Initial manifestations and short term follow-up results of Henoch-Schönlein purpura in children: A report from two centers

Abstract

OBJECTIVE: This retrospective observational study aims to demonstrate initial signs and symptoms of Henoch-Schönleinpurpura (HSP), search for risk factors for gastrointestinal and renal involvement and give short term follow-up results.METHODS: The files of newly diagnosed HSP patients from two pediatric rheumatology centers in the southeastern part ofthe country were retrospectively analyzed in this study. Demographic, clinical features and laboratory results were recordedfrom the files.RESULTS: The cohort consisted of 323 children (males: 53.6%, females: 46.4%). Median age at the time of diagnosis was7.5 (1.8–17.3) years and the median duration of follow-up was six (3–22) months. The rash was present in all cases butwas not the first symptom in 22.9% of the cases. Arthritis and abdominal pain before the development of rash were theinitial symptoms in 11.8% and 11.1% of the cases, respectively. Other manifestations were subcutaneous edema (63.2%),arthralgia (57.6%), arthritis (27.6%), myalgia (17.6%), lethargy (10.2%), orchitis (7.5%) and fever (5.3%). Gastrointestinalinvolvement was seen in 53.3% and renal involvement in 23.5% of the cases. None of the patients developed renal impairment during the follow-up. Older age at diagnosis, necrotic rash, subcutaneous edema, abdominal pain, lethargy, myalgia,arthralgia and arthritis were significantly higher in patients with renal involvement, but none of the demographic, clinical andlaboratory features was an independent risk factor for renal or gastrointestinal involvement.CONCLUSION: Abdominal pain, arthritis may be the first manifestation of HSP. Having constitutional symptoms, such asfever, myalgia and lethargy at the time of diagnosis, may be warning signs of a more aggressive course with gastrointestinaland renal involvement.