title: Relapses in patients with Henoch-Schönlein purpura: Analysis of 417 patients from a single center.
abstract: To further investigate into the relapses of Henoch-Schönlein purpura (HSP), we analyzed the frequency, clinical features, and predictors of relapses in series of 417 unselected patients from a single center. After a median follow-up of 12 (interquartile range [IQR]: 2-38) years, almost one-third of the 417 patients (n = 133; 32%; 85 men/48 women) had experienced at least 1 relapse. At the time of disease diagnosis, patients who later experienced relapses had less commonly infections than those who never suffered flares (30.8% vs 41.9%; P = 0.03). In contrast, patients who experienced relapses had a longer duration of the first episode of palpable purpura than those without relapses (palpable purpura lasting >7 days; 80.0% vs 68.1%; P = 0.04). Abdominal pain (72.3% vs 62.3%; P = 0.03) and joint manifestations (27.8% vs 15.5%; P = 0.005) were also more common in patients who later developed relapses. In contrast, patients who never suffered relapses had a slightly higher frequency of fever at the time of disease diagnosis (9.3% vs 3.8%; P = 0.06). At the time of disease diagnosis, corticosteroids were more frequently given to patients who later had relapses of the disease (44% vs 32% in nonrelapsing patients; P = 0.03). Relapses generally occurred soon after the first episode of vasculitis. The median time from the diagnosis of HSP to the first relapse was 1 (IQR: 1-2) month. The median number of relapses was 1 (IQR 1-3). The main clinical features at the time of the relapse were cutaneous (88.7%), gastrointestinal (27.1%), renal (24.8%), and joint (16.5%) manifestations. After a mean ± standard deviation follow-up of 18.9 ± 9.8 years, complete recovery was observed in 110 (82.7%) of the 133 patients who had relapses. Renal sequelae (persistent renal involvement) was found in 11 (8.3%) of the patients with relapses. The best predictive factors for relapse were joint and gastrointestinal manifestations at HSP diagnosis (odds ratio [OR]: 2.22; 95% confidence interval [CI]: 1.34-3.69, and OR: 1.60; 95% CI: 1.01-2.53, respectively). In contrast, a history of previous infection was a protective factor for relapses (OR: 0.60; 95% CI: 0.38-0.94). In conclusion, joint and gastrointestinal manifestations at the time of diagnosis of HSP are predictors of relapses.
authors.affiliation: Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria Division of Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria Division of Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria Division of Pediatrics, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria Division of Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Vanesa
authors.initials: V
authors.lastname: Calvo-Río
authors.forename: José Luis
authors.initials: JL
authors.lastname: Hernández
authors.forename: Francisco
authors.initials: F
authors.lastname: Ortiz-Sanjuán
authors.forename: Javier
authors.initials: J
authors.lastname: Loricera
authors.forename: Natalia
authors.initials: N
authors.lastname: Palmou-Fontana
authors.forename: Maria C
authors.initials: MC
authors.lastname: González-Vela
authors.forename: Domingo
authors.initials: D
authors.lastname: González-Lamuño
authors.forename: Marcos A
authors.initials: MA
authors.lastname: González-López
authors.forename: Susana
authors.initials: S
authors.lastname: Armesto
authors.forename: Ricardo
authors.initials: R
authors.lastname: Blanco
authors.forename: Miguel A
authors.initials: MA
authors.lastname: González-Gay
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D011695:IgA Vasculitis / Q000473:pathology*; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D013030:Spain; D055815:Young Adult