeding, bowel infarction, perforation, as well as intussusception and peritonitis.
Collapse
Affiliation(s)
- Anelia V Vasileva
- Prof. Dr Stoyan Kirkovich University Hospital, Stara Zagora, Bulgaria
| | - Ivan Chakarov
- Tsaritsa Yoanna University Hospital, Sofia, Bulgaria
| | | |
Collapse
|
4
|
Thalen M, Gisslander K, Segelmark M, Sode J, Jayne D, Mohammad AJ. Epidemiology and clinical characteristics of biopsy-confirmed adult-onset IgA vasculitis in southern Sweden. RMD Open 2024; 10:e003822. [PMID: 38316490 PMCID: PMC11148676 DOI: 10.1136/rmdopen-2023-003822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/26/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE Immunoglobulin A vasculitis (IgAV) is the most prevalent primary childhood vasculitis in Sweden, but is considerably rarer in adults. This study aims to describe the epidemiology, clinical characteristics and renal outcome of adult-onset IgAV in Skåne, Sweden. METHODS The study area consisted of Skåne, the southernmost region of Sweden, with a population ≥18 years of 990 464 on 31 December 2010. Adult patients assigned the International Classification of Diseases-10 code for IgAV (D69.0) from 2000 through 2019 were retrospectively identified in a population-based database. Medical records were reviewed to validate the diagnosis of IgAV and extract data. Only patients with clinical manifestations of IgAV and biopsy-confirmed disease were included. The annual incidence and point prevalence of biopsy-confirmed IgAV were estimated. RESULTS Fifty-nine patients (19 women) were classified as having adult-onset IgAV. The incidence was 3 per 1 000 000 and was higher among men than women (4 vs 2/1 000 000, p=0.004). Ninety-seven per cent of patients presented with non-thrombocytopenic purpura, 78% with renal involvement, 59% with arthritis/arthralgia and 39% with gastrointestinal symptoms. Fifteen per cent developed chronic kidney disease stage ≥G3 a and one patient progressed to end-stage kidney disease during follow-up. CONCLUSION Adult-onset IgAV is rare in southern Sweden with the incidence higher in men than in women. IgAV frequently affects the kidneys and leads to chronic kidney disease in adults, although the long-term renal outcome appears favourable compared with other small-vessel vasculitides affecting the kidneys.
Collapse
Affiliation(s)
- Michaela Thalen
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Karl Gisslander
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Mårten Segelmark
- Department of Clinical Sciences Lund, Nephrology, Lund University, Lund, Sweden
- Department of Nephrology and Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Jacob Sode
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Nephrology and Rheumatology, Skåne University Hospital, Lund, Sweden
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Nephrology and Rheumatology, Skåne University Hospital, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
5
|
Harris BW, Maxfield L, Hunter A, Alhajj M, Ban B, Pulsipher KJ. Worldwide Distribution and Extracutaneous Manifestations of Henoch-Schönlein Purpura in Adults: Narrative Review. JMIR DERMATOLOGY 2024; 7:e49746. [PMID: 38271008 PMCID: PMC10853858 DOI: 10.2196/49746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/21/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Henoch-Schönlein purpura (HSP), a leukocytoclastic small vessel vasculitis, exhibits both cutaneous and systemic manifestations. While predominantly observed in childhood, it may manifest in adults with more pronounced systemic involvement. Furthermore, HSP is a global phenomenon showcasing epidemiological and systemic variances. OBJECTIVE This study aims to scrutinize extracutaneous manifestations in adults with HSP, discerning distinctions according to geographical regions on a worldwide scale. METHODS A comprehensive search encompassing PubMed, Embase, Cochrane Library, and Web of Science was executed, covering papers published from January 1, 1970, to December 1, 2019. Keywords used included "Henoch-Schönlein purpura," "henoch schonlein purpura+adult," "IgA vasculitis+adult," "HSP+adult," and "IgAV." A total of 995 publications were identified, from which 42 studies encompassing 4064 patients were selected, with a predominant focus on cases reported in Asia, Europe, and the Americas. RESULTS Among adults afflicted with HSP, European patients exhibited a higher propensity for male predominance (P<.001), gastrointestinal involvement (P<.001), and musculoskeletal complications (P<.001). Conversely, patients from the Americas were least likely to experience genitourinary involvement (P<.001). CONCLUSIONS HSP demonstrates a variance in distribution and extracutaneous manifestations within distinct geographical boundaries. In the adult population, European patients exhibited a higher prevalence of male gender and gastrointestinal and musculoskeletal involvement. Asian patients were more predisposed to genitourinary involvement when compared to their American counterparts. The establishment of prospective studies using standardized reporting measures is imperative to validate the relationships unveiled in this investigation.
Collapse
Affiliation(s)
- Blair W Harris
- Department of Dermatology, Sampson Regional Medical Center, Campbell University, Clinton, NC, United States
| | - Luke Maxfield
- Department of Dermatology, Sampson Regional Medical Center, Campbell University, Clinton, NC, United States
| | - Abigail Hunter
- Department of Dermatology, Sampson Regional Medical Center, Campbell University, Clinton, NC, United States
| | - Mandy Alhajj
- Department of Dermatology, Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Byung Ban
- Department of Rheumatology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Kayd J Pulsipher
- Department of Dermatology, Sampson Regional Medical Center, Campbell University, Clinton, NC, United States
| |
Collapse
|
6
|
Javadi V, Kamfar S, Zeinali V, Rahmani K, Moghaddamemami FH. Online information-seeking behavior of Iranian web users on Google about Henoch-Schönlein purpura (HSP): an infodemiology study. BMC Health Serv Res 2023; 23:1389. [PMID: 38082454 PMCID: PMC10714479 DOI: 10.1186/s12913-023-10357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUNDS Previous studies have indicated that users' health information-seeking behavior can serve as a reflection of current health issues within a community. This study aimed to investigate the online information-seeking behavior of Iranian web users on Google about Henoch-Schönlein purpura (HSP). METHODS Google Trends (GTr) was utilized to collect big data from the internet searches conducted by Iranian web users. A focus group discussion was employed to identify users' selected keywords when searching for HSP. Additionally, keywords related to the disease's symptoms were selected based on recent clinical studies. All keywords were queried in GTr from January 1, 2012 to October 30, 2022. The outputs were saved in an Excel format and analyzed using SPSS. RESULTS The highest and lowest search rates of HSP were recorded in winter and summer, respectively. There was a significant positive correlation between HSP search rates and the terms "joint pain" (P = 0.007), "vomiting" (P = 0.032), "hands and feet swelling" (P = 0.041) and "seizure" (P < 0.001). CONCLUSION The findings were in accordance with clinical facts about HSP, such as its seasonal pattern and accompanying symptoms. It appears that the information-seeking behavior of Iranian users regarding HSP can provide valuable insights into the outbreak of this disease in Iran.
Collapse
Grants
- 18441 Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- 18441 Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- 18441 Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- 18441 Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- 18441 Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Pediatric Pathology Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Collapse
Affiliation(s)
- Vadood Javadi
- Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sharareh Kamfar
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahide Zeinali
- Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Khosro Rahmani
- Department of pediatric rheumatology, Shahid Beheshti University of Medical Sciences, Mofid children's Hospital, Tehran, Iran
| | | |
Collapse
|
7
|
Sunar Yayla EN, Bakkaloğlu SA. Does age at disease onset affect the clinical presentation and outcome in children with immunoglobulin A vasculitis? Arch Rheumatol 2023; 38:633-641. [PMID: 38125056 PMCID: PMC10728748 DOI: 10.46497/archrheumatol.2023.9914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/09/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives The study aimed to determine whether there is a relationship between the age at diagnosis and the clinical, laboratory, and prognostic features in pediatric immunoglobulin A vasculitis (IgAV) patients. Patients and methods In this study, 539 pediatric IgAV patients (298 males, 241 females; mean age: 7.74±3.36 years; range, 1 to 17.8 years) were retrospectively evaluated between January 2005 and July 2020. The relationship between clinical findings and age at diagnosis was analyzed by univariate logistic regression analysis. Factors associated with renal involvement, steroid-dependent or refractory disease, and recurrence were examined. Results The median age of diagnosis was 7.1 (1-17.8) years in all patients. At the time of admission, purpura, abdominal pain, and arthritis were the most common clinical findings. At the time of diagnosis, there was a positive association between age and purpura and an inverse association with the presence of arthritis. There were associations between renal involvement and age at diagnosis (odds ratio=1.22, 95% confidence interval 1.13-1.31, p<0.001), follow-up time (p<0.001), no history of previous infection (p<0.001), and presence of gastrointestinal (GI) involvement (p=0.003). Significant relationships were found between the age at diagnosis, follow-up time, GI involvement, renal involvement, scrotal involvement, the C-reactive protein value at the time of diagnosis, and the presence of steroid-dependent disease. An association was found between recurrence and GI involvement. All refractory patients had renal involvement. Age at diagnosis (p<0.001) and follow-up time (p<0.001) was found to be associated with refractory disease. Conclusion Age at diagnosis and follow-up time may be associated with renal involvement and refractory and steroid-dependent disease in IgAV. In addition, there may be a relationship between steroid-dependent disease and renal, GI, and scrotal involvement and between GI involvement and recurrence.
Collapse
Affiliation(s)
- Emine Nur Sunar Yayla
- Department of Pediatrics, Division of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Sevcan A. Bakkaloğlu
- Department of Pediatrics, Division of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Türkiye
| |
Collapse
|
8
|
Rose K, Turner JE, Iking-Konert C. [Immunoglobulin A vasculitis (IgAV)]. Z Rheumatol 2023; 82:587-598. [PMID: 37266676 PMCID: PMC10236391 DOI: 10.1007/s00393-023-01355-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 06/03/2023]
Abstract
IgA vasculitis (IgAV) is an immune complex-mediated vasculitis characterized by IgA1-dominant immune deposits in small vessels. It is the most common systemic vasculitis in childhood with a mostly uncomplicated and self-limiting course. Adults are less affected but the course is frequently more complicated and more frequently accompanied by renal involvement. IgAV characteristically manifests itself on the skin with palpable purpura and in joints, the kidneys and the gastrointestinal tract. In cases of incomplete or atypical symptoms a differential diagnostic work-up is required. A number of triggers have been suggested, especially infections and drugs. Disease management is tailored to organ manifestations and the severity of the symptoms. For children, optimized supportive care and targeted symptom relief are usually sufficient. Management of renal and gastrointestinal manifestations follows recommendations for ANCA-associated vasculitis and IgA nephropathy. Treatment options include glucocorticoids and immunosuppressive agents with varying and mostly insufficient evidence.
Collapse
Affiliation(s)
- Katharina Rose
- Abteilung für Rheumatologie, Stadtspital Zürich, Birmensdorferstr. 497, 8063, Zürich, Schweiz.
| | - Jan-Eric Turner
- III. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Christof Iking-Konert
- Abteilung für Rheumatologie, Stadtspital Zürich, Birmensdorferstr. 497, 8063, Zürich, Schweiz
| |
Collapse
|
9
|
Alsubaie A, Alshabanat A, Almizel A, Omair M, Alodaini R. A 20-Year-Old Man with IgA Vasculitis following COVID-19 Vaccination. Case Rep Rheumatol 2023; 2023:9505383. [PMID: 37492803 PMCID: PMC10365908 DOI: 10.1155/2023/9505383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/04/2023] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Abstract
IgA vasculitis is a common type of vasculitis that is generally triggered by infectious causes. Vaccines have been reported as a trigger as well. Herein, we report a case of a young man who is previously healthy and who developed IgA vasculitis after the first dose of the COVID-19 mRNA vaccine Pfizer-BioNTech. The patient's symptoms were mainly skin and joint without renal or other system involvement. The patient had an excellent outcome with complete resolution after treatment with steroid tapering and azathioprine as a steroid-sparing agent over 6 months.
Collapse
Affiliation(s)
- Abdulaziz Alsubaie
- King Saud University College of Medicine, Department of Infectious Diseases, Riyadh, Saudi Arabia
| | - Abdulmajeed Alshabanat
- King Saud University College of Medicine, Department of Internal Medicine, Riyadh, Saudi Arabia
| | | | - Mohammed Omair
- King Saud University College of Medicine, Department of Internal Medicine, Riyadh, Saudi Arabia
| | - Rahaf Alodaini
- King Saud University College of Medicine, Department of Internal Medicine, Riyadh, Saudi Arabia
| |
Collapse
|
10
|
Farisogullari B, Cuceoglu MK, Oral H, Yardimci GK, Bilginer Y, Ozen S, Karadag O. Biologics for immunoglobulin A vasculitis: targeting vasculitis or comorbid disease? Intern Emerg Med 2022; 17:1599-1608. [PMID: 35347546 DOI: 10.1007/s11739-022-02968-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/01/2022] [Indexed: 11/05/2022]
Abstract
In this study, we aimed to evaluate the clinical features and treatments, including the use of biological disease-modifying anti-rheumatic drugs (bDMARDs) in a large cohort of pediatric and adult immunoglobulin A vasculitis (IgAV). Since data on the use of bDMARDs in IgAV are very limited, we collated the reasons for use of bDMARDs during the disease course. Patients who were enrolled in the Hacettepe University Vasculitis Research Centre (HUVAC) registry were included. In this prospective database dating from 2014, there were 436 IgAV patients classified as IgAV according to Ankara 2008 and/or American College of Rheumatology 1990 criteria. 88 adults and 330 pediatric IgAV patients were included as the main study group. Concomitant spondyloarthritis (SpA) was observed only in adult patients (10% vs 0% in children, p < 0.001). IgAV relapse was more common in adults than in children (p: 0.017). Adult patients were mostly treated with corticosteroid (p < 0.001) and conventional synthetic disease-modifying anti-rheumatic drug treatment (< 0.001), while more than half of the pediatric patients were followed up without immunosuppressive treatment. Ten (11%) adult patients used biologics. Among them, two patients used rituximab due to IgAV disease activity, three used infliximab due to SpA, three used etanercept due to SpA (one patient had a pediatric onset enthesitis-related arthritis), and two used anakinra due to recurrent familial Mediterranean fever attacks. This is the first study evaluating the use of all bDMARDs for any reason in the IgAV cohorts in the literature. None of the pediatric patients used biologics. Our data suggest biologics are mainly used for comorbid inflammatory diseases over refractory vasculitis in adult IgAV.
Collapse
Affiliation(s)
- Bayram Farisogullari
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Sihhiye, 06100, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Hakan Oral
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gozde Kubra Yardimci
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Sihhiye, 06100, Ankara, Turkey
| | - Yelda Bilginer
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Seza Ozen
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Sihhiye, 06100, Ankara, Turkey.
| |
Collapse
|
11
|
Delapierre A, Terrier B, Pillebout E, Baudart P, Jourde-Chiche N, Lioger B, Martis N, Moulis G, Rivière E, Le Gouellec N, Raffray L, Urbanski G, Sanges S, Maurier F, Deroux A, Mekinian A, Monteiro R, Marcelli C, Guillevin L, Maillot F, Lucas B, Aouba A, Audemard-Verger A. Clinical phenotype and cytokine profile of adult IgA vasculitis with joint involvement. Clin Rheumatol 2022; 41:1483-1491. [PMID: 35041109 DOI: 10.1007/s10067-021-05937-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 09/01/2021] [Accepted: 09/21/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Joint involvement can be observed during the course of adult IgA vasculitis (IgAV). However, clinical picture, prognosis, or pathophysiological data associated with this condition have been overlooked. We aimed to describe the clinical characteristics and outcome of IgAV patients with joint involvement and look to a specific cytokine profile. METHODS We analyzed clinical and biological data from a nationwide study that included adult IgAV patients. Presentation and outcomes of patients with or without joint involvement were compared at baseline and during follow-up. Plasma cytokine measurements of IgAV patients included in a prospective study were also analyzed using multiplex assays. RESULTS Among 260 patients, 62% had joint involvement. Among them, rheumatological manifestations included arthralgia (100%) or arthritis (16%), mostly involving the knees and ankles. In multivariate analysis, patients with joint involvement, compared to those without, were younger (p = 0.002; OR 0.87; 95% CI 0.80-0.95) and showed more frequent gastrointestinal tract involvement (p = 0.012; OR = 2.08; 95% CI 1.18-3.67). However, no difference in terms of clinical response, relapse, end-stage renal disease, or death was observed between groups. Among 13 cytokines measured, plasma interleukin (IL)-1β level was higher in patients with joint involvement compared to those without (mean ± SEM IL-1β, 3.5 ± 1.2 vs. 0.47 ± 0.1 pg/ml; p = 0.024) or healthy controls (vs. 1.2 ± 0.5 pg/ml; p = 0.076). CONCLUSION Joint involvement is frequent in adult IgAV and is associated with more frequent gastrointestinal involvement. Increased plasma IL-1β levels raise the question of targeting this cytokine in patients with chronic and/or refractory joint involvement. Key Points • Joint involvement in adult IgAV is a frequent manifestation. • Joint involvement is associated with more frequent gastrointestinal manifestations. • Interleukin-1β (IL-1β) might orchestrate joint inflammation in adult IgAV. • IL-1β might be a therapeutic target in patients with chronic and/or refractory joint involvement.
Collapse
Affiliation(s)
- Alice Delapierre
- Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France
| | - Benjamin Terrier
- Université Paris Descartes, Paris, France.,Department of Internal Medicine, Hôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Evangéline Pillebout
- Department of Nephrology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Pauline Baudart
- Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie Et Transplantation Rénale, CHU de La Conception, AP-HM, Marseille, France
| | - Bertrand Lioger
- Department of Internal Medicine, Hôpital Saint Louis, APHP, Paris, France
| | - Nihal Martis
- Department of Internal Medicine, CHU, Nice, France
| | | | | | - Noémie Le Gouellec
- Department of Internal Medicine and Nephrology, Valenciennes, CH, France
| | - Loïc Raffray
- Department of Internal Medicine, CHU, La Réunion, France
| | | | - Sébastien Sanges
- Département de Médecine Interne Et Immunologie Clinique, CHU Lille, 59000, Lille, France.,Univ. Lille, INSERM, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France
| | | | - Alban Deroux
- Department of Internal Medicine, CHU de Grenoble, Grenoble, France
| | - Arsène Mekinian
- Department of Internal Medicine, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Renato Monteiro
- Center of Research On Inflammation INSERM U1149, CNRS ERL8252, Paris Diderot University, Paris, France
| | - Christian Marcelli
- Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France
| | - Loïc Guillevin
- Université Paris Descartes, Paris, France.,Department of Internal Medicine, Hôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Francois Maillot
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France.,University of Tours, Tours, France
| | - Bruno Lucas
- Paris Descartes University, Cochin Institute, CNRS UMR8104, INSERM U1016, Paris, France
| | - Achille Aouba
- Department of Internal Medicine and Clinical Immunology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Alexandra Audemard-Verger
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France. .,University of Tours, Tours, France.
| | | |
Collapse
|
12
|
Dawood SA, Abodiah AM, Alqahtani SM, Shati AA, Alqahtani YA, Alshehri MA, Mahmood SE. Clinico-Epidemiological Profile and Outcome of Children with IgA Vasculitis in Aseer Region, Southwestern Saudi Arabia. Healthcare (Basel) 2021; 9:1694. [PMID: 34946420 PMCID: PMC8701005 DOI: 10.3390/healthcare9121694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction: Immunoglobulin A (IgA) vasculitis is one of the most common forms of primary vasculitis in children; it typically has a benign course but can be aggressive and require intervention. Aim of the work: The aim of this retrospective study was to evaluate the epidemiological and clinical profile and treatment modalities used for children with IgA vasculitis in the southwestern region of Saudi Arabia. Material and Methods: We reviewed the medical records of 89 children admitted to Abha Maternity and Children Hospital in the southwestern region of Saudi Arabia from January 2016 to December 2020 with a confirmed diagnosis of IgA vasculitis according to the European League Against Rheumatism/Paediatric Rheumatology International Trials Organisation/Pediatric Rheumatology European Society criteria. Results: Eighty-nine children had a confirmed diagnosis of IgA vasculitis, with 50 boys (56.2%) and 39 girls (43.8%; male-to-female ratio of 1.28:1) and a mean age at diagnosis of 5.87 ± 2.81 years. The mean hospital stay duration was 5.66 ± 4.72 days. Infections preceded 29.2% of the cases, with upper respiratory tract infections comprising 24.7%. Approximately 31.5% of the cases were diagnosed in summer, followed by autumn in 28% of the cases. Rash was present in 100%, arthritis in 72.2%, gastrointestinal tract involvement in 60.7%, and renal involvement in 23.5% of cases. Thrombocytosis and leukocytosis were found in 35% and 46% of all cases, and 52.3% and 47.6.25% of cases with renal involvement, respectively (OR = 2.035, 95% CI: 0.75-5.52 and OR = 1.393, 95% CI: 0.522-1.716, respectively). Approximately 26% of cases experienced relapses. Treatment was conservative in 23.6%, oral prednisolone in 23.6%, and pulse steroid in 45% of cases. Abdominal pain with lower gastrointestinal tract bleeding was the primary indication for initiating pulse steroid treatment. Conclusions: There were similarities and differences in the epidemiology and frequency of clinical manifestations of patients with IgA vasculitis compared to previous studies. Children presenting with such epidemiological and clinical profile need to be closely monitored and long-term follow-up is recommended to improve the outcomes.
Collapse
Affiliation(s)
- Samy A. Dawood
- Department of Child Health, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (S.A.D.); (S.M.A.); (Y.A.A.); (M.A.A.)
| | - Abdoh M. Abodiah
- Pediatric Rheumatology Unit, Department of Pediatrics, Abha Maternity and Children Hospital, Abha 62562, Saudi Arabia;
| | - Saleh M. Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (S.A.D.); (S.M.A.); (Y.A.A.); (M.A.A.)
| | - Ayed A. Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (S.A.D.); (S.M.A.); (Y.A.A.); (M.A.A.)
| | - Youssef A. Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (S.A.D.); (S.M.A.); (Y.A.A.); (M.A.A.)
| | - Mohammed A. Alshehri
- Department of Child Health, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (S.A.D.); (S.M.A.); (Y.A.A.); (M.A.A.)
| | - Syed E. Mahmood
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia;
| |
Collapse
|
13
|
Mizerska-Wasiak M, Turczyn A, Cichoń-Kawa K, Małdyk J, Miklaszewska M, Drożdż D, Bieniaś B, Sikora P, Drożyńska-Duklas M, Żurowska A, Szczepańska M, Pańczyk-Tomaszewska M. IgA vasculitis nephritis clinical course and kidney biopsy - national study in children. Pediatr Rheumatol Online J 2021; 19:150. [PMID: 34620183 PMCID: PMC8495907 DOI: 10.1186/s12969-021-00616-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/20/2021] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED The aim of the study was to investigate the relationship between the severity of typical clinical symptoms, severity of histopathological lesions in kidney biopsies in IgA vasculitis nephritis (IgAVN) and to propose indications for kidney biopsy in children. MATERIAL AND METHODS This retrospective study enrolled 106 patients, included in the IgAVN registry of Polish children, diagnosed by kidney biopsy. Renal and extrarenal symptoms at onset of the disease were analyzed. Biopsy results were assessed using Oxford classifications (MEST-C). The patients were divided into 3 groups depending on the severity of proteinuria: A-nephrotic proteinuria with hematuria; B-non-nephrotic proteinuria with hematuria; C-isolated hematuria. RESULTS The first symptoms of nephropathy were observed at the 0.7 (1-128.4) months from the onset of extrarenal symptoms. Kidney biopsy was performed on 39 (6-782) days after the onset of nephropathy symptoms. MEST-C score 4 or 5 was significantly more frequent in children from group A than in groups B and C. Significantly higher mean MEST-C score was found in patients with abdominal symptoms than without. In group A: S0 and T0 we found in significantly shorter time to kidney biopsy than in S1, T1-2 p < 0.05) and in group B the significantly shorter time in T0 compare to T1-2 p < 0.05). The ROC analysis shows that S1 changes appear in kidney biopsies in group A with cut off 21 days (AUC 0,702, p = 0.004, sensitivity 0.895 specificity 0.444) T1-2 changes after 35 days (AUC 0.685, p = 0.022, sensitivity 0.750, specificity 0.615), and in goupn B T1-2 cut off is 74 days (AUC 0,738, p = 0.002, sensitivity 0.667, specificity 0.833). CONCLUSIONS In childhood IgAVN, the severity of changes in the urine is clearly reflected in the result of a kidney biopsy. The biopsy should be performed in patients with nephrotic proteinuria no later than 3 weeks after the onset of this symptom in order to promptly apply appropriate treatment and prevent disease progression. Accompanying abdominal symptoms predispose to higher MESTC score.
Collapse
Affiliation(s)
| | - Agnieszka Turczyn
- grid.13339.3b0000000113287408Department of Paediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Karolina Cichoń-Kawa
- grid.13339.3b0000000113287408Department of Paediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Jadwiga Małdyk
- grid.13339.3b0000000113287408Department of Pathomorphology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Miklaszewska
- grid.5522.00000 0001 2162 9631Department of Pediatric Nephrology, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - Dorota Drożdż
- grid.5522.00000 0001 2162 9631Department of Pediatric Nephrology, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - Beata Bieniaś
- grid.411484.c0000 0001 1033 7158Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Przemysław Sikora
- grid.411484.c0000 0001 1033 7158Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Magdalena Drożyńska-Duklas
- grid.11451.300000 0001 0531 3426Department of Paediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdansk, Poland
| | - Aleksandra Żurowska
- grid.11451.300000 0001 0531 3426Department of Paediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdansk, Poland
| | - Maria Szczepańska
- grid.411728.90000 0001 2198 0923Department of Paediatrics, Medical University of Silesia, Zabrze, Poland
| | | |
Collapse
|
14
|
Sestan M, Kifer N, Frkovic M, Sapina M, Srsen S, Batnozic Varga M, Ovuka A, Held M, Gudelj Gracanin A, Kozmar A, Bulimbasic S, Coric M, Laskarin G, Gagro A, Jelusic M. Gastrointestinal involvement and its association with the risk for nephritis in IgA vasculitis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211024828. [PMID: 34262620 PMCID: PMC8252396 DOI: 10.1177/1759720x211024828] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/24/2021] [Indexed: 01/29/2023] Open
Abstract
Background: We analysed clinical and biochemical parameters in predicting severe gastrointestinal (GI) manifestations in childhood IgA vasculitis (IgAV) and the risk of developing renal complications. Methods: A national multicentric retrospective study included children with IgAV reviewed in five Croatian University Centres for paediatric rheumatology in the period 2009–2019. Results: Out of 611 children, 281 (45.99%) had at least one GI manifestation, while 42 of 281 (14.95%) had the most severe GI manifestations. Using logistic regression several clinical risk factors for the severe GI manifestations were identified: generalized rash [odds ratio (OR) 2.09 (95% confidence interval (CI) 1.09–4.01)], rash extended on upper extremities (OR 2.77 (95% CI 1.43–5.34)] or face [OR 3.69 (95% CI 1.42–9.43)] and nephritis (IgAVN) [OR 4.35 (95% CI 2.23–8.50)], as well as lower values of prothrombin time (OR 0.05 (95% CI 0.01–0.62)], fibrinogen [OR 0.45 (95% CI 0.29–0.70)] and IgM [OR 0.10 (95% I 0.03–0.35)]] among the laboratory parameters. Patients with severe GI involvement more frequently had relapse of the disease [OR 2.14 (CI 1.04–4.39)] and recurrent rash [OR 2.61 (CI 1.27–5.38)]. Multivariate logistic regression found that the combination of age, GI symptoms at the beginning of IgAV and severity of GI symptoms were statistically significant predictors of IgAVN. Patients in whom IgAV has started with GI symptoms [OR 6.60 (95% CI 1.67–26.06)], older children [OR 1.22 (95% CI 1.02–1.46)] with severe GI form of IgAV (OR 5.90 (95% CI 1.12–31.15)] were particularly high-risk for developing IgAVN. Conclusion: We detected a group of older children with the onset of GI symptoms before other IgAV symptoms and severe GI form of the IgAV, with significantly higher risk for acute and chronic complications of IgAV.
Collapse
Affiliation(s)
- Mario Sestan
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nastasia Kifer
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marijan Frkovic
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Matej Sapina
- Department of Paediatrics, Josip Juraj Strossmayer University of Osijek, Medical Faculty and Faculty of Dental Medicine and Health Osijek, University Hospital Centre Osijek, Osijek, Croatia
| | - Sasa Srsen
- Department of Paediatrics, University of Split School of Medicine, University Hospital Centre Split, Split, Croatia
| | - Mateja Batnozic Varga
- Department of Paediatrics, Josip Juraj Strossmayer University of Osijek, Medical Faculty Osijek, University Hospital Centre Osijek, Osijek, Croatia
| | - Aleksandar Ovuka
- Department of Paediatrics, University of Rijeka, Faculty of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Martina Held
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Ana Kozmar
- Clinical Department of Laboratory Diagnostics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Stela Bulimbasic
- Department of Pathology and Cytology, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marijana Coric
- Department of Pathology and Cytology, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Alenka Gagro
- Department of Paediatrics, Children's Hospital Zagreb, Zagreb, Croatia
| | - Marija Jelusic
- Department of Paediatrics, University of Zagreb School of Medicine, Division of Clinical Immunology, Rheumatology and Allergology, Centre of Reference for Paediatric and Adolescent Rheumatology of Ministry of Health of the Republic Croatia, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10 000, Croatia
| |
Collapse
|
15
|
CORREIA CP, MARTINS A, FREITAS JG, GUIOMAR V, OLIVEIRA J, MENG C. Immunoglobulin A vasculitis: challenging renal implications of adult onset. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.19.04211-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
16
|
Sapina M, Frkovic M, Sestan M, Srsen S, Ovuka A, Batnozic Varga M, Kramaric K, Brdaric D, Milas K, Gagro A, Jelusic M. Geospatial clustering of childhood IgA vasculitis and IgA vasculitis-associated nephritis. Ann Rheum Dis 2020; 80:610-616. [PMID: 33208346 DOI: 10.1136/annrheumdis-2020-218649] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Research on spatial variability of the incidence of IgA vasculitis (IgAV) in children and its potential implications for elucidation of the multifactorial aetiology and pathogenesis is limited. We intended to observe spatial variability of the incidence of IgAV and IgA vasculitis-associated nephritis (IgAVN) using modern geostatistical methods, and hypothesised that their spatial distribution may be spatially clustered. METHODS Patients' data were retrospectively collected from 2009 to 2019 in five Croatian University Hospital Centres for paediatric rheumatology, and census data were used to calculate the incidence of IgAV. Using spatial empirical Bayesian smoothing, local Morans' I and local indicator of spatial autocorrelation (LISA), we performed spatial statistical analysis. RESULTS 596 children diagnosed with IgAV were included in this study, of which 313 (52.52%) were male. The average annual incidence proportion was estimated to be 6.79 per 100 000 children, and the prevalence of IgAVN was 19.6%. Existence of spatial autocorrelation was observed in both IgAV and IgAVN; however, clustering distribution differed. While IgAV showed clustering in Mediterranean and west continental part around cities, IgAVN was clustered in the northern Mediterranean and eastern continental part, where a linear cluster following the Drava and Danube river was observed. CONCLUSION IgAV incidence in Croatia is similar to other European countries. Spatial statistical analysis showed a non-random distribution of IgAV and IgAVN. Although aetiological associations cannot be inferred, spatial analytical techniques may help in investigating and generating new hypotheses in non-communicable diseases considering possible environmental risk factors and identification of potential genetic or epigenetic diversity.
Collapse
Affiliation(s)
- Matej Sapina
- Department of Paediatrics, Josip Juraj Strossmayer University of Osijek, Medical Faculty Osijek, University Hospital Centre Osijek, Osijek, Croatia.,Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Marijan Frkovic
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mario Sestan
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sasa Srsen
- Department of Paediatrics, University of Split School of Medicine, University Hospital Centre Split, Split, Croatia
| | - Aleksandar Ovuka
- Department of Paediatrics, University of Rijeka, Faculty of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Mateja Batnozic Varga
- Department of Paediatrics, Josip Juraj Strossmayer University of Osijek, Medical Faculty Osijek, University Hospital Centre Osijek, Osijek, Croatia
| | - Karolina Kramaric
- Department of Paediatrics, Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, University Hospital Centre Osijek, Osijek, Croatia
| | - Dario Brdaric
- Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia.,Institute of Public Health for the Osijek-Baranja County, Osijek, Croatia
| | - Kresimir Milas
- Department of Paediatrics, Josip Juraj Strossmayer University of Osijek, Medical Faculty Osijek, University Hospital Centre Osijek, Osijek, Croatia
| | - Alenka Gagro
- Department of Paediatrics, University of Zagreb School of Medicine, Children's Hospital Zagreb, Zagreb, Croatia.,Josip Juraj Strossmayer University of Osijek, Medical Faculty Osijek, Osijek, Croatia
| | - Marija Jelusic
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| |
Collapse
|
17
|
Liao CH, Tsai M, Yang YH, Chiang BL, Wang LC. Onset age is a risk factor for refractory pediatric IgA vasculitis: a retrospective cohort study. Pediatr Rheumatol Online J 2020; 18:86. [PMID: 33172497 PMCID: PMC7654143 DOI: 10.1186/s12969-020-00480-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 11/01/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Though outcome differences between children and adults with immunoglobulin A vasculitis (IgAV) has been well documented, it remains unclear if disease features in pediatric IgAV patients vary with onset age. We aimed to explore clinical features and prognosis of pediatric IgAV stratified by onset age. METHODS We retrospectively reviewed records of patients under 18 years old diagnosed with IgAV from January 1999 to December 2018 in one tertiary medical center in Taiwan. Patients were grouped by onset age: ≤ 6 years old, 6-12 years old (> 6, ≤ 12), and 12-18 years old (> 12, < 18). Demographics, laboratory data, incidence of gastrointestinal, renal, and joint involvement, corticosteroid dependence, recurrence, and refractory disease were analyzed. Recurrence was defined as disease flare-up after complete remission and discontinuation of all medications for at least 3 months. Corticosteroid dependence was defined by more than 6 weeks of daily oral corticosteroid intake. Refractory disease was defined as not achieving complete remission 6 months after disease onset. Statistical analysis was performed using R software (v3.6.0). RESULTS There were 484 IgAV patients, with an onset age of 6.10 (4.72-8.58) (median (IQR)) years old. There were 234 (48.3%) patients ≤6 years old, 210 (43.4%) 6-12 years old, and 40 (8.3%) 12-18 years old. One hundred and thirty (26.9%) patients had renal involvement, which was more frequent in older children (≤ 6 years old, 18.4%; 6-12 years old, 31.0%; 12-18 years old, 55.0%; p < 0.001). There were 361 patients (74.6%) with joint involvement; younger children were affected more frequently (≤ 6 years old, 82.1%; 6-12 years old, 71.9%; 12-18 years old, 45.0%; p < 0.001). Gastrointestinal involvement was present in 311 (64.3%) patients, showing no difference among age groups. There were 46 patients (9.5%) with recurrent IgA vasculitis, 136 (28.1%) with corticosteroid dependent and 76 (15.7%) with refractory disease. Corticosteroid dependence and refractory disease occurred more frequently as onset age increased (p < 0.001). CONCLUSION Pediatric IgAV with different onset ages are associated with distinct clinical manifestations and outcomes. The risk of developing corticosteroid dependence, refractory disease and renal involvement increased with onset age.
Collapse
Affiliation(s)
- Chun-Hua Liao
- grid.412094.a0000 0004 0572 7815Department of Pediatrics, National Taiwan University Hospital, No.8, Chung Shan South Road, Taipei, 10002 Taiwan
| | - Melody Tsai
- grid.412094.a0000 0004 0572 7815Department of Pediatrics, National Taiwan University Hospital, No.8, Chung Shan South Road, Taipei, 10002 Taiwan
| | - Yao-Hsu Yang
- grid.412094.a0000 0004 0572 7815Department of Pediatrics, National Taiwan University Hospital, No.8, Chung Shan South Road, Taipei, 10002 Taiwan
| | - Bor-Luen Chiang
- grid.412094.a0000 0004 0572 7815Department of Pediatrics, National Taiwan University Hospital, No.8, Chung Shan South Road, Taipei, 10002 Taiwan ,grid.412094.a0000 0004 0572 7815Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Chieh Wang
- Department of Pediatrics, National Taiwan University Hospital, No.8, Chung Shan South Road, Taipei, 10002, Taiwan.
| |
Collapse
|
18
|
Kounatidis D, Vadiaka M, Kouvidou C, Sampaziotis D, Skourtis A, Panagopoulos F, Konstantinou F, Vallianou NG. Clostridioides difficile infection in a patient with immunoglobulin A vasculitis: a triggering factor or a rare complication of the disease? A case-based review. Rheumatol Int 2020; 40:997-1000. [PMID: 32318801 DOI: 10.1007/s00296-020-04586-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/09/2020] [Indexed: 12/29/2022]
Abstract
IgA vasculitis, formerly known as Henoch-Schonlein purpura (HSP), is the most common form of systemic vasculitis in children and is characterized by inflammation of the small vessels with typical deposition of IgA immune complexes. It is a leukocytoclastic type of vasculitis and is characterized by a tetrad of clinical manifestations: non-thrombocytopenia or coagulopathy-induced palpable purpura, arthritis, or arthralgia, gastrointestinal, and renal involvement. The exact cause of IgA vasculitis is not known yet, although infections, vaccinations and insect bites have been implicated in the appearance of the disease. The main risk factors for Clostridioides difficile infection (CDI) are previous CDI, age > 65 years old, pharmacologic agents (antibiotics, PPIs, histamine-2 receptor antagonists, glucocorticoids, and chemotherapy), prior hospitalization, the presence of co-morbidities, especially inflammatory bowel diseases and chronic kidney disease (CKD) and immunosuppression. Oral vancomycin or fidaxomicin are the gold standard of the therapy, with metronidazole being an alternative choice. The purpose of this study was to describe a case of IgA vasculitis and Clostridioides difficile infection to see whether there is any association between the two distinct clinical entities. Herein, we describe a 17-year old patient with IgA vasculitis and bloody diarrhea due to Clostridioides difficile infection and we discuss the co-existence of these two pathological conditions. The patient presented to the hospital with diffuse abdominal pain, nausea, vomiting, and two episodes of bloody diarrhea. Stools tested positive for Clostridioides difficile toxins, while he remained afebrile with hs-CRP = 1.5 mg/dL (normal range < 0.5 mg/dL). Direct immunofluorescence from the extremities' purplish eruption showed leukocytoclastic vasculitis with IgA deposition. Whether co-existence of the two above-mentioned distinct clinical entities is just a co-incidence or CDI is a triggering factor for IgA vasculitis remains to be elucidated in future large-scale studies.
Collapse
Affiliation(s)
| | - Maria Vadiaka
- Evangelismos General Hospital, 45-47 Ipsilantou Str, Athens, Greece
| | | | | | | | | | | | - Natalia G Vallianou
- Evangelismos General Hospital, 45-47 Ipsilantou Str, Athens, Greece.
- Evangelismos General Hospital, 5 Pyramidon Str, 19005, Athens, Greece.
| |
Collapse
|
19
|
Yi F, Bai Z, Li Y, Xu X, Guo X, Qi X. A good response to glucocorticoid for Henoch-Schönlein purpura with abdominal pain and gastrointestinal bleeding in an adult: A CARE case report. Medicine (Baltimore) 2020; 99:e18602. [PMID: 31895810 PMCID: PMC6946351 DOI: 10.1097/md.0000000000018602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Henoch-Schönlein purpura (HSP) is a small-vessel vasculitis that has been extensively studied in children, but little is known about its natural history in adults. There is no consensus regarding the treatment of glucocorticosteroids use for HSP. The efficacy of glucocorticoid for preventing from severe complications or relapse is also controversial in HSP. PATIENT CONCERNS A 21-year-old male was admitted to the hospital due to abdominal pain for more than 20 days, hematochezia for more than 10 days, and rash for 2 days. DIAGNOSES The diagnosis of HSP is based on the European League against Rheumatism and the Paediatric Rheumatology European Society in 2006. INTERVENTIONS The patient received glucocorticosteroids treatment for 17 days at the time of first hospitalization. OUTCOMES The abdominal pain and hematochezia completely disappeared on the 6th day after the use of glucocorticosteroids, and purpura completely disappeared on the 8th day. LESSONS Our patient has a good response to glucocorticoid. Glucocorticosteroids may be effective for the treatment of HSP.
Collapse
Affiliation(s)
- Fangfang Yi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang
- Postgraduate College, Dalian Medical University, Dalian
| | - Zhaohui Bai
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang
| | - Yingying Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang
- Postgraduate College, Jinzhou Medical University, Jinzhou 121001, P.R. China
| | - Xiangbo Xu
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang
| |
Collapse
|
20
|
Prognostic implications of normal or minimal urinary findings on long-term renal impairment in adults with Henoch-Schönlein purpura. J Am Acad Dermatol 2019; 82:1393-1399. [PMID: 31881295 DOI: 10.1016/j.jaad.2019.12.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/03/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Renal involvement in adult Henoch-Schönlein purpura is a major cause of morbidity and can lead to significant long-term renal impairment. The prognostic significance of normal or minimal urinary abnormalities at diagnosis is unknown. OBJECTIVE To assess the risk of long-term renal impairment in patients with Henoch-Schönlein purpura who present with normal or minimal urinary abnormalities. METHODS Retrospective cohort study of adult Henoch-Schönlein purpura patients presenting with normal urinalysis results, microscopic hematuria, or low-grade proteinuria. Patients were followed for development of long-term renal impairment, with adjusting for comorbidities. RESULTS Forty-seven patients were included, with median follow-up 73.9 months (interquartile range 35 to 98 months). Thirty-nine patients (83.0%) had abnormal urinalysis results, of whom 15 (38.5%) progressed to long-term renal impairment. In contrast, 8 patients (17%) had normal urinalysis results, of whom only 1 (12.5%) developed long-term renal impairment (adjusted hazard ratio 10.58; 95% confidence interval 1.18-94.73). Renal events occurred at a median 36.1 months (interquartile range 17.1 to 61 months) from diagnosis, earlier in patients with comorbidities compared with those with none, and in a constant event rate over time. LIMITATIONS Small sample size. CONCLUSIONS Microscopic hematuria and low-grade proteinuria at Henoch-Schönlein purpura diagnosis is a poor prognostic sign for the development of long-term renal impairment. This population should be targeted for prolonged surveillance.
Collapse
|
21
|
Sathishkumar D, Udhayakumar P, Adhikari DD, George R. Pediatric Cutaneous Emergencies and their Outcome: Study from a Tertiary Care Center in South India. Indian Dermatol Online J 2019; 10:650-656. [PMID: 31807443 PMCID: PMC6859774 DOI: 10.4103/idoj.idoj_37_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Skin problems are commonly encountered in the pediatric emergency department (PED). Although there are a few studies on the prevalence and spectrum of skin conditions in children attending the PED, only limited information is available on the outcome of the children with skin-related ailments requiring hospitalization. Aim: To study the clinical profile of skin manifestations in children presenting to the PED over a period of one year and assess the impact of skin lesions on the clinical outcome. Materials and Methods: All children <16 years of age attending the PED were screened and children with skin lesions were referred to the dermatologist for further evaluation, and those admitted were followed up until discharge. Children with skin lesions were categorized into seven subsets based on their diagnosis. Outcomes evaluated were duration of hospital stay, associated systemic inflammatory response syndrome (SIRS), and mortality. Results: Of the 24,324 patients screened, 203 (0.83%) had skin lesions, of whom 158 (77.83%) were discharged from the PED. Forty five (22.16%) patients required admission of whom 2 (0.99%) died. Inflammatory disorders were the most common, 102 (50.24%), followed by infections in 91 (44.82%) patients. Among the hospitalized patients, 25 (55.6%) had SIRS, which included infections in 14 (56%), vasculitis in 5 (20%), and urticaria in 3 (12%) patients. Two patients with SIRS died and the causes were purpura fulminans and febrile exanthem of probable viral etiology. Conclusion: Our study highlights the spectrum of pediatric cutaneous emergencies and their outcome. A subset of patients can present with severe skin ailments and SIRS in whom early diagnosis and prompt treatment can impact the outcome.
Collapse
Affiliation(s)
| | | | | | - Renu George
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
22
|
Villatoro-Villar M, Crowson CS, Warrington KJ, Makol A, Ytterberg SR, Koster MJ. Clinical Characteristics of Biopsy-Proven IgA Vasculitis in Children and Adults: A Retrospective Cohort Study. Mayo Clin Proc 2019; 94:1769-1780. [PMID: 31486380 DOI: 10.1016/j.mayocp.2019.04.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/12/2019] [Accepted: 04/02/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the differences in clinical characteristics and outcome between adult- and childhood-onset biopsy-proven IgA vasculitis (IgAV) in North America. PATIENTS AND METHODS Patients with IgAV diagnosed from January 1, 1997, through December 31, 2016, were retrospectively identified. Data were abstracted from direct medical record review. Kaplan-Meier methods were used to estimate survival rates. RESULTS A total of 243 patients with IgAV were included (227 [93.4%] white, 141 [58.0%] male); 174 patients were adults (≥21 years), and 69 were younger than 21 years. Compared with patients younger than 21 years, adults at baseline more frequently had ulcerative skin lesions (19 [10.9%] vs 1 [1.4%]; P=.02) and nephrotic-range proteinuria (21 of 96 [21.9%] vs 1 of 38 [2.6%]; P=.007) but less commonly had abdominal pain (59 [33.9%] vs 42 [60.9%]; P<.001), ischemic gastrointestinal tract involvement (18 [10.3%] vs 14 [20.3%]; P=.04), and arthralgias (66 [37.9%] vs 42 [60.8%]; P<.001). During 389 person-years of follow-up, 29 deaths were observed. Five-year survival rates for patients aged younger than 21, 21 to 50, and 51 years or older were 100%, 94%, and 40%, respectively. In comparison to data from the United States life tables for whites, patients 51 years or older at diagnosis had a greater than 7-fold increased risk of mortality (standardized mortality, 7.60 [95% CI, 5.01-11.06]; P<.001). CONCLUSION IgA vasculitis in adults is associated with more severe skin/kidney involvement and poorer renal outcome. Among adults with IgAV, patients aged 51 years or older at diagnosis have significantly higher mortality (P<.001).
Collapse
Affiliation(s)
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Ashima Makol
- Division of Rheumatology, Mayo Clinic, Rochester, MN
| | | | | |
Collapse
|
23
|
George R, Sathishkumar D, Udhayakumar P, Adhikari D. Pediatric cutaneous emergencies and their outcome: Study from a Tertiary Care Center in South India. Indian Dermatol Online J 2019. [DOI: 10.4103/2229-5178.261550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
24
|
Oni L, Sampath S. Childhood IgA Vasculitis (Henoch Schonlein Purpura)-Advances and Knowledge Gaps. Front Pediatr 2019; 7:257. [PMID: 31316952 PMCID: PMC6610473 DOI: 10.3389/fped.2019.00257] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/06/2019] [Indexed: 12/21/2022] Open
Abstract
Immunoglobulin A vasculitis (IgAV; formerly Henoch Schonlein Purpura) is the most common form of childhood vasculitis. It can occur in any age and peaks around 4-6 years old. It demonstrates seasonal variation implicating a role for environmental triggers and geographical variation. The diagnosis is made clinically and 95% of patients will present with a rash, together with any from a triad of other systems-gastrointestinal, musculoskeletal, and renal. Most cases of IgAV in children have an excellent outcome. Treatment may be required during the acute phase for gastrointestinal involvement and renal involvement, termed IgAV nephritis (previously HSP nephritis), is the most serious long-term manifestation accounting for ~1-2% of all childhood end stage kidney disease (ESKD). It therefore requires a period of renal monitoring conducted for 6-12 months. Patients presenting with nephrotic and/or nephritic syndrome or whom develop significant persistent proteinuria should undergo a renal biopsy to evaluate the extent of renal inflammation and there are now international consensus guidelines that outline the indications for when to do this. At present there is no evidence to support the use of medications at the outset in all patients to prevent subsequent renal inflammation. Consensus management guidelines suggest using oral corticosteroids for milder disease, oral, or intravenous corticosteroids plus azathioprine or mycophenolate mofetil or intravenous cyclophosphamide for moderate disease and intravenous corticosteroids with cyclophosphamide for severe disease. Angiotensin system inhibitors act as adjunctive treatment for persisting proteinuria and frequently relapsing disease may necessitate the use of immunosuppressant agents. Renal outcomes in this disease have remained static over time and progress may be hindered due to many reasons, including the lack of reliable disease biomarkers and an absence of core outcome measures allowing for accurate comparison between studies. This review article summarizes the current evidence supporting the management of this condition highlighting recent findings and areas of unmet need. In order to improve the long term outcomes in this condition international research collaboration is urgently required.
Collapse
Affiliation(s)
- Louise Oni
- Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Sunil Sampath
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom
| |
Collapse
|
25
|
Tracy A, Subramanian A, Adderley NJ, Cockwell P, Ferro C, Ball S, Harper L, Nirantharakumar K. Cardiovascular, thromboembolic and renal outcomes in IgA vasculitis (Henoch-Schönlein purpura): a retrospective cohort study using routinely collected primary care data. Ann Rheum Dis 2018; 78:261-269. [PMID: 30487151 DOI: 10.1136/annrheumdis-2018-214142] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND IgA vasculitis (IgAV, Henoch-Schönlein purpura) is a small-vessel vasculitis most common in children but also occurring in adults. Case series have suggested that IgAV may be associated with cardiovascular disease and venous thromboembolism, but this has not been evaluated in population-based studies. Renal disease and hypertension are possible complications of the disease with unknown incidence. METHODS Using a large UK primary care database, we conducted an open retrospective matched cohort study of cardiovascular, venous thrombotic and renal outcomes in adult-onset and childhood-onset IgAV. Control participants were selected at a 2:1 ratio, matched for age and sex. Adjusted HRs (aHRs) were calculated using Cox proportional hazards models. RESULTS 2828 patients with adult-onset IgAV and 10 405 patients with childhood-onset IgAV were compared with age-matched and sex-matched controls. There was significantly increased risk of hypertension (adult-onset aHR 1.42, 95% CI 1.19 to 1.70, p < 0.001; childhood-onset aHR 1.52, 95% CI 1.22 to 1.89, p < 0.001) and stage G3-G5 chronic kidney disease (adult-onset aHR 1.54, 95% CI 1.23 to 1.93, p < 0.001; childhood-onset aHR 1.89, 95% CI 1.16 to 3.07, p=0.010). There was no evidence of association with ischaemic heart disease, cerebrovascular disease or venous thromboembolism. All-cause mortality was increased in the adult-onset IgAV cohort compared with controls (aHR 1.27, 95% CI 1.07 to 1.50, p=0.006). CONCLUSIONS Patients with IgAV are at increased risk of hypertension and chronic kidney disease (CKD) compared with individuals without IgAV; analysis restricted to adult-onset IgAV patients showed increased mortality. Appropriate surveillance and risk factor modification could improve long-term outcomes in these patients.
Collapse
Affiliation(s)
- Alexander Tracy
- Centre for Translational Inflammation Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | | | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Charles Ferro
- Department of Renal Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Simon Ball
- Department of Renal Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Lorraine Harper
- Centre for Translational Inflammation Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | | |
Collapse
|
26
|
Huang X, Wu J, Wu XM, Hao YX, Zeng CH, Liu ZH, Tang Z. Significance of histological crescent formation in patients with IgA vasculitis (Henoch-Schönlein purpura)-related nephritis: a cohort in the adult Chinese population. BMC Nephrol 2018; 19:334. [PMID: 30466400 PMCID: PMC6249918 DOI: 10.1186/s12882-018-1117-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 10/24/2018] [Indexed: 11/14/2022] Open
Abstract
Background IgA vasculitis (IgAV, formerly Henoch-Schönlein purpura) is a type of systemic vasculitis. This study aimed to explore the clinicopathological features, treatment and renal outcomes of adult IgAV-related nephritis (Henoch-Schönlein purpura nephritis) patients with different degrees of crescent formation. Methods Adult patients with biopsy-proven IgAV-related nephritis in Nanjing Jinling Hospital were enrolled and divided into three groups as follows: control (no crescents, n = 257), group 1 (crescents < 25%, n = 381), and group 2 (crescents ≥25%, n = 60). The clinicopathological features, treatment and renal outcomes were compared among the three groups. Results There were no significant differences in gender and age at biopsy among the three groups. Groups with more crescents had shorter renal durations and higher prevalence of macroscopic hematuria, proteinuria and nephrotic syndrome than the control group. The presence of renal insufficiency at biopsy was similar, whereas laboratory findings indicated that patients with ≥25% crescents had higher levels of serum creatinine and blood urea nitrogen than the control and group 1. Histologically, the incidence of glomeruli-Bowman’s capsule adhesion and capillary necrosis were proportional to the degree of crescent formation. Patients with more crescents received more positive immunosuppressive therapies. During follow-up, the levels of proteinuria and hematuria were in remission after treatment, and patients without crescents had lower levels of proteinuria. At the last follow-up, the renal function had deteriorated in the control and group 1, whereas the levels of serum creatinine at biopsy and last follow-up were similar in group 2. There was a significant difference in renal survival from end-stage renal disease (ESRD) or 50% decline in renal function among the three groups (log-rank, P = 0.030). However, no association between crescent formation and renal outcomes was found after adjusting potential confounders. Conclusions Adult IgAV-related nephritis patients with more crescents had more-severe renal manifestations and worse treatment responses, whereas the proportions of crescents were not associated with higher risks for ESRD or 50% decline in renal function. A more suitable pathological classification standard is needed to predict renal prognosis.
Collapse
Affiliation(s)
- Xiao Huang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Republic of China
| | - Jing Wu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Republic of China
| | - Xiao-Mei Wu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Republic of China
| | - Ya-Xin Hao
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Republic of China
| | - Cai-Hong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Republic of China
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Republic of China
| | - Zheng Tang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Republic of China.
| |
Collapse
|
27
|
Koshiba K, Muraoka S, Nanki T, Komatsumoto S. Successful Treatment of IgA Vasculitis Complicated with Bowel Perforation and Crescentic Glomerulonephritis by Combination Therapy of Glucocorticoid, Cyclosporine and Factor XIII Replacement. Intern Med 2018; 57:3035-3040. [PMID: 29877285 PMCID: PMC6232042 DOI: 10.2169/internalmedicine.0931-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We report the findings of an 18-year-old boy with immunoglobulin A vasculitis (IgAV) complicated with bowel perforation and nephritis. He presented with abdominal pain, arthralgia and palpable purpura. Massive proteinuria developed during his clinical course. The patient was treated successfully using combination therapy of glucocorticoid (GC), cyclosporine (CYA) and factor XIII (F XIII) replacement. A standard treatment strategy for severe IgAV patients has not been established due to its rarity. Combination therapy using GC, CYA and F XIII replacement should be considered for severe IgAV patients.
Collapse
Affiliation(s)
- Keiko Koshiba
- Department of Internal Medicine, Japanese Red Cross Ashikaga Hospital, Japan
| | - Sei Muraoka
- Department of Internal Medicine, Japanese Red Cross Ashikaga Hospital, Japan
- Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Japan
| | - Toshihiro Nanki
- Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Japan
| | - Satoru Komatsumoto
- Department of Internal Medicine, Japanese Red Cross Ashikaga Hospital, Japan
| |
Collapse
|
28
|
Wang K, Sun X, Cao Y, Dai L, Sun F, Yu P, Dong L. Risk factors for renal involvement and severe kidney disease in 2731 Chinese children with Henoch-Schönlein purpura: A retrospective study. Medicine (Baltimore) 2018; 97:e12520. [PMID: 30235770 PMCID: PMC6160025 DOI: 10.1097/md.0000000000012520] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To identify the risk factors for developing renal involvement and severe kidney disease in Chinese childhood Henoch-Schönlein purpura (HSP) patients.This was a retrospective study of 2731 children with HSP diagnosed between 2012 and 2015. We analyzed their demographic data, clinical manifestations, and laboratory tests retrospectively. Multivariate logistic regression analysis was used to assess the risk factors.Renal involvement occurred in 844 HSP patients (35.60%), and severe kidney disease occurred in 104 HSP patients (4.39%). Age over 6 years old at onset, colder season, more than 8 days interval between symptom onset and diagnosis, residence in rural, recurrence, angioedema, and the central nervous system (CNS) involvement were the significant risk factors for renal involvement. At the same time, age over 6 years at onset, more than 8 days interval between symptom onset and diagnosis, recurrence, angioedema, and CNS involvement were highly associated with severe kidney disease. Angioedema, longer interval between symptom onset and diagnosis, older age at HSP onset, and recurrence are prognostic indicators for renal involvement and severe kidney disease in children with HSP. The onset in colder season and rural residence associated with an increased risk for renal involvement, and the CNS involvement had an increased risk for severe kidney disease.HSP tends not to be self-limiting, and could progress into renal involvement or severe kidney disease for some of the HSP patients. Pediatricians should pay more attention to the children diagnosed with HSP, who also have these risk factors, for potential to develop renal involvement, and severe kidney disease, especially.
Collapse
Affiliation(s)
- Ke Wang
- Department of Pediatrics
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | | | | | | | | | - Ping Yu
- Department of Pediatrics
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Liqun Dong
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| |
Collapse
|
29
|
Maxfield L, Peck A, Youngblood LB. Adult Henolch-Schonlein purpura: multiorgan failure in the setting of a purpuric rash. BMJ Case Rep 2018; 2018:bcr-2018-224816. [DOI: 10.1136/bcr-2018-224816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
30
|
Insight into inflammatory cell and cytokine profiles in adult IgA vasculitis. Clin Rheumatol 2018; 38:331-338. [PMID: 30073458 DOI: 10.1007/s10067-018-4234-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022]
Abstract
Immunoglobulin A vasculitis (IgAV) is an immune complex, small vessel vasculitis with dominant IgA deposits in vessel walls, predominantly affecting the pediatric population. However, adults frequently have more severe gastrointestinal tract (GIT) and renal involvements as compared to children. Our aim was to study serological and cellular biomarkers to support clinicians in their diagnosis and the course of IgAV in adult patients. This cross-sectional study included 62 adult IgAV patients and 53 healthy blood donors (HBDs). Demographic and clinical data, as well as routine laboratory tests, were meticulously analyzed. Serum levels of IL-1β, IL-2, IL-6, IL-8, IL-9, IL-10, IL-17A, IL-23, TNF-α and serum amyloid A (SAA) were measured. Percentages of neutrophils, lymphocytes, and monocytes with neutrophil expression of L-selectin and integrin αM were determined by flow cytometry. SAA (12-fold), IL-6 (3-fold), IL-8 (2-fold), and TNF-α (2-fold) were significantly elevated in sera of adult IgAV patients compared to HBDs. There was a 16% elevation in neutrophils in IgAV patients, with IgAV neutrophils showing significantly higher CD62L surface expression. IgAV patients with GIT involvement exhibited elevated numbers of leukocytes, neutrophils, and neutrophil/lymphocyte (NLR), but lower neutrophil CD11b expression, as compared to IgAV patients without GIT. IgAV patients exhibit a low-medium grade inflammatory, neutrophil-driven response. Patients with GIT can be distinguished by their elevated NLR.
Collapse
|
31
|
Lava SAG, Milani GP, Fossali EF, Simonetti GD, Agostoni C, Bianchetti MG. Cutaneous Manifestations of Small-Vessel Leukocytoclastic Vasculitides in Childhood. Clin Rev Allergy Immunol 2018; 53:439-451. [PMID: 28836099 DOI: 10.1007/s12016-017-8626-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In childhood, cutaneous small-vessel vasculitides include Henoch-Schönlein syndrome, a systemic vasculitis, and Finkelstein-Seidlmayer syndrome, a skin-limited vasculitis. Both Henoch-Schönlein and Finkelstein-Seidlmayer syndromes are seen more frequently in white or Asian compared with black children and occur especially in winter and spring with a male-to-female ratio of approximately 2:1. In everyday clinical practice, both conditions are diagnosed on clinical grounds without histological confirmation. The characteristic cutaneous hallmarks of Henoch-Schönlein syndrome include a purpuric rash in all and a subcutaneous edema in approximately every second case, which are often preceded by non-specific red or pink macular elements that mimic a non-itching urticarial rash. Recent data point out that Henoch-Schönlein children often present further cutaneous findings such as Köbnerization, Rumpel-Leede capillary fragility phenomenon, and blistering eruptions. Children with Finkelstein-Seidlmayer syndrome are usually ≤24 months of age and not ill-appearing. They present with (a) large, round, red to purpuric plaques (often with a targetoid appearance) predominantly over the cheeks, ears, and extremities and (b) often tender non-pitting edema of the distal extremities, ears, and face (without pruritus). Both in Henoch-Schönlein syndrome and Finkelstein-Seidlmayer syndrome, there is often scrotal involvement. The cutaneous findings remit without sequelae within 2 months in Henoch-Schönlein and 3 weeks in Finkelstein-Seidlmayer syndrome.
Collapse
Affiliation(s)
- Sebastiano A G Lava
- Department of Pediatrics, University Children's Hospital of Bern, Inselspital, Bern, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Emilio F Fossali
- Pediatric Emergency Department, Università degli Studi di Milano, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo D Simonetti
- Pediatric Department of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
- Università della Svizzera Italiana, Lugano, Switzerland
| | - Carlo Agostoni
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Mario G Bianchetti
- Pediatric Department of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland.
- Università della Svizzera Italiana, Lugano, Switzerland.
| |
Collapse
|
32
|
Batu ED, Sarı A, Erden A, Sönmez HE, Armağan B, Kalyoncu U, Karadağ Ö, Bilginer Y, Akdoğan A, Kiraz S, Özen S. Comparing immunoglobulin A vasculitis (Henoch-Schönlein purpura) in children and adults: a single-centre study from Turkey. Scand J Rheumatol 2018; 47:481-486. [PMID: 29912602 DOI: 10.1080/03009742.2018.1448111] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Immunoglobulin A vasculitis/Henoch-Schönlein purpura (IgAV/HSP) is a systemic vasculitis involving small vessels with the deposition of immune complexes containing IgA. It is the most common primary systemic vasculitis of childhood and is much less common in adults. Our aim was to investigate the differences and similarities between adult and paediatric patients with IgAV/HSP. METHOD We retrospectively evaluated the medical records of 35 adult and 159 paediatric (˂ 18 years old) patients with a clinical diagnosis of IgAV/HSP who were seen at the Departments of Rheumatology and Pediatric Rheumatology, Hacettepe University, Ankara, Turkey. The paediatric and adult patients were classified with IgAV/HSP according to the Ankara 2008 and American College of Rheumatology 1990 criteria, respectively. RESULTS Upper respiratory tract infection was a common predisposing factor for both adults (34.3%) and children (21.4%). Creatinine and C-reactive protein were higher; and skin biopsy, hypertension, renal involvement, haematuria, proteinuria, and renal insufficiency at diagnosis were more frequent in adults than in children. Thrombocyte count was higher in children than in adults. Follow-up without treatment and complete recovery were more frequent in children, while persistent haematuria, chronic renal failure, relapse, and the use of corticosteroids/azathioprine were more frequent in adults. The only independent predictive factor for relapse was persistent haematuria. CONCLUSION Various clinical and laboratory characteristics differ between children and adults with IgAV/HSP. Overall, IgAV/HSP has a self-limiting course in children but represents a more severe form of disease in adults, with more severe renal involvement. Persistent haematuria is a predictive factor for relapse.
Collapse
Affiliation(s)
- E D Batu
- a Division of Rheumatology, Department of Pediatrics , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - A Sarı
- b Division of Rheumatology, Department of Internal Medicine , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - A Erden
- b Division of Rheumatology, Department of Internal Medicine , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - H E Sönmez
- a Division of Rheumatology, Department of Pediatrics , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - B Armağan
- b Division of Rheumatology, Department of Internal Medicine , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - U Kalyoncu
- b Division of Rheumatology, Department of Internal Medicine , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Ö Karadağ
- b Division of Rheumatology, Department of Internal Medicine , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Y Bilginer
- a Division of Rheumatology, Department of Pediatrics , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - A Akdoğan
- b Division of Rheumatology, Department of Internal Medicine , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - S Kiraz
- b Division of Rheumatology, Department of Internal Medicine , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - S Özen
- a Division of Rheumatology, Department of Pediatrics , Hacettepe University Faculty of Medicine , Ankara , Turkey
| |
Collapse
|
33
|
Zhang N, Guo PJ, Liu PL, Yang HR, Xiao J, Li XP, Huang JB, Zheng YZ. [Comparison of age-based clinical and abnormal immune parameters in patients with Henoch-Schönlein purpura]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 38:60-64. [PMID: 28219228 PMCID: PMC7348411 DOI: 10.3760/cma.j.issn.0253-2727.2017.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: To explore age-based clinical and immune parameters in Henoch-Schönlein purpura (HSP) to determine clinically useful markers reflecting disease characteristic. Methods: A cohort of 502 patients with HSP were enrolled into this retrospective study to evaluate their clinical and immune data. Results: Majority HSP cases occurred at age ≤14 years and showed significant immune imbalances of ESR, CD3(+) cells, CD4(+) cells, CD3(-)CD16(+)CD56(+) cells, CD4(+)/CD8(+) cells, IgG, IgA, IgM, IgE, complements C3/C4 and ASO in the acute phase. Compared to patients aged >14 years, symptoms of joint were more frequent at disease onset in patients aged ≤14 years (20.8% vs 7.6%, χ(2)=13.547, P<0.001) , and involvement of digestive tract and joint were also more frequent (57.4% vs 33.8%, χ(2)=24.106, P<0.001; 55.9% vs 32.5%, χ(2)=23.768, P<0.001, respectively) , but not for involvement of kidney (21.4% vs 51.3%, χ(2)=42.440, P<0.001) . The patients aged ≤14 years had distinct immune state, reductions of CD3(+) cells, CD4(+) cells and IgG were more frequent than patients aged >14 years, also increase of ASO (33.1% vs 20.0%, χ(2)=6.656, P=0.010) , but not increase of IgA (2.6% vs 39.4%, χ(2)=15.582, P<0.001) . In addition, reduction of IgG and increase of IgE were positively associated with digestive tract involvement (P<0.001, P=0.001, respectively) , reduction of CD3(+)CD4(+) cells and normal IgM were positively associated with joint involvement (P=0.004, P=0.003, respectively) , increase of CD3(+)CD8(+) cells and normal CD3(+) cells were positively associated with kidney involvement (P=0.032, P=0.014, respectively) . Conclusion: HSP showed significant immune imbalance in the acute phase, patients between aged ≤14 and >14 years had distinct clinical and immune characteristic, and abnormal immune parameters were significantly associated with organ involvements.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Y Z Zheng
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| |
Collapse
|
34
|
Renal Prognosis and Related Risk Factors for Henoch-Schönlein Purpura Nephritis: A Chinese Adult Patient Cohort. Sci Rep 2018; 8:5585. [PMID: 29615640 PMCID: PMC5882881 DOI: 10.1038/s41598-018-23638-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/07/2018] [Indexed: 12/26/2022] Open
Abstract
This study investigated the clinicopathological characteristics of Henoch-Schönlein purpura nephritis (HSPN) in Chinese adult patients and analyzed the renal outcomes and prognostic risk factors for progression to end-stage renal disease (ESRD). Adult patients who had biopsy-proven HSPN were studied. Their clinicopathological data, renal prognoses and related risk factors were assessed. A total of 698 patients were studied, including 363 men (52.0%) and 335 women (48.0%). Most of the patients had hematuria (85.8%) and/or proteinuria (82.1%). During a median follow-up of 54.0 months, 32 patients (4.6%) progressed to ESRD. The 5- and 10-year cumulative renal survival rates from ESRD were 96.4% and 88.6%, respectively. Baseline urinary protein, renal insufficiency, glomerular sclerosis and tubular atrophy/interstitial fibrosis were independent predictors of renal outcomes. Both the time-average mean arterial pressure and proteinuria during follow-up also influenced the renal prognosis. The patients with a time-average proteinuria <0.4 g/day had the lowest rates of ESRD or a 50% decline in renal function. In conclusion, identifying of clinical and histological prognostic factors may permit the prediction of renal outcomes. The optimal goal of therapy for HSPN patients may be to lower proteinuria to <0.4 g/day and control hypertension to achieve an ideal renal outcome.
Collapse
|
35
|
Akizue N, Suzuki E, Yokoyama M, Inoue M, Wakamatsu T, Saito T, Kusakabe Y, Ogasawara S, Ooka Y, Tawada A, Maru Y, Matsue H, Chiba T. Henoch-Schönlein Purpura Complicated by Hepatocellular Carcinoma. Intern Med 2017; 56:3041-3045. [PMID: 28943572 PMCID: PMC5725858 DOI: 10.2169/internalmedicine.8885-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Although Henoch-Schönlein purpura (HSP) is known to be accompanied by malignancies, cases with hepatobiliary cancer are extremely rare. A 62-year-old man with palpable purpura rapidly extending to both lower legs was admitted to our hospital. He was undergoing follow-up for cirrhosis caused by chronic hepatitis B virus infection and hepatocellular carcinoma (HCC). He had renal dysfunction with hematuria and proteinuria and abdominal pain. Based on the clinical presentation and skin biopsy findings, he was diagnosed with HSP. The administration of steroids resulted in the rapid improvement of the patient's symptoms and he was discharged 12 days after admission.
Collapse
Affiliation(s)
- Naoki Akizue
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Japan
| | - Eiichiro Suzuki
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Japan
| | - Masayuki Yokoyama
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Japan
| | - Masanori Inoue
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Japan
| | - Toru Wakamatsu
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Japan
| | - Tomoko Saito
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Japan
| | - Yuko Kusakabe
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Japan
| | - Akinobu Tawada
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Japan
| | - Yugo Maru
- Department of Dermatology, Graduate School of Medicine, Chiba University, Japan
| | - Hiroyuki Matsue
- Department of Dermatology, Graduate School of Medicine, Chiba University, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Japan
| |
Collapse
|
36
|
Gupta V, Aggarwal A, Gupta R, Chandra Chowdhury A, Agarwal V, Lawrence A, Misra R. Differences between adult and pediatric onset Henoch-Schonlein purpura from North India. Int J Rheum Dis 2017; 21:292-298. [PMID: 29115055 DOI: 10.1111/1756-185x.13221] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Henoch-Schönlein purpura (HSP), a primary vasculitis, characterized by purpura, abdominal pain, arthritis and renal involvement, is predominantly a disease of childhood. However, rarely it can occur in adults in whom it is believed to be a more severe form with poor renal outcomes. We aimed to answer if the age of onset affected the clinical spectrum and renal outcomes of the disease in a north Indian population. Hence, we studied the differences in clinical spectrum and renal outcomes between adult-onset HSP and childhood-onset HSP. METHODS Case records of all adult patients diagnosed with HSP (onset ≥ 18 years) over the last 25 years in our department (1992-2017) were retrieved. Data on clinical features, lab abnormalities and outcomes were extracted and compared with that in pediatric HSP patients (onset < 18 years) seen during the same period. RESULTS A total of 87 patients, including 30 adults and 57 children, were seen during this period. Compared to children, most of the adults had purpura as the first clinical manifestation (86.7% vs. 56.1%, P < 0.01) whereas abdominal pain was only rarely the initial symptom in adults (10.0% vs. 36.8%, P < 0.02). During the disease course, adults had a higher frequency of joint involvement as compared to children (90.0% vs. 43.9%, P < 0.001). There was no significant difference in the frequency of renal involvement (60.0% vs. 50.9%, P = NS) and gastrointestinal involvement (66.7% vs. 84.2%, P = NS) between adults and children. Outcomes were good in both groups and most adults and children achieved complete recovery (83.3% and 86.0%, respectively). There was no difference in the frequency of immunosuppressive treatment required by the two groups. None of the patients developed renal insufficiency on follow-up. CONCLUSION Compared to children, adults with HSP seldom have abdominal pain as the first clinical manifestation while joint involvement is seen more commonly in them during the disease course.
Collapse
Affiliation(s)
- Vikas Gupta
- Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Amita Aggarwal
- Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Ranjan Gupta
- Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Abhra Chandra Chowdhury
- Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Vikas Agarwal
- Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Able Lawrence
- Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Ramnath Misra
- Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| |
Collapse
|
37
|
Audemard-Verger A, Terrier B, Dechartres A, Chanal J, Amoura Z, Le Gouellec N, Cacoub P, Jourde-Chiche N, Urbanski G, Augusto JF, Moulis G, Raffray L, Deroux A, Hummel A, Lioger B, Catroux M, Faguer S, Goutte J, Martis N, Maurier F, Rivière E, Sanges S, Baldolli A, Costedoat-Chalumeau N, Roriz M, Puéchal X, André M, Lavigne C, Bienvenu B, Mekinian A, Zagdoun E, Girard C, Bérezné A, Guillevin L, Thervet E, Pillebout E. Characteristics and Management of IgA Vasculitis (Henoch-Schönlein) in Adults: Data From 260 Patients Included in a French Multicenter Retrospective Survey. Arthritis Rheumatol 2017; 69:1862-1870. [DOI: 10.1002/art.40178] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 06/08/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Alexandra Audemard-Verger
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes; Paris France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes; Paris France
| | - Agnès Dechartres
- Center for Clinical Epidemiology, Hôtel Dieu, AP-HP; Paris France
| | - Johan Chanal
- Department of Dermatology, Hôpital Tarnier, AP-HP; Paris France
| | - Zahir Amoura
- Department of Internal Medicine, Hôpital Pitié-Salpétrière, AP-HP; Paris France
| | - Noémie Le Gouellec
- Department of Internal Medicine and Nephrology, Centre Hospitalier de Valenciennes; Valenciennes France
| | - Patrice Cacoub
- Department of Internal Medicine, Hôpital Pitié-Salpétrière, AP-HP; Paris France
| | | | - Geoffrey Urbanski
- Department of Internal Medicine and Vascular Disease, Centre Hospitalier Universitaire d'Angers; Angers France
| | | | - Guillaume Moulis
- Department of Internal Medicine, Centre Hospitalier Universitaire de Toulouse; Toulouse France
| | - Loic Raffray
- Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion; Réunion France
| | - Alban Deroux
- Department of Internal Medicine, Centre Hospitalier Universitaire de Grenoble; Grenoble France
| | - Aurélie Hummel
- Department of Nephrology, Hôpital Necker, AP-HP; Paris France
| | - Bertrand Lioger
- Department of Internal Medicine, Centre Hospitalier Universitaire de Tours; Tours France
| | - Mélanie Catroux
- Department of Internal Medicine, Centre Hospitalier Universitaire de Poitiers; Poitiers France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire de Toulouse; Toulouse France
| | - Julie Goutte
- Department of Internal Medicine, Centre Hospitalier Universitaire de St. Etienne; St. Etienne France
| | - Nihal Martis
- Department of Internal Medicine, Centre Hospitalier Universitaire de Nice; Nice France
| | - François Maurier
- Department of Internal Medicine, Hôpitaux Privés de Metz; Metz France
| | - Etienne Rivière
- Department of Internal Medicine, Centre Hospitalier Universitaire de Bordeaux; Bordeaux France
| | - Sébastien Sanges
- Centre Hospitalier Universitaire Lille, Département de Médecine Interne et Immunologie Clinique; Lille France
| | - Aurélie Baldolli
- Department of Internal Medicine, Centre Hospitalier Universitaire de Caen; Caen France
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes; Paris France
| | - Mélanie Roriz
- Department of Internal Medicine, Centre Hospitalier Universitaire de Tours; Tours France
| | - Xavier Puéchal
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes; Paris France
| | - Marc André
- Department of Internal Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand; Clermont-Ferrand France
| | - Christian Lavigne
- Department of Internal Medicine and Vascular Disease, Centre Hospitalier Universitaire d'Angers; Angers France
| | - Boris Bienvenu
- Department of Internal Medicine, Centre Hospitalier Universitaire de Caen; Caen France
| | - Arsène Mekinian
- Department of Internal Medicine, Hôpital de Bondy, AP-HP; Paris France
| | - Elie Zagdoun
- Department of Nephrology, Centre Hospitalier de St. Lo; St. Lo France
| | - Charlotte Girard
- Department of Internal Medicine, Centre Hospitalier Universitaire de Lyon; Lyon France
| | - Alice Bérezné
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes; Paris France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes; Paris France
| | - Eric Thervet
- Department of Nephrology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes; Paris France
| | - Evangéline Pillebout
- Department of Nephrology, Hôpital Saint Louis, AP-HP, Université Paris Descartes; Paris France
| | | |
Collapse
|
38
|
Hemorragia pulmonar en paciente con nefropatía IgA. Nefrologia 2017. [DOI: 10.1016/j.nefro.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
39
|
Nagy GR, Kemény L, Bata-Csörgő Z. Neutrophil-to-lymphocyte ratio: a biomarker for predicting systemic involvement in adult IgA vasculitis patients. J Eur Acad Dermatol Venereol 2017; 31:1033-1037. [PMID: 28222228 DOI: 10.1111/jdv.14176] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/06/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND IgA vasculitis (IgAV) is a small-vessel leucocytoclastic cutaneous vasculitis, often associated with kidney and gastrointestinal (GI) manifestations. Although predictive factors for systemic involvement have been extensively studied in children, there is paucity in the literature regarding adult patients. Neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker, used to assess systemic inflammation in various diseases. OBJECTIVE We sought to evaluate whether NLR can be used for predicting renal and GI involvement in adult IgA vasculitis patients. METHODS This was a retrospective review of adult patients who were diagnosed with IgAV at our institution between 2004 and 2016. RESULTS A total of 40 patients met our inclusion criteria. Half of the enrolled patients had clinical symptoms suggestive of systemic involvement, of which 6 (15%) had only renal, 3 (7.5%) had only GI and 11 (27.5%) had both renal and GI involvement. Pretreatment NLR was significantly associated with renal and/or GI manifestations of the disease (P < 0.001). The optimal cut-off value of NLR, for predicting systemic involvement was 3.34, with a specificity of 95% and a sensitivity of 85%. In addition, pretreatment NLR was also found to be significantly correlated with the severity of the systemic manifestations of IgAV (P = 0.022). CONCLUSION This study suggests that NLR is a potential indicator for prognosticating systemic involvement in adult IgAV.
Collapse
Affiliation(s)
- G R Nagy
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - L Kemény
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Z Bata-Csörgő
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| |
Collapse
|
40
|
Shin SB, Choi YJ, Lee J, Kwak BG, Kim YH, Ha KS, Kang JH. Henoch-Schönlein Purpura with Concurrent Cytomegalovirus Duodenitis. Infect Chemother 2017; 49:146-150. [PMID: 28271648 PMCID: PMC5500272 DOI: 10.3947/ic.2017.49.2.146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/01/2016] [Indexed: 12/05/2022] Open
Abstract
Henoch-Schönlein purpura (HSP) is a systemic vasculitis involving the small vessels with distinct clinical features. The etiology of HSP is diverse, and viral infection is one of the many predisposing factors. Cytomegalovirus (CMV) infection mostly affects immune-suppressed patients, but rarely patients with normal immunity can also be affected. Authors experienced a case of HSP patient, with underlying small-cell lung cancer (SCLC) with CMV duodenitis. This is a rare case of HSP diagnosed in SCLC patient with predisposing factor of CMV infection.
Collapse
Affiliation(s)
- Sae Bom Shin
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yeong Jin Choi
- Department of Pathology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jieun Lee
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
| | - Bong Gye Kwak
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yong Hee Kim
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kyung Sun Ha
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jin Hyoung Kang
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
41
|
Calvo-Río V, Hernández JL, Ortiz-Sanjuán F, Loricera J, Palmou-Fontana N, González-Vela MC, González-Lamuño D, González-López MA, Armesto S, Blanco R, González-Gay MA. Relapses in patients with Henoch-Schönlein purpura: Analysis of 417 patients from a single center. Medicine (Baltimore) 2016; 95:e4217. [PMID: 27428226 PMCID: PMC4956820 DOI: 10.1097/md.0000000000004217] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To further investigate into the relapses of Henoch-Schönlein purpura (HSP), we analyzed the frequency, clinical features, and predictors of relapses in series of 417 unselected patients from a single center. After a median follow-up of 12 (interquartile range [IQR]: 2-38) years, almost one-third of the 417 patients (n = 133; 32%; 85 men/48 women) had experienced at least 1 relapse. At the time of disease diagnosis, patients who later experienced relapses had less commonly infections than those who never suffered flares (30.8% vs 41.9%; P = 0.03). In contrast, patients who experienced relapses had a longer duration of the first episode of palpable purpura than those without relapses (palpable purpura lasting >7 days; 80.0% vs 68.1%; P = 0.04). Abdominal pain (72.3% vs 62.3%; P = 0.03) and joint manifestations (27.8% vs 15.5%; P = 0.005) were also more common in patients who later developed relapses. In contrast, patients who never suffered relapses had a slightly higher frequency of fever at the time of disease diagnosis (9.3% vs 3.8%; P = 0.06). At the time of disease diagnosis, corticosteroids were more frequently given to patients who later had relapses of the disease (44% vs 32% in nonrelapsing patients; P = 0.03). Relapses generally occurred soon after the first episode of vasculitis. The median time from the diagnosis of HSP to the first relapse was 1 (IQR: 1-2) month. The median number of relapses was 1 (IQR 1-3). The main clinical features at the time of the relapse were cutaneous (88.7%), gastrointestinal (27.1%), renal (24.8%), and joint (16.5%) manifestations. After a mean ± standard deviation follow-up of 18.9 ± 9.8 years, complete recovery was observed in 110 (82.7%) of the 133 patients who had relapses. Renal sequelae (persistent renal involvement) was found in 11 (8.3%) of the patients with relapses. The best predictive factors for relapse were joint and gastrointestinal manifestations at HSP diagnosis (odds ratio [OR]: 2.22; 95% confidence interval [CI]: 1.34-3.69, and OR: 1.60; 95% CI: 1.01-2.53, respectively). In contrast, a history of previous infection was a protective factor for relapses (OR: 0.60; 95% CI: 0.38-0.94). In conclusion, joint and gastrointestinal manifestations at the time of diagnosis of HSP are predictors of relapses.
Collapse
Affiliation(s)
- Vanesa Calvo-Río
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria
| | - José Luis Hernández
- Division of Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria
| | - Francisco Ortiz-Sanjuán
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria
| | - Javier Loricera
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria
| | - Natalia Palmou-Fontana
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria
| | - Maria C. González-Vela
- Division of Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria
| | - Domingo González-Lamuño
- Division of Pediatrics, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria
| | - Marcos A. González-López
- Division of Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Susana Armesto
- Division of Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Ricardo Blanco
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria
- Correspondence: Miguel A. González-Gay, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda, Valdecilla s/n, ES-39008 Santander, Spain (e-mail: ); Ricardo Blanco, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda, Valdecilla s/n, ES-39008 Santander, Spain (e-mail: )
| | - Miguel A. González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria
- Correspondence: Miguel A. González-Gay, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda, Valdecilla s/n, ES-39008 Santander, Spain (e-mail: ); Ricardo Blanco, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda, Valdecilla s/n, ES-39008 Santander, Spain (e-mail: )
| |
Collapse
|
42
|
Clinical manifestations of Henoch-Schönlein purpura nephritis and IgA nephropathy: comparative analysis of data from the Japan Renal Biopsy Registry (J-RBR). Clin Exp Nephrol 2015; 20:552-560. [PMID: 26456327 PMCID: PMC4956699 DOI: 10.1007/s10157-015-1177-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/30/2015] [Indexed: 11/26/2022]
Abstract
Background The clinical presentation of Henoch–Schönlein purpura nephritis (HSPN) has not been thoroughly investigated among patients of different ages. We therefore compared the features of HSPN and IgA nephropathy (IgAN) based on data from the Japan Renal Biopsy Registry (J-RBR). Methods This cross-sectional study analyzed data from patients who were registered in the J-RBR between 2007 and 2012. Clinico-pathological findings at diagnosis were compared among children (aged ≤18 years), adult (aged 19–64 years) and elderly (aged ≥65 years) patients with HSPN (n = 513) and IgAN (n = 5679). Results The age at diagnosis considerably differed between HSPN and IgAN; HSPN peaked at 1–19 and at 60–69 years, whereas IgAN peaked at 30–39 years. The clinical features were significantly more severe for HSPN than IgAN, especially proteinuria (children, 1.28 vs. 0.57; adult, 1.95 vs. 1.05; elderly patients, 2.71 vs. 1.64 g/day), and low albumin levels (children, 3.72 vs. 4.13; adults, 3.62 vs. 3.99; elderly patients, 3.07 vs. 3.57 g/dL). The rate (%) of histologically classified endocapillary proliferative or crescentic glomerulonephritis was higher in patients with HSPN than with IgAN. Multiple regression analysis revealed that low albumin level and high BP were independent factors associated with decreased estimated glomerular filtration rates in adult and elderly patients with HSPN. Conclusions Age at HSPN diagnosis was bimodally distributed, and the clinical features of HSPN were more severe than those of IgAN across all age groups.
Collapse
|
43
|
Bellan M, Pirisi M, Sainaghi PP. Long-term remission of corticosteroid- and cyclophosphamide-resistant Henoch-Schönlein purpura with rituximab. Scand J Rheumatol 2015; 45:83-84. [PMID: 26312648 DOI: 10.3109/03009742.2015.1058417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M Bellan
- a Department of Translational Medicine , University of Piemonte Orientale , Novara , Italy.,b Division of Internal Medicine, Immunology and Rheumatology Unit , Maggiore della Carità Hospital , Novara , Italy
| | - M Pirisi
- a Department of Translational Medicine , University of Piemonte Orientale , Novara , Italy.,b Division of Internal Medicine, Immunology and Rheumatology Unit , Maggiore della Carità Hospital , Novara , Italy.,c Interdisciplinary Research Centre of Autoimmune Diseases (IRCAD) , Novara , Italy
| | - P P Sainaghi
- b Division of Internal Medicine, Immunology and Rheumatology Unit , Maggiore della Carità Hospital , Novara , Italy.,c Interdisciplinary Research Centre of Autoimmune Diseases (IRCAD) , Novara , Italy
| |
Collapse
|
44
|
Spencer CH, Patwardhan A. Pediatric Rheumatology for the Primary Care Clinicians-Recognizing Patterns of Disease. Curr Probl Pediatr Adolesc Health Care 2015. [PMID: 26205101 DOI: 10.1016/j.cppeds.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This review presents a diagnostic approach to musculoskeletal and rheumatic diseases in children for primary care clinicians. The focus is on juvenile idiopathic arthritis (JIA) as the major arthritis disease in children. It is necessary to know the personalities of these JIA categories. It is also crucial to be able to recognize the common infectious, orthopedic and mechanical, malignant, genetic, other rheumatic diseases, and other miscellaneous syndromes that can mimic JIA. To do so requires recognition of clinical patterns using a thorough musculoskeletal and rheumatic history and repeated complete physical exams with emphasis on the musculoskeletal exam. It also requires targeted and limited laboratory testing with careful follow-up over time.
Collapse
|
45
|
Terraneo L, Lava SA, Camozzi P, Zgraggen L, Simonetti GD, Bianchetti MG, Milani GP. Unusual Eruptions Associated with Mycoplasma pneumoniae Respiratory Infections: Review of the Literature. Dermatology 2015; 231:152-7. [DOI: 10.1159/000430809] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/18/2015] [Indexed: 11/19/2022] Open
|
46
|
Lu S, Liu D, Xiao J, Yuan W, Wang X, Zhang X, Zhang J, Liu Z, Zhao Z. Comparison between adults and children with Henoch-Schönlein purpura nephritis. Pediatr Nephrol 2015; 30:791-6. [PMID: 25481021 DOI: 10.1007/s00467-014-3016-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Henoch-Schönlein purpura (HSP) mainly affects children, but age is also thought to be an important prognostic factor. Kidney involvement is a major cause of mortality in HSP patients. The purpose of this study was to analyze the clinicopathological correlations between adults and children. METHODS A total of 208 children and 75 adult patients with HSP nephritis (HSPN) were evaluated. All patients underwent a renal biopsy. RESULTS Extra-renal symptoms (arthritis and abdominal pain) were more common in the pediatric patient group than in the adult group (P < 0.05), but renal symptoms (edema and hypertension) were relatively rare (P < 0.05). A significant positive correlation was noted between pathological type and clinical type (P < 0.01). Pathological activity was positively related to renal failure, abdominal pain, microscopic hematuria, hypertension, and proteinuria (P < 0.05). Pathological chronicity was positively associated with age, duration of follow-up since the onset of palpable purpura, renal failure, lower extremity edema, hypertension, and proteinuria (P < 0.05). CONCLUSIONS Various clinicopathological differences exist between children and adults with HSPN. Massive proteinuria, renal failure, and abdominal pain usually correlated with severe pathology. Renal biopsy should be performed in both pediatric and adult HSPN patients with repeated hematuria and/or consistent minimal proteinuria.
Collapse
Affiliation(s)
- Shan Lu
- Department of Nephrology, First Affiliated Hospital of Zhengzhou University, No.1, JianShe East Road, Zhengzhou, Henan Province, The People's Republic of China
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Pulmonary hemorrhage associated with Henoch-Schöenlein purpura in an adult patient primary diagnosed of IgA nephropathy. CEN Case Rep 2015; 4:48-54. [PMID: 28509268 DOI: 10.1007/s13730-014-0138-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 07/14/2014] [Indexed: 10/25/2022] Open
Abstract
We describe a case of IgA nephropathy (IgAN) followed by pulmonary hemorrhage associated with Henoch-Schöenlein purpura (HSP) in an adult female. The patient had a history of renal insufficiency and persistent hematuria and proteinuria, without any extra-renal involvement. She was diagnosed with IgAN 7 years before the onset of HSP and had received immunosuppressive therapy for 6 years. One year after discontinuing oral prednisolone and mizoribine, she suffered a pulmonary hemorrhage. She presented with exacerbated urinary findings, and palpable purpura, resulting in the diagnosis of HSP. Intravenous pulse methylprednisolone followed by oral prednisolone (1 mg/kg/day) and a monthly intravenous cyclophosphamide pulse resolved the pulmonary hemorrhage. In a review of 36 HSP patients complicated with pulmonary hemorrhage, 27.8 % of the patients perished [Rajagopala et al., Semin Arthritis Rheum 42:391-400, 1]. While the most efficient therapeutic strategies for these patients have yet to be determined, we speculate that an aggressive therapy of pulse methylprednisolone combined with immunosuppression agents is likely to bring about the best outcome in cases with pathological conditions similar to our patient's. On the other hand, discontinuance of immunosuppressive therapy might have resulted in the aggravation of the disease, hence we should examine patients carefully not to miss the cue.
Collapse
|
48
|
Predictors of hospital length of stay in pediatric Henoch-Schönlein purpura. Rheumatol Int 2015; 35:1561-4. [DOI: 10.1007/s00296-015-3257-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/16/2015] [Indexed: 11/25/2022]
|
49
|
Yong AMY, Lee SX, Tay YK. The profile of adult onset Henoch-Schönlein purpura in an Asian population. Int J Dermatol 2015; 54:1236-41. [PMID: 25772502 DOI: 10.1111/ijd.12732] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 02/11/2014] [Accepted: 04/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Adeline Mei-Yen Yong
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Shan-Xian Lee
- Department of Dermatology; Changi General Hospital; Singapore Singapore
| | - Yong-Kwang Tay
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
- Department of Dermatology; Changi General Hospital; Singapore Singapore
| |
Collapse
|
50
|
Hong J, Yang HR. Laboratory markers indicating gastrointestinal involvement of henoch-schönlein purpura in children. Pediatr Gastroenterol Hepatol Nutr 2015; 18:39-47. [PMID: 25866732 PMCID: PMC4391999 DOI: 10.5223/pghn.2015.18.1.39] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/12/2015] [Accepted: 01/16/2015] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To determine clinically useful biochemical markers reflecting disease activity and/or gastrointestinal (GI) tract involvement in Henoch-Schönlein purpura (HSP). METHODS A total of 185 children with HSP and 130 controls were included. Laboratory data indicating inflammation, standard coagulation, and activated coagulation were analyzed for the HSP patients, including measurements of the hemoglobin level, white blood cell (WBC) count, absolute neutrophil count (ANC), platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, prothrombin time, activated partial thromboplastin time, and fibrinogen, D-dimer, and fibrin degradation product (FDP) levels. The clinical scores of the skin, joints, abdomen, and kidneys were assessed during the acute and convalescence phases of HSP. RESULTS The WBC count, ANC, ESR, and CRP, fibrinogen, D-dimer, and FDP levels were significantly higher in the acute phase compared with the convalescent phase of HSP (p<0.05). The total clinical scores were more strongly correlated with the D-dimer (r=0.371, p<0.001) and FDP (r=0.369, p<0.001) levels than with inflammatory markers, such as the WBC count (r=0.241, p=0.001), ANC (r=0.261, p<0.001), and CRP (r=0.260, p<0.001) levels. The patients with GI symptoms had significantly higher ANC (median [interquartile range], 7,138.0 [4,446.4-9,470.0] vs. 5,534.1 [3,263.0-8,153.5], p<0.05) and CRP (0.49 [0.15-1.38] vs. 0.23 [0.01-0.67], p<0.05), D-dimer (2.63 [1.20-4.09] vs. 1.75 [0.62-3.39]), and FDP (7.10 [0.01-13.65] vs. 0.10 [0.01-7.90], p<0.05) levels than those without GI symptoms. CONCLUSION D-dimer and FDPs are more strongly associated with disease activity and more consistently reflect GI involvement than inflammatory markers during the acute phase of HSP.
Collapse
Affiliation(s)
- Jeana Hong
- Department of Pediatrics, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|