Joint Affection in Henoch-Schönlein Purpura

Abstract

Background. Hemorrhagic vasculitis, or Henoch-Schönlein purpura (HSP), in children has its onset in the form of the articular syndrome in the vast number of patients, which is a part of the diagnostic criteria of this disease. The nature of the arthritis after the disease transformation from the juvenile HSP remains unexplored. In adulthood, articular patho­logy can manifest as migratory intermittent or chronic arthritis, but this information should be clarified. The objective was to study the clinical, X-ray and sonographic features of arti­cular syndrome course in patients with HSP and to evaluate the features of arthropathy in the presence of the disease that began in childhood and adulthood. Materials and methods. The study included 174 patients with HSP (83 % of men and 47 % of women). Childhood-onset vasculitis (on average in 12 years) was diagnosed in 92 patients, and adulthood-onset (on avera­ge in 25 years) — in 82; I, II and III degree of activity of the pathological process are established at a ratio of 1 : 2 : 2. Results. The joint affection is observed in every second patient with HPS, which is closely related to the patient’s age at the onset of the disease, duration and degree of the activity of pathological process, seropositivity by the high content of immunoglobulin A and rheumatoid factor. At that, clinical, radiological and sonographic nature of the articular syndrome’s course (involving the wrist, hip and sacroiliac joints, the development of aseptic osteonecrosis, bone erosion, meniscitis and intraarti­cular cartilage flaps) depend on extraarticular manifestations of the di­sease (lesion of heart, kidney, pancreas, central nervous system). They are accompanied by an increased concentration in the blood of β2-microglobulin and circulating immune complexes that together with the values of fibrinogenemia have predictive value. Dimorphism of HSP, transformed from a juvenile one, is characterized by the less serum levels of fibronectin, circulating immune complexes and rheumatoid factor. Conclusions. The changes in the joints, regardless of the age of patients at the onset of HSP, occur with the same rate in every second case, but arthropathy in adults is more severe with joining of the additional clinical, radiographic and sonographic features.

Keywords

• hemorrhagic vasculitis
• joints
• children
• adults