Prevalence and characteristics of arthritis in Kawasaki disease: a Chinese cohort study

Yu, Peng; Liu, Xiaohui; Duan, Zhao; Deng, Yuhong; Cai, Sufen; Wang, Zhi; Xu, Ke; Kang, Hui; Jiang, Man; Li, Lin; Zhou, Yujiao; Zheng, Zongheng

doi:10.1007/s10238-019-00547-w

Cited by 18 publications

(23 citation statements)

References 21 publications

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“…[19] Previous studies showed that the older children have a risk of non-cardiac complications including arthritis, ocular complications, and AARF during acute phase of KD. [2,3,20] Those findings were consistent with the present study in the patients who received initial IVIG therapy with DUA. Two patients were associated with arthritis in the present study.…”

Section: Discussionsupporting

confidence: 92%

“…The prevalence of arthritis in the acute phase of KD was 7.5% to 10.6%. [2,21] Most cases of arthritis resolve without additional therapeutic intervention. [21] A Chinese cohort study with regard to arthritis in KD showed that the clinical course of arthritis was short-lived in most patients, and that no additional anti-inflammatory drug was needed in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…[21] A Chinese cohort study with regard to arthritis in KD showed that the clinical course of arthritis was short-lived in most patients, and that no additional anti-inflammatory drug was needed in these patients. [2] On the other hand, another study showed that rescue therapy including corticosteroid treatment was necessary in 13 % of the patients with arthritis in KD. [21] In the present study, 2 patients with arthritis required the second round of IVIG therapy, and one of these patients required corticosteroid treatment as 4th line therapy.…”

Section: Discussionmentioning

confidence: 99%

“…[2,3] Older children with KD who received initial IVIG therapy with concomitant use of aspirin have a risk for acute phase complications including both CAL and non-cardiac complications. [2][3][4][5] At present, the standard therapy for the acute phase of this disease is intravenous immunoglobulin (IVIG) therapy at 2 g/kg/dose with the concomitant use of medium-or higherdose aspirin. [6] However, the concomitant use of medium-or higher-dose aspirin is now controversial.…”

Section: Introductionmentioning

confidence: 99%

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Acute Phase Complications of Older Children with Kawasaki Disease

Nakada¹

2019

AJMR

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Background: Older children with Kawasaki disease (KD) have a risk for acute phase complications including coronary artery lesions (CALs). Objective: To clarify the frequency and outcomes of acute phase complications in older children who received an initial single intravenous immunoglobulin (IVIG) therapywith delayed use of aspirin. Subjects and Methods: This retrospective study included data from 216 consecutive patients who underwent initial single IVIG therapy at 2 g/kg with DUA. The data were divided into a group for cases aged 5 years or older (older group, n = 34) and another group for cases aged <5 years (younger group, n = 182). Statistical analyses were performed using Chi-square, Fisher's exact, and Mann-Whitney U tests as appropriate. Results: Six of 34 (17.6%) older group patients were associated with complications (2 with CAL and 4 with non-cardiac complications required treatment). The non-cardiac complications included arthritis, transient blindness, and atlantoaxial rotatory fixation. All of these non-cardiac complications were recovered after treatment. The rate of CAL in older group patients was similar to that in younger group patients (5.9% vs. 1.6%, P = 0.177). However, the rate of non-cardiac complications in the former was significantly higher than that of the latter (11.8% vs. 0.0%, P < 0.001). Conclusion: Whereas the older children who underwent initial single IVIG therapy at 2 g/kg with DUA have the higher risk for non-cardiac complications compared to the younger patients, the rate of CAL was similar between the older and younger children.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Phase Complications of Older Children with Kawasaki Disease

Nakada¹

2019

AJMR

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“…Except for the typical five clinical features, KD could have multiple other manifestations including arthritis, aseptic meningitis, colitis, etc [9][10][11] . Indeed, KD in early stage with atypical manifestations often leads to misdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

The cerebrospinal fluid changes and clinical characteristics of aseptic meningitis in Kawasaki disease

Hu¹,

Shi²,

Fan³

et al. 2020

Preprint

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Background: Aseptic meningitis is not a common feature in Kawasaki disease (KD). However, it could cause difficulty in making correct and in-time diagnosis Methods: We retrospectively investigated patients of KD and bacterial meningitis (BM). Totally 38 KD patients and 126 BM patients were brought into this study. Clinical symptoms, signs and laboratory examinations were compared between the two groups, which included: duration of fever before lumbar puncture, conjunctiva injection, oral cavity change, rash, cervical lymphadenopathy and extremities change, vomiting, front fontanel bulging, neck stiffness, leukocytes, hemoglobin, platelets, C-reactive protein, cerebrospinal fluid examinations, liver function and urinalysis. Results: In clinical signs, vomit and neck stiffness were more prevalent in BM. KD patients showed higher blood leukocyte (p<0.001) and C-reactive protein (p<0.001) in the early febrile stage. Glucose in cerebrospinal fluid of BM patients was significantly lower than KD patients (p=0.003). In ROC curve, the optimal cutoff value of CSF glucose was 2.945mmol/L with the sensitivity of 84.2% and specificity of 71.4%. Pyuria was more prevalent in KD patients (p<0.001). There was no significant difference in front fontanel bulging, hemoglobin, platelet, alanine transaminase, aspartate transaminase, albumin, cerebrospinal fluid leukocytes, cerebrospinal fluid protein and cerebrospinal fluid lactate dehydrogenase. Conclusions ： Full investigation of clinical manifestation and laboratory tests is necessary to distinguish KD with aseptic meningitis and BM. In CSF study, glucose level is more efficient than other items to distinguish these two diseases. Decreased CSF glucose is possibly an indicator of BM rather than KD.

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Clinico-laboratory profile of Kawasaki disease with arthritis in children

et al. 2020

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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.

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Prevalence and characteristics of arthritis in Kawasaki disease: a Chinese cohort study

Cited by 18 publications

References 21 publications

Acute Phase Complications of Older Children with Kawasaki Disease

Acute Phase Complications of Older Children with Kawasaki Disease

The cerebrospinal fluid changes and clinical characteristics of aseptic meningitis in Kawasaki disease

Clinico-laboratory profile of Kawasaki disease with arthritis in children

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