Clinico-laboratory profile of Kawasaki disease with arthritis in children

Abstract

Kawasaki disease (KD) is associated with several musculoskeletal manifestations. Although arthritis has been reported to occur in 2.3-31% of children with KD, there is paucity of detailed studies on the subject. We report our experience on arthritis in children with KD. Data were collated from a review of records of patients diagnosed with KD and arthritis during the period January 1994-June 2019. Eight hundred sixty-five children (male:female 29:11) were diagnosed with KD during this period-of these, 40 (4.6%) had arthritis. Median day of diagnosis of KD was 17 days. Twenty-nine (72.5%), 8 (20%), and 3 (8.6%) children developed arthritis in acute, subacute, and convalescent phases of KD, respectively. Oligoarticular involvement was observed in 32 (80%) children and among these, 7 (20%) had monoarthritis. Predominant joints involved were knee (74.3%), ankle (40%), and hip (28.6%). Thirty-two children (80%) were treated with non-steroidal anti-inflammatory drugs (NSAIDs). Median duration of arthritis was 10 days (range, 2-180 days) with uneventful recovery in all cases. Three (7.5%) children had coronary artery ectasia which regressed on follow-up.Conclusion: Arthritis in KD is usually non-erosive, self-limiting, and responds well to a short course of NSAIDs.What is Known:• Arthritis has been reported to occur in 2.3-31% of children with KD.• Arthritis in KD is usually oligoarticular, non-erosive, and responds well to short course of non-steroidal anti-inflammatory drugs.What is New:• Children with KD and arthritis do not appear to be at increased risk of development of coronary artery abnormalities.• Arthritis in children with KD can result in diagnostic confusion, and diagnosis of KD may get delayed.

CT Coronary Angiography Studies After a Mean Follow-up of 3.8 Years in Children With Kawasaki Disease and Spontaneous Defervescence

“…The diagnosis of KD is always based on clinical criteria and there is no laboratory marker that can serve as a gold standard for diagnosis of this condition (21). A significant proportion of children with KD (25-50% in various series) have incomplete KD (7,(22)(23)(24)(25). And this proportion would be higher in situations wherein the patients have reported late for diagnosis, as was the case in the present series (12,13).…”

Characteristics of persistent arthritis with Kawasaki disease: A single-center retrospective study

“…Arthritis is a classic complication of KD that occurs in 4.6-17.6% of patients [6][7][8][9][10][11] , but it has been improperly evaluated and underdiagnosed for decades. Infants and toddlers may have di culty complaining about their joint symptoms, which could contribute to the underdiagnosis.…”

“…However, recently, arthritis in KD has garnered substantial attention [7][8][9][10][11] . Oligoarthritis accounts for 56.0-82.5% of cases of KD-associated arthritis [6][7][8][9][10] , and large joints in the lower extremities are more frequently involved than small joints [6,8,9] . Our results are consistent with those of previous studies [6] showing that oligoarthritis was predominantly observed (64%) and large joints in the lower extremities were primarily affected.…”

“…Moreover, patients with KD present with various symptoms, including aseptic meningitis, anterior uveitis, hepatitis, gastroenteritis, gallbladder hydrops, pancreatitis, and arthritis [5] . Arthritis occurs in 4.6-17.6% of patients [6][7][8][9][10][11] ; however, arthritis may be underdiagnosed as infants may struggle to express their symptoms. Arthritis associated with KD follows several clinical courses.…”

Grisel syndrome and peripheral arthritis simultaneously occurred in a 7-year-old Chinese boy with Kawasaki disease

“…Guleria et al . [ 6 ] retrospectively reviewed the clinical records of 865 KD patients from 1994 to 2019 in India, and identified that 4.6% of patients manifested arthritis; and among them, 30 patients had knee involvement, 15 patients had ankle involvement, 14 patients had hip involvement, and only 1 patient had cervical spine involvement. In the present report, we encountered an unusual case of KD in a 7-year-old boy with GS and peripheral arthritis.…”