Differences between adult and pediatric onset Henoch-Schonlein purpura from North India

Int J Rheum Dis. 2018 Jan;21(1):292-298. doi: 10.1111/1756-185X.13221. Epub 2017 Nov 8.

Abstract

Aim: Henoch-Schönlein purpura (HSP), a primary vasculitis, characterized by purpura, abdominal pain, arthritis and renal involvement, is predominantly a disease of childhood. However, rarely it can occur in adults in whom it is believed to be a more severe form with poor renal outcomes. We aimed to answer if the age of onset affected the clinical spectrum and renal outcomes of the disease in a north Indian population. Hence, we studied the differences in clinical spectrum and renal outcomes between adult-onset HSP and childhood-onset HSP.

Methods: Case records of all adult patients diagnosed with HSP (onset ≥ 18 years) over the last 25 years in our department (1992-2017) were retrieved. Data on clinical features, lab abnormalities and outcomes were extracted and compared with that in pediatric HSP patients (onset < 18 years) seen during the same period.

Results: A total of 87 patients, including 30 adults and 57 children, were seen during this period. Compared to children, most of the adults had purpura as the first clinical manifestation (86.7% vs. 56.1%, P < 0.01) whereas abdominal pain was only rarely the initial symptom in adults (10.0% vs. 36.8%, P < 0.02). During the disease course, adults had a higher frequency of joint involvement as compared to children (90.0% vs. 43.9%, P < 0.001). There was no significant difference in the frequency of renal involvement (60.0% vs. 50.9%, P = NS) and gastrointestinal involvement (66.7% vs. 84.2%, P = NS) between adults and children. Outcomes were good in both groups and most adults and children achieved complete recovery (83.3% and 86.0%, respectively). There was no difference in the frequency of immunosuppressive treatment required by the two groups. None of the patients developed renal insufficiency on follow-up.

Conclusion: Compared to children, adults with HSP seldom have abdominal pain as the first clinical manifestation while joint involvement is seen more commonly in them during the disease course.

Keywords: Henoch-Schönlein purpura; IgA vasculitis; adults; children; renal outcomes.

Publication types

  • Comparative Study

MeSH terms

  • Abdominal Pain / diagnosis
  • Abdominal Pain / etiology*
  • Adolescent
  • Adult
  • Age of Onset
  • Child
  • Child, Preschool
  • Female
  • Gastrointestinal Diseases / etiology
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • India
  • Joint Diseases / diagnosis
  • Joint Diseases / etiology*
  • Kidney Diseases / etiology
  • Male
  • Middle Aged
  • Prognosis
  • Purpura, Schoenlein-Henoch / complications*
  • Purpura, Schoenlein-Henoch / diagnosis
  • Purpura, Schoenlein-Henoch / drug therapy
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Young Adult

Substances

  • Immunosuppressive Agents