Clinical and Experimental Medicine

, Volume 19, Issue 2, pp 167–172 | Cite as

Prevalence and characteristics of arthritis in Kawasaki disease: a Chinese cohort study

  • Yu Peng
  • Xiaohui Liu
  • Zhao Duan
  • Yuhong Deng
  • Sufen Cai
  • Zhi Wang
  • Kun Xu
  • Hui Kang
  • Man Jiang
  • Lin Li
  • Yulan ZhouEmail author
  • Zheng ZouEmail author
Original Article


Arthritis is a major complication of Kawasaki disease (KD). The aims of this study were to define the frequency and the clinical characteristics of arthritis in KD in China and to analyze the relation between arthritis and coronary outcome in KD. We included 1420 KD patients followed at Jiangxi Children’s Hospital from January 2014 to December 2017. Demographic, clinical and laboratory features of KD were analyzed. Among the 1420 patients enrolled, 151 had arthritis. The median age of KD patients with arthritis was 29 months and older than those without arthritis (20 months). Of the 151 patients developed arthritis, 101 patients (66.9%) had oligoarticular involvement and 50 patients (33.1%) had polyarticular involvement. Early-onset and late-onset arthritis were, respectively, observed in 123 (81.45%) and 28 (18.54%) patients. The KD patients with arthritis had significantly increased levels of inflammatory markers, and we observed a higher incidence rate of coronary artery aneurysms among those with arthritis (7.28%) compared to those without arthritis (2.75%) (p = 0.003), but the prevalence of coronary artery lesions (CALs) was similar in the two groups. The arthritis in KD was self-limited, left no sequelae and did not require additional medications. KD patients with arthritis were more likely to get coronary artery aneurysms than the patients without arthritis, so examination of joints in KD was necessary.


Kawasaki disease (KD) Arthritis Coronary artery lesions (CALs) Articular outcome 



This work was supported by the Natural Science Foundation of Jiangxi Province under Grant No. 20122BAB205085 and the Health Committee Foundation of Jiangxi Province under Grant No. 20185445.

Author contributions

ZZ and YZ contributed to the study design. YP organized the study and performed the writing of the manuscript. YP and YZ performed the statistical analysis. XL, ZD, YD, SC, ZW, KX, HK, MJ and LL performed the data entry. All authors have participated in the discussion of the manuscript and approved the final version of the manuscript.


This study was funded by the Natural Science Foundation of Jiangxi Province (Grant Number 20122BAB205085 to Prof. Zou) and the Health Committee Foundation of Jiangxi Province (Grant Number 20185445 to Dr. Peng).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Ethics Committee of Jiangxi Province Children’s Hospital.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi. 1967;16(3):178–222.PubMedGoogle Scholar
  2. 2.
    Bayers S, Shulman ST, Paller AS. Kawasaki disease: part I. Diagnosis, clinical features, and pathogenesis. J Am Acad Dermatol. 2013;69(4):501 e1-11; quiz 11-2.
  3. 3.
    Bayers S, Shulman ST, Paller AS. Kawasaki disease: part II. Complications and treatment. J Am Acad Dermatol. 2013;69(4):513 e1-8; quiz 21-2.
  4. 4.
    Alves NR, Magalhaes CM, Almeida RDF, Santos RC, Gandolfi L, Pratesi R. Prospective study of Kawasaki disease complications: review of 115 cases. Rev Assoc Med Bras (1992). 2011;57(3):295–300.CrossRefGoogle Scholar
  5. 5.
    Baker AL, Lu M, Minich LL, Atz AM, Klein GL, Korsin R et al. Associated symptoms in the 10 days before diagnosis of Kawasaki disease. J Pediatr. 2009;154(4):592-5 e2.
  6. 6.
    Gong GW, McCrindle BW, Ching JC, Yeung RS. Arthritis presenting during the acute phase of Kawasaki disease. J Pediatr. 2006;148(6):800–5. Scholar
  7. 7.
    Shike H, Kanegaye JT, Best BM, Pancheri J, Burns JC. Pyuria associated with acute Kawasaki disease and fever from other causes. Pediatr Infect Dis J. 2009;28(5):440–3. Scholar
  8. 8.
    Colomba C, La Placa S, Saporito L, Corsello G, Ciccia F, Medaglia A, et al. Intestinal involvement in Kawasaki disease. J Pediatr. 2018. Scholar
  9. 9.
    Jen M, Brucia LA, Pollock AN, Burnham JM. Cervical spine and temporomandibular joint arthritis in a child with Kawasaki disease. Pediatrics. 2006;118(5):e1569–71. Scholar
  10. 10.
    Duzova A, Topaloglu R, Keskin M, Ozcelik U, Secmeer G, Tokgozoglu AM. An unusual pattern of arthritis in a child with Kawasaki syndrome. Clin Rheumatol. 2004;23(1):73–5. Scholar
  11. 11.
    Izumi G, Narugami M, Saita Y, Matsuzawa T, Sugawara O, Kawamura N, et al. Arthritis associated with Kawasaki disease: MRI findings and serum matrix metalloproteinase-3 profiles. Pediatr Int. 2011;53(6):1087–9. Scholar
  12. 12.
    D’Angelo F, Varisco PA, So A, Taponnier M, Zufferey P. A 19-year-old woman with polyarthritis, anterior uveitis and coronary vasculitis: a case of adult Kawasaki disease. Joint Bone Spine. 2015;82(6):468–70. Scholar
  13. 13.
    Martins A, Conde M, Brito M, Gouveia C. Arthritis in Kawasaki disease: a poorly recognised manifestation. J Paediatr Child Health. 2018. Scholar
  14. 14.
    Singh S, Vignesh P, Burgner D. The epidemiology of Kawasaki disease: a global update. Arch Dis Child. 2015;100(11):1084–8. Scholar
  15. 15.
    Manlhiot C, Mueller B, O’Shea S, Majeed H, Bernknopf B, Labelle M, et al. Environmental epidemiology of Kawasaki disease: linking disease etiology, pathogenesis and global distribution. PLoS ONE. 2018;13(2):e0191087. Scholar
  16. 16.
    McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017;135(17):e927–99. Scholar
  17. 17.
    Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the committee on rheumatic fever, endocarditis, and Kawasaki disease, council on cardiovascular disease in the young. American Heart Association. Pediatrics. 2004;114(6):1708–33. Scholar
  18. 18.
    Melish ME, Hicks RV. Kawasaki syndrome: clinical features. Pathophysiology, etiology and therapy. J Rheumatol Suppl. 1990;24:2–10.PubMedGoogle Scholar
  19. 19.
    Lee KY, Oh JH, Han JW, Lee JS, Lee BC. Arthritis in Kawasaki disease after responding to intravenous immunoglobulin treatment. Eur J Pediatr. 2005;164(7):451–2. Scholar
  20. 20.
    Shulman ST, Rowley AH. Kawasaki disease: insights into pathogenesis and approaches to treatment. Nat Rev Rheumatol. 2015;11(8):475–82. Scholar
  21. 21.
    Cohen E, Sundel R. Kawasaki disease at 50 years. JAMA Pediatr. 2016;170(11):1093–9. Scholar
  22. 22.
    Selmi C, Gershwin ME. Diagnosis and classification of reactive arthritis. Autoimmun Rev. 2014;13(4–5):546–9. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of RheumatologyJiangxi Province Children’s HospitalNanchangChina
  2. 2.Department of HematologyThe First Affiliated Hospital of Nanchang UniversityNanchangChina

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