Has joint involvement lessened in Kawasaki disease?
OBJECTIVE
Kawasaki disease (KD) is an acute systemic vasculitis affecting medium-sized arteries, particularly the coronary arteries. Classic diagnosis is based in prolonged fever and different clinical features, including acute arthritis. Our objective is to determine the prevalence of arthritis at the moment of the diagnosis, the response to intravenous immunoglobulin infusion and the relation with cardiac findings.


METHODS
Retrospective study through review of medical records of 42 patients with KD from 1988 to 2013. Demographic, clinical, laboratory variables and treatment were reviewed.


RESULTS
Male sex was predominant (57%). Fever (100%), exanthema (92,9%), conjunctivitis (78,6%), oropharingeal changes (76,2%), cervical lymphadenopathy (71,4%), edema (52,4%) and peripheral desquamation (46,3%) were reported. Eight patients presented ecocardiography alterations (ectasia and aneurism). Acute articular involvement was reported in 7 (16%) patients, including oligoarticular (57%), monoarticular (29%) and polyarticular (14%) patterns. All patients had elevation of acute phase reactants with neutrophilia (57%) and hypoalbuminemia (71,5%), but showed a good therapeutic response to intravenous immunoglobulin, without sequelaes. Sixteen patients had incomplete KD nine males, with 100% of fever exanthema (75%), conjunctivitis (56%) and 50% of cervical lymphadenopathy. Whereas oropharingeal changes and edemas was described in 44% and 25% of them. Four patients with incomplete KD had coronary artery abnormalities.


CONCLUSIONS
Acute arthritis was an uncommon finding (16%) and resulted in no sequelae. Maybe the treatment with intravenous immunoglobulin and aspirin prevents the development of articular abnormalities and then leading to a decrease in its follow-up requierement by reumathologist. The cardiovascular sequelae, mainly incomplete KD, remains determining its prognosis. The presence of articular involvement seems not to have influence over cardiac involvement.
Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España. Electronic address: evalvareza@hotmail.com.
Eva Pilar
EP
Álvarez
Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
Francis
F
Rey
Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
Sara Carolina
SC
Peña
Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
Aranzazu
A
Rubio
Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
Cristina
C
Calvo
Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España. Electronic address: paxcollado@yahoo.es.
Paz
P
Collado
D000208:Acute Disease; D000293:Adolescent; D001168:Arthritis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors
Afectación articular; Aneurismas; Aneurysm; Articular involvement; Enfermedad de Kawasaki; Inmunoglobulinas; Inmunoglobulins; Kawasaki disease