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TANAKA HAJIME, TANAKA TSUKASA, TOKUDA OSHI, YAMAMOTO HIROKO, MATSUNOSHITA NATSUKI, TAKENAKA KANAE, TOMINAGA KENTA, KAWASAKI KEIICHIRO. Association between Factor XIII Activity and Clinical Course in Pediatric Patients with Immunoglobulin A Vasculitis. THE KOBE JOURNAL OF MEDICAL SCIENCES 2023; 69:E57-E63. [PMID: 37661704 PMCID: PMC10501757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/28/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Immunoglobulin A vasculitis is a systemic form of vasculitis that predominantly affects children. Factor XIII activity is decreased in some cases, and several reports have shown an association between abdominal pain and decreased factor XIII activity. However, the clinical significance of decreased factor XIII activity in pediatric immunoglobulin A vasculitis has not been fully elucidated. This study aimed to identify the association between factor XIII activity and the clinical course of pediatric patients with immunoglobulin A vasculitis. METHODS Forty-four pediatric patients, admitted to Kita-Harima Medical Center with a clinical diagnosis of immunoglobulin A vasculitis between October 1, 2013 and September 30, 2022, were retrospectively reviewed, and 22 patients were analyzed. The patients' background characteristics and clinical course were compared between the normal and decreased factor XIII activity (<70%) groups. RESULTS The group with decreased factor XIII activity showed a significantly increased duration of hospitalization (14 [6-36] vs. 7 [5-13] days, p = 0.01), total glucocorticoid dose (prednisolone 22.7 [4.9-55.5] vs. 10.1 [3.4-19.6] mg/kg, p = 0.02), and duration of glucocorticoid administration (19 [4-85] vs. 10 [3-15] days, p = 0.03). Correlational analyses showed that these three parameters were negatively correlated with factor XIII activity. CONCLUSIONS Factor XIII activity was negatively correlated with the duration of hospitalization, total glucocorticoid dose, and duration of glucocorticoid administration. Factor XIII activity is not only associated with abdominal symptoms but also may be a marker to predict the overall trajectory of acute-phase treatment in pediatric patients with immunoglobulin A vasculitis.
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Affiliation(s)
- HAJIME TANAKA
- Department of Pediatrics, Kita-Harima Medical Center, Ono, Japan
| | - TSUKASA TANAKA
- Department of Pediatrics, Kita-Harima Medical Center, Ono, Japan
| | - OSHI TOKUDA
- Department of Pediatrics, Kita-Harima Medical Center, Ono, Japan
| | - HIROKO YAMAMOTO
- Department of Pediatrics, Kita-Harima Medical Center, Ono, Japan
| | | | - KANAE TAKENAKA
- Department of Pediatrics, Kita-Harima Medical Center, Ono, Japan
| | - KENTA TOMINAGA
- Department of Pediatrics, Kita-Harima Medical Center, Ono, Japan
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Xu L, Li Y, Wu X. IgA vasculitis update: Epidemiology, pathogenesis, and biomarkers. Front Immunol 2022; 13:921864. [PMID: 36263029 PMCID: PMC9574357 DOI: 10.3389/fimmu.2022.921864] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Immunoglobulin A vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, is the most common systemic vasculitis in children, characterized by diverse clinical manifestations with a wide spectrum ranging from isolated cutaneous vasculitis to systemic involvement. The incidence of IgAV is geographically and ethnically variable, with a prevalence in autumn and winter, suggesting a driving role that genetic and environmental factors play in the disease. Although IgAV has a certain degree of natural remission, it varies widely among individuals. Some patients can suffer from severe renal involvement and even progress to end-stage renal disease. Its pathogenesis is complex and has not been fully elucidated. The formation of galactose-deficient IgA1 (Gd-IgA1) and related immune complexes plays a vital role in promoting the occurrence and development of IgAV nephritis. In addition, neutrophil activation is stimulated through the binding of IgA to the Fc alpha receptor I expressed on its surface, resulting in systemic vascular inflammation and tissue damage. Starting from the epidemiological characteristics, this article will review the role of immunological factors such as Gd-IgA1, autoantibodies, circulating immune complexes, complement system, cellular immunization, and the contributions of environmental and genetic factors in the pathogenesis of IgAV, and conclude with the major biomarkers for IgAV.
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Maritati F, Canzian A, Fenaroli P, Vaglio A. Adult-onset IgA vasculitis (Henoch-Schönlein): Update on therapy. Presse Med 2020; 49:104035. [PMID: 32645417 DOI: 10.1016/j.lpm.2020.104035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/05/2019] [Indexed: 12/22/2022] Open
Abstract
Immunoglobulin A vasculitis (IgAV, formerly Henoch-Schönlein purpura) is a systemic inflammatory disease affecting small vessels. While it is common and usually benign in childhood, in adults it is rarer has a more severe course. Its main manifestations are cutaneous purpura, arthralgias or arthritis, acute enteritis and glomerulonephritis. Renal involvement is associated with a poor prognosis in adults. The treatment of adult-onset IgAV is still a matter of debate: although in patients with a non-severe phenotype remission can occur spontaneously, more severe cases may need immunosuppressive therapy. There are some areas of uncertainty with respect to the efficacy of immunosuppressive regimens: almost all data come from studies performed in children or from patients with IgA nephropathy and/or IgA-crescentic glomerulonephritis. The only randomised study performed in adults with IgAV and renal involvement showed that immunosuppressive therapy with cyclophosphamide did not improve renal outcome nor did it affect patient survival. The possible efficacy of other drugs is reported only in small case series. Recent evidences show that rituximab could be an effective therapeutic option for adult-onset IgAV, but this also needs to be confirmed in controlled trials. In this review, we focus on therapeutic options for adult-onset IgAV treatment, and discuss the main results of the studies performed so far.
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Affiliation(s)
| | - Alice Canzian
- Nephrology Unit, Parma University Hospital, Parma, Italy
| | | | - Augusto Vaglio
- Department of Biochemical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, and Meyer Children's Hospital, Firenze, Italy.
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Ono K, Fukoe Y, Lee Y, Lee M, Watanabe M, Aoki T, Murakami M. Treating Immunoglobulin A Vasculitis in an Elderly Patient Using Steroids: A Clinical Study. In Vivo 2019; 33:1325-1328. [PMID: 31280225 DOI: 10.21873/invivo.11606] [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: 03/08/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 11/10/2022]
Abstract
Herein, we report a case of immunoglobulin A vasculitis (IgAV) onset in an elderly patient. A 61-year-old male presented to our hospital with palpable purpura on his right leg and abdomen and diffuse abdominal pain. Computed tomography revealed thickened intestinal wall and ascites. In addition, his serum IgA and urinary protein levels were elevated. The histopathological finding of palpable purpura indicated vasculitis, and he was diagnosed with IgAV. Accordingly, steroid therapy was initiated. Gradually, purpura and abdominal pain disappeared, and he was discharged on day 26 after admission. Although IgAV is common in children, only few cases have been reported in elderly. Thus, when examining patients, including elderly, with palpable purpura and abdominal pain, the possibility of IgAV should be considered.
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Affiliation(s)
- Kohei Ono
- Department of Gastroenterological Surgery, Shiroyama Hospital, Gunma, Japan .,Department of Gastroenterological & General Surgery School of Medicine, Showa University, Tokyo, Japan
| | - Yoshihiro Fukoe
- Department of Gastroenterological Surgery, Shiroyama Hospital, Gunma, Japan
| | - Yugen Lee
- Department of Gastroenterological Surgery, Shiroyama Hospital, Gunma, Japan
| | - Masahiro Lee
- Department of Gastroenterological Surgery, Shiroyama Hospital, Gunma, Japan
| | - Makoto Watanabe
- Department of Gastroenterological & General Surgery School of Medicine, Showa University, Tokyo, Japan
| | - Takeshi Aoki
- Department of Gastroenterological & General Surgery School of Medicine, Showa University, Tokyo, Japan
| | - Masahiko Murakami
- Department of Gastroenterological & General Surgery School of Medicine, Showa University, Tokyo, Japan
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Yagi S, Endo I, Murakami T, Hida T, Yamamoto Y, Soga T, Ise T, Kusunose K, Yamaguchi K, Fukuda D, Yamada H, Soeki T, Wakatsuki T, Kawahito S, Sata M. Adult onset of Immunoglobulin A vasculitis – A case report. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:344-346. [DOI: 10.2152/jmi.66.344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Shusuke Yagi
- Shikoku Central Hospital, Shikokuchuo, Ehime, Japan
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Itsuro Endo
- Shikoku Central Hospital, Shikokuchuo, Ehime, Japan
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Taichi Murakami
- Department of Nephrology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tetsuya Hida
- Shikoku Central Hospital, Shikokuchuo, Ehime, Japan
- Department of Dermatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | | | - Tomohiro Soga
- Shikoku Central Hospital, Shikokuchuo, Ehime, Japan
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
- Department of Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shinji Kawahito
- Shikoku Central Hospital, Shikokuchuo, Ehime, Japan
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
- Department of Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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