Clinical course of extrarenal symptoms in Henoch-Schonlein purpura: a 6-month prospective study

Jauhola, Outi; Ronkainen, Jaana; Koskimies, Olli; Ala‐Houhala, Marja; Arikoski, Pekka; Hölttä, Tuula; Jahnukainen, Timo; Rajantie, Jukka; Örmälä, Timo; Nuutinen, Matti

doi:10.1136/adc.2009.167874

Cited by 134 publications

(122 citation statements)

References 25 publications

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“…21,22 Randomised controlled trials have found no statistically significant relationship between early prednisone treatment and a decrease in abdominal complications, namely hospitalization, intussusception, or surgery. [23][24][25] Central nervous system involvement is rare in the disease and was absent in our study. In a study by Lava et al HSP had central nervous system involvement presenting as Posterior Reversible Encephalopathy Syndrome (PRES), as a result of central nervous system vasculitis or arterial hypertension.…”

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confidence: 67%

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

Abbas

Geetha

Deepthi

et al. 2017

Int J Contemp Pediatr

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Background: Henoch Schonlein purpura (HSP) is the most common systemic vasculitis in children. It is an immunoglobulin A (IgA) mediated systemic small-vessel vasculitis, with IgA deposition in vessel walls leading to symptoms involving the skin, joints, intestines, and kidneys. The objective of present study was to identify and describe the clinical profile, pattern of joint involvement, histopathological features, treatment modalities and complications of Henoch Schonlein purpura.Methods: 52 children less than 12 years diagnosed to have Henoch Schonlein Purpura according to the European League against Rheumatism criteria were included in the study. All patients were subjected to detailed history taking and thorough examination. The clinical features, investigations, management and complications of the disease were studied. Descriptive statistics was used to analyse the results.Results: The common clinical features were palpable purpura (100%) followed by arthritis (66%) and abdominal pain (50%). Renal manifestations were in the form of hematuria in 12% of the patients. Skin biopsy was done in 25 patients of which 19 had findings suggestive of Henoch Schonlein purpura. Steroids were used in 42% of patients. The severity of illness was associated with lower mean age, arthritis, leg edema and stool occult blood.Conclusions: The clinical features of Henoch Schonlein purpura in the population were different from the previously published studies. Renal involvement was less common. The short-term outcome of the patients were satisfactory.

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confidence: 67%

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

Abbas

Geetha

Deepthi

et al. 2017

Int J Contemp Pediatr

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“…7,8 Indeed, age at onset has been considered to be a risk factor for severity, renal involvement and recurrence. [9][10][11] Henoch-Sch€ onlein purpura has been extensively studied in children but there is a relative paucity of studies on HSP in adults. 12,13 The lower incidence in adults and the possible impediment in identification of adult HSP cases by the older American College of Rheumatology (ACR) criteria (that included 'age < 20 years at onset' as one of the criteria) may partly explain the paucity of data on adults.…”

Section: Introductionmentioning

confidence: 99%

Differences between adult and pediatric onset Henoch‐Schonlein purpura from North India

et al. 2017

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Aim: Henoch-Sch€ onlein purpura (HSP), a primary vasculitis, characterized by purpura, abdominal pain, arthritis and renal involvement, is predominantly a disease of childhood. However, rarely it can occur in adults in whom it is believed to be a more severe form with poor renal outcomes. We aimed to answer if the age of onset affected the clinical spectrum and renal outcomes of the disease in a north Indian population. Hence, we studied the differences in clinical spectrum and renal outcomes between adult-onset HSP and childhood-onset HSP.Methods: Case records of all adult patients diagnosed with HSP (onset ≥ 18 years) over the last 25 years in our department were retrieved. Data on clinical features, lab abnormalities and outcomes were extracted and compared with that in pediatric HSP patients (onset < 18 years) seen during the same period.Results: A total of 87 patients, including 30 adults and 57 children, were seen during this period. Compared to children, most of the adults had purpura as the first clinical manifestation (86.7% vs. 56.1%, P < 0.01) whereas abdominal pain was only rarely the initial symptom in adults (10.0% vs. 36.8%, P < 0.02). During the disease course, adults had a higher frequency of joint involvement as compared to children (90.0% vs. 43.9%, P < 0.001). There was no significant difference in the frequency of renal involvement (60.0% vs. 50.9%, P = NS) and gastrointestinal involvement (66.7% vs. 84.2%, P = NS) between adults and children. Outcomes were good in both groups and most adults and children achieved complete recovery (83.3% and 86.0%, respectively). There was no difference in the frequency of immunosuppressive treatment required by the two groups. None of the patients developed renal insufficiency on follow-up. Conclusion:Compared to children, adults with HSP seldom have abdominal pain as the first clinical manifestation while joint involvement is seen more commonly in them during the disease course.

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“…4 Etiologi PHS sampai sekarang belum diketahui dengan pasti, tetapi terbukti terdapat pula hubungan infeksi virus, obat-obatan, pemberian vaksinasi, dan obat-obatan dengan penyakit PHS. 4,5 Gejala awal berupa serangan akut dengan beberapa manifestasi sekaligus, atau tersembunyi dan muncul satu per satu dalam periode minggu atau bulan. Setelah timbul ruam, gejala lain timbul dalam rerata 4 hari (1-19 hari).…”

Section: Pembahasanunclassified

“…Setelah timbul ruam, gejala lain timbul dalam rerata 4 hari (1-19 hari). 4 Ruam pada umumnya berupa verikel berisi darah serupa petekia hingga ekimosis yang terdistribusi simetris pada ekstremitas bawah maupun daerah yang seringkali banyak mengalami penekanan, misalnya bokong. Bula hemoragik disertai edema jaringan subkutan merupakan gambaran yang tidak umum pada PHS dan sering terlewatkan, karena hanya terjadi <2% kasus anak.…”

Section: Pembahasanunclassified

Bula Hemoragik dengan Komplikasi Perforasi Gaster Sebagai Manifestasi Klinis Purpura Henoch-Schonlein yang Tidak Biasa pada Anak

Setiabudiawan

Ghrahani

Sapartini

et al. 2016

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Purpura Henoch-Schonlein (PHS) merupakan vaskulitis pada pembuluh darah kecil tersering terjadi pada anak. Penyakit ini ditandai dengan purpura palpablenontrombositopenia disertai salah satu gejala nyeri perut, artritis atau atralgia, glomerulonefritis, dan hasil biopsi jaringan berupa gambaran vaskulitis leukositoklastik. Bula hemoragik disertai edema jaringan subkutan merupakan gambaran yang tidak umum pada PHS dan sering terlewatkan. Manifestasi klinis vesikobulosa PHS sering ditemukan pada pasien dewasa, 16%–60% kasus, sedangkan pada anak kurang dari 2% kasus. Walaupun PHS secara tipikal merupakan penyakit selflimiting, tetapi komplikasi serius dapat terjadi. Perforasi gaster sangat jarang dilaporkan sebagai komplikasi PHS. Kami melaporkan 2 kasus PHS dengan manifestasi kulit yang berat, yaitu timbulnya bula hemoragik disertai dengan perforasi gaster. Pada kedua kasus dilakukan tindakan operatif dengan keluaran yang berbeda, pada kasus pertama pasien dipulangkan dalam kondisi baik pascaoperasi setelah dilakukan laparatomi eksplorasi, walaupun masih menderita nefritis. Sedangkan pasien kedua meninggal setelah tindakan diagnostic peritoneal lavagedisebabkan sepsis berat. Simpulan, bula hemoragik dapat dipertimbangkan sebagai prediktor komplikasi perforasi gaster pada PHS yang akan meningkatkan kewaspadaan dalam tata laksana PHS

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Clinical course of extrarenal symptoms in Henoch-Schonlein purpura: a 6-month prospective study

Abstract: Objective To describe the extrarenal symptoms and clinical course of Henoch-Schönlein purpura (HSP). Design A prospective national multicentre trial with 6-month follow-up. Patients A total of 223 newly diagnosed paediatric HSP patients.

Cited by 134 publications

References 25 publications

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

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

Differences between adult and pediatric onset Henoch‐Schonlein purpura from North India

Bula Hemoragik dengan Komplikasi Perforasi Gaster Sebagai Manifestasi Klinis Purpura Henoch-Schonlein yang Tidak Biasa pada Anak

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