Henoch-Schönlein purpura with joint involvement: Analysis of 71 cases

Abstract

BackgroundAlthough joint involvement is the second most common clinical manifestation after skin involvement in patients with Henoch-Schönlein purpura (HSP), it has not been well characterized. The aim of this study was to profile the clinical characteristics and identify the potential risk factors for kidney damage in HSP patients having joint involvement.MethodsWe retrospectively reviewed 71 cases of HSP patients with joint involvement who attended our hospital between January 2010 and March 2012 and analyzed their epidemiological profile, clinical characteristics, follow-up findings (up to three years) and overall prognosis. Logistic regression analysis was performed to identify risk factors associated with renal symptoms in HSP patients with joint involvement.ResultsAverage age of patients was 8.55 ± 2.13 years with male to female ratio at 1.29:1. The peak age of disease onset was six to 11 years. The most common triggers included upper respiratory infection, vigorous physical activity, and autumn and winter seasons. Forty cases (56.35 %) had gastrointestinal involvement and 37 (52.11 %) had kidney damage; gastrointestinal system, scrotal involvement, and increased D-dimer levels were significantly associated with kidney injury (P < 0.05) by multivariate analysis. Glucocorticoid therapy was effective in alleviating symptoms.ConclusionGastrointestinal symptoms, scrotal involvement, and increased D-dimer are the potential risk factors for kidney damage in HSP patients having joint involvement. Rational use of corticosteroids was probably responsible for the good clinical outcomes.

Clinical profile and outcome of Henoch Schonlein purpura in a tertiary care hospital in South India

“…Most children developed joint symptoms simultaneously with rashes or within 11 days of appearance of the rash and 65% developed joint symptoms after having had the rash for 1 to 3 days in a study by Xuehong Wang et al 11 The most common joint involved was ankle joint followed by knee and elbow joint in contrast to the series by Xuehong Wang et al in which knee joint was most commonly affected.…”

“…11 Four of our patients presented with acute abdomen before the appearance of skin rash. Among these patients two had acute appendicitis, one had pancreatitis and one had bowel infarction.…”

“…9 Similar to our study, in previous studies rash has been reported to occur mainly in lower limbs and buttocks. 10,11 Thrombocytosis helps in distinguishing the condition from other thrombocytopenic purpuras.…”

Henoch-Schönlein purpura

“…Histopathological examinations show leukocytoclasia of small vessels with the deposition of immune complexes consisting mainly of immunoglobulin A. Although the etiology is still unclear, symptoms can develop after an upper respiratory tract infection (especially β-hemolytic streptococci) or can be provoked by drugs (e.g., ampicillin, erythromycin, penicillin, quinidine, and losartan) [1][2][3][4][5][6] . The incidence of bowel perforation in the course of HSP is 0.38%.…”

“…The incidence of bowel perforation in the course of HSP is 0.38%. Typically, the disease is localized in the ileum and jejunum, where perforation occurs about 10 days after the appearance of its first symptoms [4][5][6][7] .…”