PA Medical News about Purpura, Schoenlein-Henoch

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Henoch-Schonlein Purpura
American Family Physician, 09/30/09

Reamy BV et al. – Most patients have an antecedent upper respiratory illness. More than 90 percent of Henoch–Schönlein purpura cases occur in children younger than 10 years; however, adults with this condition are more likely to experience complications than children. All patients with Henoch–Schönlein purpura develop a purpuric rash, 75 percent develop arthritis, 60 to 65 percent develop abdominal pain, and 40 to 50 percent develop renal disease. Because Henoch–Schönlein purpura spontaneously resolves in 94 percent of children and 89 percent of adults, supportive treatment is the primary intervention. Oral prednisone at 1 to 2 mg per kg daily for two weeks has been used to treat abdominal and joint symptoms. A meta–analysis found that corticosteroid use in children reduced the mean time to resolution of abdominal pain and decreased the odds of developing persistent renal disease. Early aggressive therapy with high–dose steroids plus immunosuppressants is recommended for patients with severe renal involvement. Long–term prognosis depends on the severity of renal involvement. End–stage renal disease occurs in 1 to 5 percent of patients.