title: 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).
  
  
  METHODS
  A prospective national multicentre trial with 6-month follow-up. Patients A total of 223 newly diagnosed paediatric HSP patients.
  
  
  RESULTS
  Purpura was the initial symptom in 73% of the patients and was preceded by joint or gastrointestinal manifestations in the rest by a mean of 4 days. Joint symptoms, abdominal pain, melena, nephritis and recurrences occurred in 90%, 57%, 8%, 46% and 25% of the patients, respectively. Orchitis affected 17/122 (14%) of the boys. Seven patients developed protein-losing enteropathy characterised by abdominal pain, oedema and serum albumin under 30 g/l, and an additional 49 patients had subnormal albumin levels without any proteinuria. Positive fecal occult blood (26/117, 22%) and α1-antitrypsin (7/77, 9%) suggested mucosal injury even in the patients without gastrointestinal symptoms. HSP was often preceded by various bacterial, especially streptococcal (36%) and viral infections. Previous streptococcal infection did not induce changes in the level of complement component C3. Recurrences were more frequent in patients >8 years of age (OR 3.7, CI 2.0 to 7.0, p<0.001) and in patients with nephritis (OR 4.6, CI 2.3 to 8.9, p<0.001). Patients with severe HSP nephritis had more extrarenal symptoms up to 6 months. There was no difference in the clinical course between the prednisone-treated and non-treated patients during the 6-month follow-up.
  
  
  CONCLUSIONS
  Serum albumin is often low in HSP patients without proteinuria, due to protein loss via the intestine. Although corticosteroids alleviate the symptoms, they seem not to alter the clinical course of HSP during 6 months of follow-up.
authors.affiliation: Department of Children and Adolescents, Oulu University Hospital, OYS (Oulu), Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Jauhola
authors.forename: Jaana
authors.initials: J
authors.lastname: Ronkainen
authors.forename: Olli
authors.initials: O
authors.lastname: Koskimies
authors.forename: Marja
authors.initials: M
authors.lastname: Ala-Houhala
authors.forename: Pekka
authors.initials: P
authors.lastname: Arikoski
authors.forename: Tuula
authors.initials: T
authors.lastname: Hölttä
authors.forename: Timo
authors.initials: T
authors.lastname: Jahnukainen
authors.forename: Jukka
authors.initials: J
authors.lastname: Rajantie
authors.forename: Timo
authors.initials: T
authors.lastname: Ormälä
authors.forename: Matti
authors.initials: M
authors.lastname: Nuutinen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000627:therapeutic use; D004812:Epidemiologic Methods; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000209:etiology; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D007223:Infant; D007592:Joint Diseases / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009920:Orchitis / Q000188:drug therapy / Q000209:etiology; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012008:Recurrence; D012709:Serum Albumin / Q000378:metabolism; D013290:Streptococcal Infections / Q000150:complications; D016896:Treatment Outcome; D014777:Virus Diseases / Q000150:complications
chemical_list: D005938:Glucocorticoids; D012709:Serum Albumin; D016572:Cyclosporine; D011241:Prednisone; D008775:Methylprednisolone