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Risk Factors Related to Recurrence of Immunglobulin A Vasculitis

Yıl 2023, Cilt: 45 Sayı: 2, 172 - 179, 15.03.2023
https://doi.org/10.20515/otd.1120184

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.

Kaynakça

  • 1. Ozen S, Marks SD, Brogan P, et al. European consensus-based recommendations for diagnosis and treatment of Immunoglobulin A vasculitis-the SHARE initiative. Rheumatology (Oxford). 2019;58 (9):1607-1616.
  • 2. Petty RE, Laxer RM, Lindsley CB, et al. (2021), Textbook of Pediatric Rheumatology. Eighth Edition. Philedephia: Elsevier. p:456-466.
  • 3. Ozen S, Pistorio A, Iusan SM, et al. EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008 Part II: final classification criteria. Ann Rheum Dis. 2010;69:798-806.
  • 4. Yang YH, Chuang YH, Wang LC, et al. The immunobiology of Henoch-Schonlein purpura. Autoimmun Rev. 2008;7(3): 179–84.
  • 5. Narchi H. Risk of long term renal impairment and duration of follow up recommended for Henoch‐ Schonlein purpura with normal or minimal urinary findings: a systematic review. Arch Dis Child. 2005; 90:916–920.
  • 6. Calvo-Rio V, Hernandez JL, Ortiz-Sanjuan F, et al. Relapses in patients with Henoch-Schonlein purpura: analysis of 417 patients from a single center. Medicine. 2016;95(28): e4217.
  • 7. Fretzayas A, Sionti I, Moustaki M, et al. HenochSchonlein purpura: a long-term prospective study in Greek children. J Clin Rheumat. 2008;14(6):324 –31.
  • 8. Wei-Te Lei, Po-Li Tsai, Szu-Hung Chu, et al. Incidence and risk factors for recurrent Henoch-Schönlein purpura in children from a 16-year nationwide database. Pediatric Rheumatology. 2018;16:25.
  • 9. Ji-Won Byun, Hee-Jin Song, Lucia Kim, et al. Predictive factors of relapse in adult with Henoch-Schönlein Purpura. Am J Dermatopathol. 2012;34:139–144.
  • 10. Trapani S, Micheli A, Grisolia F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum. 2005;35:143–53.
  • 11. Shin JI, Park JM, Shin YH, et al. Predictive factors for nephritis, relapse, and significant proteinuria in childhood Henoch-Schonlein purpura. Scand J Rheumatol. 2006;35:56–60.
  • 12. Prais D, Amir J, Nussinovitch M. Recurrent Henoch-Schonlein purpura in children. J Clin Rheumatol. 2007;13:25–8
  • 13. Rigante D, Candelli M, Federico G, et al. Predictive factors of renal involvement or relapsing disease in children with Henoch–Schönlein purpura. Rheumatol Int. 2005;25:45– 8.
  • 14. Alfredo CS, Nunes NA, Len CA, et al. Henoch-Schönlein purpura: recurrence and chronicity. J Pediatr (Rio J). 2007;83:177-80
  • 15. Calvino MC, Llorca J, García-Porrúa C, et al. Henoch-Schönlein Purpura in children from Northwestern Spain: A 20-Year Epidemiologic and Clinical Study. Medicine. 2001;80:279-90.
  • 16. Ekinci RMK, Balci S, Bisgin A, et al. MEFV gene variants in children with Henoch-Schönlein purpura and association with clinical manifestations: a single-center Mediterranean experience. Postgrad Med 2019;131(1):68-72.
  • 17. Cakici EK, Kurt Şükür ED, Özlü SG, et al. MEFV gene mutations in children with Henoch-Schönlein purpura and their correlations-do mutations matter? Clin Rheumatol 2019;38(7):1947-1952.
  • 18. Can E, Yaprak ZK, Hamilçıkan Ş, et al. MEFV gene mutations and clinical course in pediatric patients with Henoch-Schönlein purpura. Arch Argent Pediatric 2018;116(3):e385-e391.
  • 19. Lee YH, Kim YB, Koo JW, et al. Henoch-Schonlein Purpura in children hospitalized at a tertiary hospital during 2004-2015 in Korea: epidemiology and clinical management. Pediatr Gastroenterol Hepatol Nutr. 2016;19(3): 175–85.

İmmünglobulin A Vaskülit Nüksü ile İlişkili Risk Faktörleri

Yıl 2023, Cilt: 45 Sayı: 2, 172 - 179, 15.03.2023
https://doi.org/10.20515/otd.1120184

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

Kaynakça

  • 1. Ozen S, Marks SD, Brogan P, et al. European consensus-based recommendations for diagnosis and treatment of Immunoglobulin A vasculitis-the SHARE initiative. Rheumatology (Oxford). 2019;58 (9):1607-1616.
  • 2. Petty RE, Laxer RM, Lindsley CB, et al. (2021), Textbook of Pediatric Rheumatology. Eighth Edition. Philedephia: Elsevier. p:456-466.
  • 3. Ozen S, Pistorio A, Iusan SM, et al. EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008 Part II: final classification criteria. Ann Rheum Dis. 2010;69:798-806.
  • 4. Yang YH, Chuang YH, Wang LC, et al. The immunobiology of Henoch-Schonlein purpura. Autoimmun Rev. 2008;7(3): 179–84.
  • 5. Narchi H. Risk of long term renal impairment and duration of follow up recommended for Henoch‐ Schonlein purpura with normal or minimal urinary findings: a systematic review. Arch Dis Child. 2005; 90:916–920.
  • 6. Calvo-Rio V, Hernandez JL, Ortiz-Sanjuan F, et al. Relapses in patients with Henoch-Schonlein purpura: analysis of 417 patients from a single center. Medicine. 2016;95(28): e4217.
  • 7. Fretzayas A, Sionti I, Moustaki M, et al. HenochSchonlein purpura: a long-term prospective study in Greek children. J Clin Rheumat. 2008;14(6):324 –31.
  • 8. Wei-Te Lei, Po-Li Tsai, Szu-Hung Chu, et al. Incidence and risk factors for recurrent Henoch-Schönlein purpura in children from a 16-year nationwide database. Pediatric Rheumatology. 2018;16:25.
  • 9. Ji-Won Byun, Hee-Jin Song, Lucia Kim, et al. Predictive factors of relapse in adult with Henoch-Schönlein Purpura. Am J Dermatopathol. 2012;34:139–144.
  • 10. Trapani S, Micheli A, Grisolia F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum. 2005;35:143–53.
  • 11. Shin JI, Park JM, Shin YH, et al. Predictive factors for nephritis, relapse, and significant proteinuria in childhood Henoch-Schonlein purpura. Scand J Rheumatol. 2006;35:56–60.
  • 12. Prais D, Amir J, Nussinovitch M. Recurrent Henoch-Schonlein purpura in children. J Clin Rheumatol. 2007;13:25–8
  • 13. Rigante D, Candelli M, Federico G, et al. Predictive factors of renal involvement or relapsing disease in children with Henoch–Schönlein purpura. Rheumatol Int. 2005;25:45– 8.
  • 14. Alfredo CS, Nunes NA, Len CA, et al. Henoch-Schönlein purpura: recurrence and chronicity. J Pediatr (Rio J). 2007;83:177-80
  • 15. Calvino MC, Llorca J, García-Porrúa C, et al. Henoch-Schönlein Purpura in children from Northwestern Spain: A 20-Year Epidemiologic and Clinical Study. Medicine. 2001;80:279-90.
  • 16. Ekinci RMK, Balci S, Bisgin A, et al. MEFV gene variants in children with Henoch-Schönlein purpura and association with clinical manifestations: a single-center Mediterranean experience. Postgrad Med 2019;131(1):68-72.
  • 17. Cakici EK, Kurt Şükür ED, Özlü SG, et al. MEFV gene mutations in children with Henoch-Schönlein purpura and their correlations-do mutations matter? Clin Rheumatol 2019;38(7):1947-1952.
  • 18. Can E, Yaprak ZK, Hamilçıkan Ş, et al. MEFV gene mutations and clinical course in pediatric patients with Henoch-Schönlein purpura. Arch Argent Pediatric 2018;116(3):e385-e391.
  • 19. Lee YH, Kim YB, Koo JW, et al. Henoch-Schonlein Purpura in children hospitalized at a tertiary hospital during 2004-2015 in Korea: epidemiology and clinical management. Pediatr Gastroenterol Hepatol Nutr. 2016;19(3): 175–85.
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Merve Cansu Polat 0000-0003-3279-8435

Zahide Ekici Tekin 0000-0002-5446-667X

Elif Çelikel 0000-0003-0129-4410

Vildan Güngörer 0000-0002-9838-2603

Tuba Kurt 0000-0003-3711-8347

Nilüfer Tekgöz 0000-0002-2235-4489

Müge Sezer 0000-0002-9254-9935

Cüneyt Karagöl 0000-0002-2987-1980

Serkan Coşkun 0000-0003-2568-9329

Melike Kaplan 0000-0002-8012-2774

Nimet Öner 0000-0003-0403-151X

Banu Acar 0000-0002-1808-3655

Yayımlanma Tarihi 15 Mart 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 45 Sayı: 2

Kaynak Göster

Vancouver Polat MC, Ekici Tekin Z, Çelikel E, Güngörer V, Kurt T, Tekgöz N, Sezer M, Karagöl C, Coşkun S, Kaplan M, Öner N, Acar B. İmmünglobulin A Vaskülit Nüksü ile İlişkili Risk Faktörleri. Osmangazi Tıp Dergisi. 2023;45(2):172-9.


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