title: The profile of adult onset Henoch-Schönlein purpura in an Asian population.
abstract: BACKGROUND
  Henoch-Schönlein purpura (HSP) is less common in adults and has been linked with a more severe clinical syndrome as well as a higher frequency of renal disease and internal malignancy. Renal involvement in adult HSP has been significantly associated with antecedent infections, pyrexia at time of first presentation, and purpura above the waist. We aim to evaluate the frequency of cutaneous and extra-cutaneous features and identify the predictive factors for renal involvement in Asian adults with HSP.
  
  
  METHODS
  We performed a retrospective study of 48 adult Asian patients diagnosed with HSP based on the European League Against Rheumatism (EULAR) criteria at a tertiary hospital in Singapore between January 2000 and December 2011.
  
  
  RESULTS
  The most common cutaneous manifestations were palpable purpura (73%), papules (31%), and petechiae (27%). Forty-percent had cutaneous lesions extending above the waist. Fifteen patients (31%) had gastrointestinal symptoms, 21 (44%) had joint involvement, and 27 (56%) had renal disease. Seventy-percent of patients with pyrexia at presentation experienced renal disease, whereas only 30% without pyrexia had renal involvement (P = 0.018). Sixty-six percent of patients with purpura had renal involvement as compared to 31% in those without purpura (P = 0.049). The frequency of renal involvement in patients with purpura above the waist (52%) was similar to those with purpura below the waist (55%).
  
  
  CONCLUSIONS
  Our study confirms that HSP in adults tends to be more severe with a high incidence of extracutaneous manifestations, especially renal disease. Pyrexia at presentation and the presence of purpura were significant predictive factors for renal involvement.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Adeline Mei-Yen
authors.initials: AM
authors.lastname: Yong
authors.affiliation: Department of Dermatology, Changi General Hospital, Singapore, Singapore.
authors.forename: Shan-Xian
authors.initials: SX
authors.lastname: Lee
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.|Department of Dermatology, Changi General Hospital, Singapore, Singapore.
authors.forename: Yong-Kwang
authors.initials: YK
authors.lastname: Tay
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000209:etiology; D044466:Asian People; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D007674:Kidney Diseases / Q000209:etiology*; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012846:Singapore; D060726:Torso; D034941:Upper Extremity; D055815:Young Adult