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Relapses in patients with Henoch–Schönlein purpura
Author(s) -
V. Calvo-Río,
José L. Hernández,
Francisco Miguel Ortíz Sanjuán,
J. Loricera,
Natalia Palmou-Fontana,
M. Carmen GonzálezVela,
Domingo GonzálezLamuño,
Marcos A. GonzálezLópez,
Susana Armesto,
Ricardo Blanco,
Miguel Á. González-Gay
Publication year - 2016
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000004217
Subject(s) - medicine , interquartile range , purpura (gastropod) , abdominal pain , henoch schonlein purpura , vasculitis , surgery , gastroenterology , disease , ecology , biology
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

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