Relapses in patients with Henoch–Schönlein purpura

To further investigate into the relapses of Henoch?Schönlein purpura (HSP), we analyzed the frequency, clinical features, and\udpredictors of relapses in series of 417 unselected patients from a single center. After a median follow-up of 12 (interquartile range\ud[IQR]: 2?38) years, almost one-third of the 417 patients (n=133; 32%; 85men/48 women) had experienced at least 1 relapse. At\udthe time of disease diagnosis, patients who later experienced relapses had less commonly infections than those who never\udsuffered flares (30.8% vs 41.9%; P=0.03). In contrast, patients who experienced relapses had a longer duration of the first\udepisode of palpable purpura than those without relapses (palpable purpura lasting >7 days; 80.0% vs 68.1%; P=0.04).\udAbdominal 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\udpatients who later developed relapses. In contrast, patients who never suffered relapses had a slightly higher frequency of fever at\udthe time of disease diagnosis (9.3% vs 3.8%; P=0.06). At the time of disease diagnosis, corticosteroids were more frequently\udgiven to patients who later had relapses of the disease (44% vs 32% in nonrelapsing patients; P=0.03). Relapses generally\udoccurred soon after the first episode of vasculitis. The median time from the diagnosis of HSP to the first relapse was 1 (IQR: 1?2)\udmonth. The median number of relapses was 1 (IQR 1?3). The main clinical features at the time of the relapse were cutaneous\ud(88.7%), gastrointestinal (27.1%), renal (24.8%), and joint (16.5%) manifestations. After a mean±standard deviation follow-up of\ud18.9±9.8 years, complete recovery was observed in 110 (82.7%) of the 133 patients who had relapses. Renal sequelae\ud(persistent renal involvement) was found in 11 (8.3%) of the patients with relapses. The best predictive factors for relapse were\udjoint and gastrointestinal manifestations at HSP diagnosis (odds ratio [OR]: 2.22; 95% confidence interval [CI]: 1.34?3.69, and\udOR: 1.60; 95% CI: 1.01?2.53, respectively). In contrast, a history of previous infection was a protective factor for relapses (OR:\ud0.60; 95% CI: 0.38?0.94). In conclusion, joint and gastrointestinal manifestations at the time of diagnosis of HSP are predictors of\udrelapses