Abstract
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.
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References
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.
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. https://doi.org/10.1016/j.jaad.2013.07.002.
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. https://doi.org/10.1016/j.jaad.2013.06.040.
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.
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. https://doi.org/10.1016/j.jpeds.2008.10.006.
Gong GW, McCrindle BW, Ching JC, Yeung RS. Arthritis presenting during the acute phase of Kawasaki disease. J Pediatr. 2006;148(6):800–5. https://doi.org/10.1016/j.jpeds.2006.01.039.
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. https://doi.org/10.1097/INF.0b013e318193ec8e.
Colomba C, La Placa S, Saporito L, Corsello G, Ciccia F, Medaglia A, et al. Intestinal involvement in Kawasaki disease. J Pediatr. 2018. https://doi.org/10.1016/j.jpeds.2018.06.034.
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. https://doi.org/10.1542/peds.2006-1089.
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. https://doi.org/10.1007/s10067-003-0828-9.
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. https://doi.org/10.1111/j.1442-200X.2011.03393.x.
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. https://doi.org/10.1016/j.jbspin.2014.10.021.
Martins A, Conde M, Brito M, Gouveia C. Arthritis in Kawasaki disease: a poorly recognised manifestation. J Paediatr Child Health. 2018. https://doi.org/10.1111/jpc.14102.
Singh S, Vignesh P, Burgner D. The epidemiology of Kawasaki disease: a global update. Arch Dis Child. 2015;100(11):1084–8. https://doi.org/10.1136/archdischild-2014-307536.
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. https://doi.org/10.1371/journal.pone.0191087.
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. https://doi.org/10.1161/CIR.0000000000000484.
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. https://doi.org/10.1542/peds.2004-2182.
Melish ME, Hicks RV. Kawasaki syndrome: clinical features. Pathophysiology, etiology and therapy. J Rheumatol Suppl. 1990;24:2–10.
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. https://doi.org/10.1007/s00431-005-1653-8.
Shulman ST, Rowley AH. Kawasaki disease: insights into pathogenesis and approaches to treatment. Nat Rev Rheumatol. 2015;11(8):475–82. https://doi.org/10.1038/nrrheum.2015.54.
Cohen E, Sundel R. Kawasaki disease at 50 years. JAMA Pediatr. 2016;170(11):1093–9. https://doi.org/10.1001/jamapediatrics.2016.1446.
Selmi C, Gershwin ME. Diagnosis and classification of reactive arthritis. Autoimmun Rev. 2014;13(4–5):546–9. https://doi.org/10.1016/j.autrev.2014.01.005.
Acknowledgements
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.
Funding
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).
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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.
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Peng, Y., Liu, X., Duan, Z. et al. Prevalence and characteristics of arthritis in Kawasaki disease: a Chinese cohort study. Clin Exp Med 19, 167–172 (2019). https://doi.org/10.1007/s10238-019-00547-w
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DOI: https://doi.org/10.1007/s10238-019-00547-w