title: Recent advances in the treatment of Kawasaki disease.
abstract: Kawasaki disease (KD) is acute systemic vasculitis that occurs mainly in infants and children under 5 years of age. The etiology of KD remains unknown. KD is liable to be complicated by coronary artery lesions (CALs), which develop in approximately 15-25% of untreated KD children and in approximately 5% of KD children after intravenous immunoglobulin (IVIG) therapy. A single high dose of IVIG (2 g/kg) is the gold standard therapy in the acute stage of KD. However, approximately 8--38% of children are unresponsive to initial IVIG treatment and at increased risk for CAL development. Anti-inflammatory high doses of aspirin are recommended in conjunction with IVIG, but our study demonstrated that there is no evidence of efficacy in preventing CAL development. The usefulness of steroids in initial therapy for KD or treatment of IVIG-resistant patients is not well established. Other immunosuppressive therapies, including infliximab, have been used in the treatment of refractory KD, but merit additional investigation. Subclinical atherosclerosis may develop early in KD patients, which makes early initiation of therapy to improve chronic inflammation an important issue. Future multicenter studies may help to define the optimal management of KD patients.
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Ken-Pen
authors.initials: KP
authors.lastname: Weng
authors.forename: Shan-F
authors.initials: SF
authors.lastname: Ou
authors.forename: Chu-Chuan
authors.initials: CC
authors.lastname: Lin
authors.forename: Kai-Sheng
authors.initials: KS
authors.lastname: Hsieh
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000517:prevention & control; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D016756:Immunoglobulins, Intravenous; D001241:Aspirin