Arthritis presenting during the acute phase of Kawasaki disease.
OBJECTIVE
To define the prevalence, pattern, and clinical course of arthritis presenting at the time of diagnosis of Kawasaki disease.


METHODS
A single-center, retrospective study of 414 consecutive patients diagnosed with Kawasaki disease between January 1997 and December 2002 was performed. Standardized clinical assessments, laboratory and imaging test results, and treatment regimens were reviewed. The clinical, laboratory, treatment response, and coronary outcome data were analyzed for children with and without arthritis.


RESULTS
The prevalence of arthritis was 7.5% (31/414). In the 31 children with arthritis, 55% had oligoarticular involvement and 45% had polyarticular involvement. In both of these groups, the large joints were predominantly involved. Some 88% of the children with arthritis responded to standard intravenous immunoglobulin therapy for acute Kawasaki disease and did not require additional medications. The children with arthritis had significantly increased levels of inflammatory markers, but their demographical and clinical features were otherwise similar to those of the children without arthritis, including coronary outcome, with the same proportion (13%) of children from each group having coronary artery lesions (z-score > or = 2.5).


CONCLUSIONS
Arthritis is a short-lived phenomenon included in the clinical spectrum of acute Kawasaki disease. Children with arthritis have evidence of increased systemic inflammation but otherwise share the same clinical features, response to treatment, and coronary outcomes as patients without arthritis. Most cases of arthritis resolve without additional therapeutic intervention.
Gong
Grace W K
GW
Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
McCrindle
Brian W
BW
Ching
Joyce C
JC
Yeung
Rae S M
RS
D000208:Acute Disease; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001168:Arthritis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000453:epidemiology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007223:Infant; D016014:Linear Models; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors