AGE RELATED CHARACTERISTICS OF CHILDREN AND ADOLESCENT WITH HENOCH SCHÖNLEIN PURPURA AND SYSTEMS INVOLVEMENT: AN EXPERIENCE FROM TERTIARY CARE CENTER
Keywords:Vasculitis, Purpura, Arthritis, Hematuria, Gastrointestinal Bleeding
AbstractBackground: Henoch-Schönlein Purpura (HSP) is the most common vasculitis among children and adolescent characterized by skin, joints, renal and gastrointestinal involvement. There is different presenting feature of Henoch-Schönlein Purpura (HSP) and systemic involvement may vary at a certain age group. Methods: This was a ten-year retrospective cohort study done at a tertiary care hospital of Pakistan conducted from 2011–2020. Patients admitted with the diagnosis of Henoch-Schönlein Purpura (HSP) and in accordance with inclusion criteria were divided into groups based on their age, gastrointestinal symptoms and renal symptoms with the objective to compare the clinical features and investigations of Henoch-Schönlein Purpura (HSP) patients. Younger age group had patients age 7 years and less while the other group included patients who were older than 7 years. p-value <0.05 was considered as significant and SPSS 23 was used to analyzed the data. Result: Total 104 patients diagnosed with Henoch-Schönlein Purpura (HSP) were studied. Henoch-Schönlein Purpura (HSP) was more prevalent in males with an increased frequency during autumn and winter. Purpuric rash was present in more than 90% of the patients involved. Joint swelling was significantly (p=0.029) more common in the younger age group (73.3%) while renal involvement was seen more frequent in the older age group (57.1%) (p=0.002). Renal symptoms were less commonly seen in patients with GI involvement. There was no significant difference in platelet count, WBC count and ESR levels among any of the groups. Conclusion: Age related difference in presentation help us to anticipate more renal involvement in older children and adolescent likewise joint involvement is more commonly seen in younger children.
Gardner-Medwin JM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet 2002;360(9341):1197–202.
Calvino MC, Llorca J, Garcia-Porrua C, Fernandez-Iglesias JL, Rodriguez-Ledo P, Gonzalez-Gay MA. Henoch-Schönlein purpura in children from Northwestern Spain: a 20-year epidemiologic and clinical study. Medicine (Baltimore) 2001;80(5):279–90.
Mills JA, Michel BA, Bloch DA, Calabrese LH, Hunder GG, Arend WP, et al. The American College of Rheumatology 1990 criteria for the classification of Henoch‐Schönlein purpura. Arthritis Rheum 1990;33(8):1114–21.
García-Porrúa C, González-Gay MA. Comparative clinical and epidemiological study of hypersensitivity vasculitis versus Henoch-Schönlein purpura in adults. Semin Arthritis Rheum 1999;28(6):404–12.
Saulsbury FT. Henoch-Schönlein purpura in children. Report of 100 patients and review of the literature. Medicine (Baltimore) 1999;78(6):395–409.
Yang YH, Chuang YH, Wang LC, Huang HY, Gershwin ME, Chiang BL. The immunobiology of Henoch–Schönlein purpura. Autoimmun Rev 2008;7(3):179–84.
Saulsbury FT. Clinical update: Henoch-Schönlein purpura. Lancet 2007;369(9566):976–8.
Trapani S, Micheli A, Grisolia F, Resti M, Chiappini E, Falcini F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum 2005;35(3):143–53.
Stewart M, Savage JM, Bell B, McCord B. Long term renal prognosis of Henoch-Schönlein purpura in an unselected childhood population. Eur J Pediatr 1988;147(2):113–5.
Tarvin SE, Ballinger S. Henoch Schonlein Purpura. Curr Paediatr 2006;16(4):259–63.
Allen DM, Diamond LK, Howell DA. Anaphylactoid purpura in children (Schonlein-Henoch syndrome): review with follow-up of the renal complications. Am J Dis Child 1960;99:833–54.
Hung SP, Yang YH, Lin YT, Wang LC, Lee JH, Chiang BL. Clinical Manifestations and Outcomes of Henoch-Schonlein Purpura: Comparison between Adults and Children. Pediatr Neonatol 2009;50(4):162–8.
Blanco R, Martínez-Taboada VM, Rodríguez-Valverde V, García-Fuentes M, González-Gay MA. Henoch-Schönlein purpura in adulthood and childhood: two different expressions of the same syndrome. Arthritis Rheum 1997;40(5):859–64.
García-Porrúa C, Calviño MC, Llorca J, Couselo JM, González-Gay MA. Henoch-Schönlein purpura in children and adults: clinical differences in a defined population. Semin Arthritis Rheum 2002;32(3):149–56.
Lee YH, Kim YB, Koo JW, Chung JY. Henoch-Schonlein Purpura in Children Hospitalized at a Tertiary Hospital during 2004-2015 in Korea: Epidemiology and Clinical Management. Pediatr Gastroenterol Hepatol Nutr 2016;19(3):175–85.
Uppal SS, Hussain MA, Al-Raqum HA, Nampoory MR, Al-Saeid K, AlAssousi A, et al. Henoch-Schönlein’s purpura in adults versus children/adolescents: a comparative study. Clin Exp Rheumatol 2006;24(2 Suppl 41):S26–30.
Rostoker G. Schönlein-henoch purpura in children and adults: diagnosis, pathophysiology and management. BioDrugs 2001;15(2):99–138.
Calvo-Río V, Loricera J, Mata C, Martín L, Ortiz-Sanjuán F, Alvarez L, et al. Henoch-Schönlein purpura in northern Spain: clinical spectrum of the disease in 417 patients from a single center. Medicine (Baltimore) 2014;93(2):106–13.
Zhao YL, Liu ZJ, Bai XM, Wang YC, Li GH, Yan XY. Obesity increases the risk of renal involvement in children with Henoch-Schönlein purpura. Eur J Pediatr 2015;174(10):1357–63.
Ozen S, Bilginer Y. Henoch-Schönlein purpura/immunoglobulin-A vasculitis. InRheumatology, 2015; p.1338–43.
Hung SP, Yang YH, Lin YT, Wang LC, Lee JH, Chiang BL. Clinical manifestations and outcomes of Henoch-Schönlein purpura: comparison between adults and children. Pediatr Neonatol 2009;50(4):162–8.
Lin SJ, Huang JL. Henoch-Schönlein purpura in Chinese children and adults. Asian Pac J Allergy Immunol 1998;16(1):21–5.
Shin JI, Park JM, Shin YH, Hwang DH, Kim JH, Lee JS. Predictive factors for nephritis, relapse, and significant proteinuria in childhood Henoch-Schönlein purpura. Scand J Rheumatol 2006;35(1):56–60.
Nagamori T, Oka H, Koyano S, Takahashi H, Oki J, Sato Y, et al. Construction of a scoring system for predicting the risk of severe gastrointestinal involvement in Henoch-Schönlein purpura. Springerplus 2014;3:171.