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Vol. 13. Issue 3.
Pages 145-149 (May - June 2017)
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Vol. 13. Issue 3.
Pages 145-149 (May - June 2017)
Original Article
DOI: 10.1016/j.reumae.2016.04.011
Has Articular Involment Lessened in Kawasaki Disease?
¿La enfermedad de Kawasaki ha perdido su afectación articular?
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Eva Pilar Álvarez
Corresponding author
evalvareza@hotmail.com

Corresponding author.
, Francis Rey, Sara Carolina Peña, Aranzazu Rubio, Cristina Calvo, Paz Collado
Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
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Tables (2)
Table 1. Clinical and Analytical Findings in Children Diagnosed With Kawasaki Disease.
Table 2. Cardiac Involvement in Complete and Incomplete Kawasaki Disease and in Patients With Arthritis.
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Abstract
Objective

Kawasaki disease (KD) is an acute systemic vasculitis affecting medium-sized arteries, particularly the coronary arteries. Classic diagnosis is based in prolonged fever and different clinical features, including acute arthritis. Our objective is to determine the prevalence of arthritis at the moment of the diagnosis, the response to intravenous immunoglobulin infusion and the relation with cardiac findings.

Material and methods

Retrospective study through review of medical records of 42 patients with KD from 1988 to 2013. Demographic, clinical, laboratory variables and treatment were reviewed.

Results

Male sex was predominant (57%). Fever (100%), exanthema (92.9%), conjunctivitis (78.6%), oropharingeal changes (76.2%), cervical lymphadenopathy (71.4%), edema (52.4%) and peripheral desquamation (46.3%) were reported. Eight patients presented ecocardiography alterations (ectasia and aneurism). Acute articular involvement was reported in 7 (16%) patients, including oligoarticular (57%), monoarticular (29%) and polyarticular (14%) patterns. All patients had elevation of acute phase reactants with neutrophilia (57%) and hypoalbuminemia (71.5%), but showed a good therapeutic response to intravenous immunoglobulin, without sequelaes. Sixteen patients had incomplete KD nine males, with 100% of fever exanthema (75%), conjunctivitis (56%) and 50% of cervical lymphadenopathy. Whereas oropharingeal changes and edemas was described in 44% and 25% of them. Four patients with incomplete KD had coronary artery abnormalities.

Conclusions

Acute arthritis was an uncommon finding (16%) and resulted in no sequelae. Maybe the treatment with intravenous immunoglobulin and aspirin prevents the development of articular abnormalities and then leading to a decrease in its follow-up requirement by reumathologist. The cardiovascular sequelae, mainly incomplete KD, remains determining its prognosis. The presence of articular involvement seems not to have influence over cardiac involvement.

Keywords:
Kawasaki disease
Articular involvement
Aneurysm
Inmunoglobulins
Resumen
Objetivo

La enfermedad de Kawasaki (EK) es una vasculitis sistémica aguda de arterias de tamaño medio, especialmente las coronarias. Su diagnóstico clásico se basa en la presencia de fiebre prolongada y diversas manifestaciones clínicas. En la era preinmunoglobulinas, la artritis aguda constituía un hallazgo común. Nuestro objetivo es definir la prevalencia de la artritis al diagnóstico, su respuesta a inmunoglobulinas intravenosas y su relación con eventos cardiacos.

Material y métodos

Estudio retrospectivo de 42 pacientes con EK desde enero de 1988 a noviembre de 2013. Las variables demográficas, clínicas, laboratorio y tratamiento fueron revisadas.

Resultados

Se encontró predominio de varones (57,1%), fiebre (100%), exantema (92,9%), conjuntivitis (78,6%), afectación oral (76,2%), adenopatía cervical (71,4%), edema (52,4%) y descamación (46,3%). Ocho pacientes presentaron clínica cardiológica y ecocardiograma con alteraciones coronarias. Siete pacientes (16%) presentaron afectación articular aguda. El 57% fue oligoarticular con predominio de tobillos, 29% monoarticular de cadera y 14% poliarticular. El 100% aumentó los reactantes de fase aguda, con neutrofilia (57%) e hipoalbuminemia (71,5%). Todos respondieron a inmunoglobulinas intravenosas, sin afectación cardiaca ni secuelas posteriores. Hubo dieciséis EK incompletos: nueve varones, con fiebre (100%), exantema (75%), conjuntivitis (56%), adenopatía cervical (50%), alteración de mucosa oral (44%) y edemas (25%). Cuatro tuvieron afectación cardiaca (un aneurisma; tres ectasias).

Conclusiones

La artritis aguda fue poco frecuente (16%) y sin secuelas posteriores. El tratamiento con inmunoglobulinas intravenosas y ácido acetilsalicílico posiblemente previene su desarrollo, disminuyendo el seguimiento por Reumatología. La afectación cardiaca, principalmente en EK incompleta, sigue marcando su pronóstico, sin hallar empeoramiento cardíaco en pacientes con artritis.

Palabras clave:
Enfermedad de Kawasaki
Afectación articular
Aneurismas
Inmunoglobulinas

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