1Pediatric Infectious Diseases Unit, 2Pediatric Rheumatology
Head of Department: Gonçalo Cordeiro Ferreira
Hospital Dona Estefânia. CHLC - EPE, Lisbon, Portugal
- Comunicação oral no 32nd Annual Meetting of the European Society for Paediatric Infectious Diseases. Dublin, 6-10 de Maio de 2014
BACKGROUND AND AIMS Kawasaki disease (KD) is an idiopathic acute systemic vasculitis of young children. Arthritis is still being a common manifestation not always evaluated.Aim: determination of arthritis prevalence in KD and definition of its pattern and clinical course.
METHODS Descriptive study of children admitted with KD and arthritis during a 15-year period. Clinics, laboratory, treatment response and coronary involvement were evaluated.
RESULTS 63 patients with KD were identified, 60.3% male. The prevalence of arthritis was 12.7%(8/63); in these patients the median-age (3.0 versus 1.8) and the criteria for complete KD (75% vs 67%) were higher than non-arthritic KD patients. 62.5% had oligoarthritis (≤4joints) and 37.5% polyarthritis. In both groups large joints were predominantly involved (100%). Early presentation arthritis was observed in 75%(5/8). Median days of fever to arthritis was 4.5 (p25=3.25;p75=10.25). Median days of fever to treatment was superior in arthritic-patients (7.0(p25=5.0;p75=9.0) versus 6.5(p25=6.0;p75=14.0)). The mean C-reactive protein was higher in arthritic-patients (127.72mg/L versus 109.36mg/L). Cardiac involvement in arthritic-patients was detected in 37.5%(3/8) versus 30.9%(17/55) in non-arthritic. Most arthritis-patients responded to initial IVIG with apyrexia and joint recovery (62.5%); in non-arthritis patients the response was 85.4%. Arthritis duration reached 12.71 days (±6.55). All recovered with no joint sequelae.
CONCLUSIONS This study shows the importance of a systematic evaluation of articular involvement in KD. It’s a short-lived phenomenon with higher cardiac involvement and a statistical tendency for less response to initial IVIG. Its expression can be sufficiently relevant to lead clinicians to alternative diagnoses and delay of KD therapeutics.