A case of henoch-Sch?nlein purpura complicated by hemorrhagic gastroenteritis and IgA nephropathy in a patient suffering with juvenile rheumatoid arthritis / 대한내과학회지

Henoch-Sch?nlein purpura (HSP) is a systemic vasculitis with IgA dominant immune complex deposits that affect the small vessels in the skin, joints, gastrointestinal tract and kidneys. Gastrointestinal symptoms are common and the manifestations include abdominal pain, bleeding, bowel infarction, intussusceptions or even perforation. Polyarticular onset juvenile rheumatoid arthritis (JRA) is a rare form of arthritis that affects children and young adults. The relationship between HSP and JRA is uncertain. We report on a 24-year-old man with a history of polyarticular onset JRA and HSP that was complicated by hemorrhagic gastroenteritis. The gastroscopy and colonoscopic findings showed extensive hemorrhagic inflammatory changes of the gastric and intestinal mucosa. The patient had severe bloody diarrheal symptoms, abdominal pain and gross hematuria. The 24 hours urine chemistry profile showed the proteinuria was greater than 4.5 g/day, and immunofluorescent staining of the renal biopsy specimen showed diffuse granular mesangial deposits of IgA and C3. The abdominal manifestations and proteinuria were improved after methylprednisolone therapy.

A Clinical Study on Polyarticular Juvenile Rheumatoid Arthritis (JRA) (III. Polyarticular Type) / 대한류마티스학회지

OBJECTIVE: The purpose of this study was to analyse clinical manifestations and laboratory findings in childhood patients with polyarticularonset juvenile rheumatoid arthritis (JRA). METHODS: Eleven cases of polyarticular JRA who were diagnosed and treated in the Department of Pediatrics, Seoul National University Children's Hospital from June 1988 to May 1995 were investigated for clinical manifestations and laboratory findings. RESULTS: 1) There were 6 males and 5 females and their ages of onset were 4 years to 15.1 years(mean 10.9 years). 2) Systemic manifestations were not observed, but low-grade fever was noted in 5 patients. 3) The involvement of joints was symmetric in 9 patients and asymmetric in 2 patients. 4) The most commonly affected joints were knees and ankles, followed by proximal interphalangeal joints of hand, shoulder, elbow, temporomandibular joint, and other joints. 5) Roentgenographic changes of joints were detected in 6 patients and bone scan in 7 patients showed increased uptake in the involved joints. 6) The main laboratory findings observed were microcytic and hypochromic anemia (64%), thrombocytosis (82%), elevated eryhtrocyte sedimentation rate (100%), positive or increased C-reactive protein(100%), positive rheumatoid factor(RF) (18%), positive antinuclear antibody(ANA) (27%). RF was positive in 2 girls with later age of onset and the pattern of immunofluorescent ANA were all homogeneous. 7) Nonsteroid antiinflammatory drugs (NSAIDs) were used most frequently and steroid with or without sulfasalazine was tried in 4 patients unresponsive to NSAIDs. 8) At last follow-up, 6 cases(55%) were classified as functional class I, 4 cases(36%) as class II, and 1 case(9%) as class III. CONCLUSION: These data showed the clinical manifestations and laboratory findings of polyarticularonset juvenile rheumatoid arthritis in Korean children.