Henoch-Schonlein Purpura in Children Hospitalized at a Tertiary Hospital during 2004-2015 in Korea: Epidemiology and Clinical Management

Abstract

PurposeTo investigate the epidemiology, clinical manifestations, investigations and management, and prognosis of patients with Henoch-Schonlein purpura (HSP).MethodsWe performed a retrospective review of 212 HSP patients under the age of 18 years who were admitted to Inje University Sanggye Paik Hospital between 2004 and 2015.ResultsThe mean age of the HSP patients was 6.93 years, and the ratio of boys to girls was 1.23:1. HSP occurred most frequently in the winter (33.0%) and least frequently in the summer (11.3%). Palpable purpura spots were found in 208 patients (98.1%), and gastrointestinal (GI) and joint symptoms were observed in 159 (75.0%) and 148 (69.8%) patients, respectively. There were 57 patients (26.9%) with renal involvement and 10 patients (4.7%) with nephrotic syndrome. The incidence of renal involvement and nephrotic syndrome was significantly higher in patients with severe GI symptoms and in those over 7 years old. The majority of patients (88.7%) were treated with steroids. There was no significant difference in the incidence of renal involvement or nephrotic syndrome among patients receiving different doses of steroids.ConclusionIn this study, the epidemiologic features of HSP in children were similar to those described in previous studies, but GI and joint symptoms manifested more frequently. It is essential to carefully monitor renal involvement and progression to chronic renal disease in patients ≥7 years old and in patients affected by severe GI symptoms. It can be assumed that there is no direct association between early doses of steroids and prognosis.

Sonographic Findings of Arthralgia in Children with Henoch-Schönlein Purpura

“…Among patients with HSP, the risk of developing arthritis was reported to be highest in children up to 7 years of age, 2 as in our study. A pronounced gender predominance for HSP occurrence was not reported in other studies, 1,2,7 whereas in our study, arthralgia was slightly more predominant among boys.…”

“…7 In Korea, younger children are more at risk of developing arthritis, according to a nationwide populationbased study, 3 and affected children younger than 7 years had frequent joint symptoms. 2 Our results also demonstrated that the rate of arthralgia was highest among children aged 2-5 years (51.6%) and decreased with age (32.3% of patients aged 6-10 years and 16.1% of those aged 11-17 years).…”

“…Arthralgia in patients with HSP is probably caused by swelling and edema of subcutaneous tissues around joints. The prognosis of children with HSP-related arthritis is therefore good because the arthritis is nondeforming and, in our patients, healed spontaneously or with steroids, [1][2][3] in comparison with septic arthritis or synovitis, which necessitate treatments and last longer.…”

“…20,21 In one study, children with HSP-related arthritis received steroid therapy more frequently than those without HSP-related arthritis (77.4% vs. 56.5%, P < 0.001). 2 In our study, steroids for managing the arthralgia were administered in 80.6% of patients. In the other patients, arthralgia spontaneously resolved with supportive care.…”

“…Gastrointestinal and renal manifestations are related to the morbidity and mortality from HSP. [1][2][3] Arthralgia and arthritis have become the common manifestations of HSP in children. 4,5 According to pediatric textbook, arthritis and arthralgia were observed in 50-80% of patients in HSP.…”