Risk Factors Related to Recurrence of Immunglobulin A Vasculitis

Öz

Immunoglobulin A vasculitis (IgAV) is the most common childhood vasculitis. It is a systemic vasculitis that is characterized by the accumulation of immunoglobulin A and immune complexes in small vessels and usually self-limited. Immunoglobulin A vasculitis is diagnosed by clinical and histopathological findings and has no specific laboratory test. Although the recurrence of IgAV are common the exact prognostic parameters have not been clearly defined yet. In this study, it was aimed to determine the risk factors that can predict relapses by evaluating the demographic, clinical features and laboratory markers of IgAV. The clinical and laboratory data of 318 patients with IgAV who were followed up in Ankara City Hospital Pediatric Rheumatology Clinic between January 2012 and June 2021 were evaluated retrospectively. Relapse was observed in 17 (5.3%) of 318 cases in the study. There was no significant difference between the median age of disease onset, gender, and season of the disease between patients with and without relapse. It was found that fewer recurrence rate in IgAV triggered by infection (p=0.048). There was no difference in white blood cell, hemoglobin, platelet, erythrocyte sedimentation rate, C-reactive protein, immunoglobulin A, antinuclear antibody, complement 3 and 4 levels measured at the time of admission between the groups. There was no difference in the rates of gastrointestinal, renal, joint and testicular involvement at the time of diagnosis. There was no significant difference between corticosteroid use and duration of treatment and recurrence (p=0.512). In this study, the recurrence rate of IgAV was found to be 5.3%. It has been shown that renal involvement accompanying skin involvement and corticosteroid therapy used for more than 10 days are risk factors for recurrence. In present study no risk factors were found to be associated with recurrence. We observed fewer recurrence in patients with a history of infection. The large patient series are necessary to identify other possible risk factors for recurrence in patients with IgAV.

Anahtar Kelimeler

• Childhood Immunoglobulin A vasculitis
• purpura
• recurrence
• treatment

İmmünglobulin A Vaskülit Nüksü ile İlişkili Risk Faktörleri

Öz

Çocukluk çağının en sık görülen vasküliti olan immünglobulin A vasküliti (IgAV) küçük damarlarda immünglobulin A ve immün kompleks birikimi ile karakterize, genellikle kendi kendini sınırlayan sistemik bir vaskülittir. Spesifik bir laboratuvar testi olmayan IgAV’ne klinik ve histopatolojik bulgular ile tanı konulmaktadır. Kesin prognostik parametreler henüz net olarak tanımlanmamakla beraber nüksler yaygındır. Bu çalışmada, IgAV’nin demografik, klinik özellikleri ve laboratuvar belirteçleri değerlendirilerek nüksleri öngörebilecek risk faktörlerinin belirlenmesi amaçlanmıştır. Ankara Şehir Hastanesi Çocuk Romatolojisi Kliniği’nde Ocak 2012 ile Haziran 2021 tarihleri arasında takip edilen IgAV tanılı 318 hastanın klinik ve laboratuvar verileri geriye dönük olarak değerlendirildi. Çalışmada yer alan 318 olgunun 17’sinde (%5,3) nüks gelişti. Nüks gelişen ve gelişmeyen hastaların medyan başlangıç yaşı, cinsiyet, hastalık başlangıç mevsimi arasında istatistiksel olarak anlamlı fark saptanmadı. Enfeksiyonun tetiklediği IgAV’nde daha az nüks geliştiği saptandı (p=0,048). Her iki grup arasında başvuruda bakılan; beyaz küre, hemoglobin, platelet, eritrosit sedimentasyon hızı, C-reaktif protein, immünglobulin A, anti nükleer antikor, kompleman 3 ve 4 düzeyleri arasında fark yoktu. Tanı anında gastrointestinal, renal, eklem ve testis tutulum oranları arasında fark saptanmadı. Kortikosteroid kullanımı ve tedavi süresi açısından 2 grup arasında anlamlı fark yoktu (p=0,512). Bu çalışmada IgAV’nin nüks oranı %5,3 olarak bulundu. Literatürde cilt tutulumuna renal tutulumun eşlik etmesinin ve 10 günden uzun süreli kullanılan kortikosteroid tedavisinin nüks için risk faktörü olduğu gösterilmiştir. Çalışmamızda nüks ile ilişkili herhangi bir risk faktörü saptanmamakla beraber semptomlar başlamadan önce enfeksiyon öyküsü olan hastalarda daha az nüks geliştiği gösterildi. IgAV tanılı hastalarda nüksleri öngörmemize katkıda bulunan diğer olası faktörleri belirlemek için ileriye yönelik takip edilen geniş hasta serilerine ihtiyaç vardır

Anahtar Kelimeler

• Çocukluk çağı İmmünglobulin A vasküliti
• döküntü
• nüks
• tedavi

Kaynakça

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