Henoch-Schönlein purpura history and symptoms: Difference between revisions

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==Overview==
==Overview==
===History and symptoms===
The signs and symptoms of Henoch-Schönlein purpura (HSP) are skin lesions such as palpable [[purpura]], abdominal pain, [[melena]], bloody [[diarrhea]], [[hematemesis]], [[duodenal]] [[ulcers]], [[arthralgia]].
[[Purpura]], [[arthritis]] and [[abdominal pain]] are known as the "classic triad" of Henoch-Schönlein purpura.<ref name=Kraft1998>{{cite journal |author=Kraft DM, Mckee D, Scott C |title=Henoch-Schönlein purpura: a review |journal=Am Fam Physician|volume=58 |issue=2 |pages=405–8, 411 |year=1998 |pmid=9713395 |url=http://www.aafp.org/afp/980800ap/kraft.html}}</ref> Purpura occur in all cases, joint pains and arthritis in 80%, and abdominal pain in 62%. Some include [[Gastrointestinal bleeding|gastrointestinal hemorrhage]] as a fourth criterion - this occurs in 33% of cases (sometimes but not necessarily due to [[Intussusception (medical disorder)|intussusception]]).<ref name=Saulsbury1999>{{cite journal |author=Saulsbury FT |title=Henoch-Schönlein purpura in children. Report of 100 patients and review of the literature |journal=Medicine (Baltimore) |volume=78 |issue=6 |pages=395–409 |year=1999|pmid=10575422 |doi=}}</ref> The purpura typically appear on the legs and buttocks, but may also be seen on the arms, face and trunk. The abdominal pain is [[colic]]ky in character. The joints involved tend to be the [[ankle]]s, [[knee]]s, and [[elbow]]s but arthritis in the hands and feet is possible; the arthritis is non-erosive and hence causes no permanent deformity.<ref name=Kraft1998/> 40% have evidence of [[kidney]] involvement, mainly in the form of [[hematuria]] (blood in the urine), but only a quarter will have this in sufficient quantities to be noticeable without laboratory tests.<ref name=Saulsbury1999/> Problems in other organs, such as the[[central nervous system]] (brain and spinal cord) and [[lung]]s may occur, but much less commonly than the skin, bowel and kidneys.<ref name=Saulsbury2001/>
 
==History==  
Obtaining history gives important information in making a diagnosis of HSP. It provides an insight into the cause, precipitating factors, and associated comorbid conditions. A complete history will help determine the correct therapy and helps in determining the [[prognosis]]. The areas of focus should be on onset, duration, and progression of [[symptoms]] such as
 
==Signs and Symptoms==
Clinical features of HSP:<ref name="pmid29438165">{{cite journal |vauthors=Louie CY, Gomez AJ, Sibley RK, Bass D, Longacre TA |title=Histologic Features of Gastrointestinal Tract Biopsies in IgA Vasculitis (Henoch-Schönlein Purpura) |journal=Am. J. Surg. Pathol. |volume=42 |issue=4 |pages=529–533 |date=April 2018 |pmid=29438165 |doi=10.1097/PAS.0000000000001036 |url=}}</ref><ref name="pmid18351468">{{cite journal |vauthors=Ebert EC |title=Gastrointestinal manifestations of Henoch-Schonlein Purpura |journal=Dig. Dis. Sci. |volume=53 |issue=8 |pages=2011–9 |date=August 2008 |pmid=18351468 |doi=10.1007/s10620-007-0147-0 |url=}}</ref><ref name="pmid28637108">{{cite journal |vauthors=Kim KY |title=[Henoch-Schönlein Purpura Presenting as Intussusception] |language=Korean |journal=Korean J Gastroenterol |volume=69 |issue=6 |pages=372–376 |date=June 2017 |pmid=28637108 |doi=10.4166/kjg.2017.69.6.372 |url=}}</ref><ref name="pmid19687709">{{cite journal |vauthors=Mannenbach MS, Reed AM, Moir C |title=Atypical presentation of Henoch-Schönlein purpura |journal=Pediatr Emerg Care |volume=25 |issue=8 |pages=513–5 |date=August 2009 |pmid=19687709 |doi=10.1097/PEC.0b013e3181b0a46f |url=}}</ref><ref name="pmid9767498">{{cite journal |vauthors=Choong CK, Beasley SW |title=Intra-abdominal manifestations of Henoch-Schönlein purpura |journal=J Paediatr Child Health |volume=34 |issue=5 |pages=405–9 |date=October 1998 |pmid=9767498 |doi= |url=}}</ref>
* '''Skin'''- The skin lesions start as [[Macule|maculae]] progressing to papules and then to [[Purpura|palpable purpura]] involving the symmetrical dependent areas such as buttocks, back, upper and lower limbs.
** Other skin lesions include [[hives]], [[angioedema]], and target lesions.
* '''Gastrointestinal'''
**Abdominal pain
**[[Melena]]
**[[Bloody diarrhea]]
**[[Hematemesis]]
**[[Duodenal ulcers]]
**[[GI bleeding|GI bleed]]
* '''Joints'''
**[[Arthralgia]] is most common in the knees and ankles and rarely the [[interphalangeal joints]] and wrist.


The disease tends to last about 4 weeks, and then resolves spontaneously.<ref name=Saulsbury2001/> On the basis of symptoms, it is possible to distinguish HSP from [[hypersensitivity vasculitis]] (HV). In a series comparing 85 HSP patients with 93 HV patients, five symptoms were found to be indicative of HSP: palpable purpura, [[abdominal angina]], digestive tract hemorrhage (not due to intussussception), hematuria and age less than 20. The presence of three or more of these indicators has an 87% [[Sensitivity (tests)|sensitivity]] for predicting HSP.<ref name="pmid1613701">{{cite journal |author=Michel BA, Hunder GG, Bloch DA, Calabrese LH |title=Hypersensitivity vasculitis and Henoch-Schönlein purpura: a comparison between the 2 disorders|journal=J. Rheumatol. |volume=19 |issue=5 |pages=721–8 |year=1992 |pmid=1613701}}</ref>
==References==
==References==


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{{reflist|2}}
[[Category:Disease]]
[[Category:Rheumatology]]
[[Category:Pediatrics]]
[[Category:Nephrology]]
[[Category:Autoimmune diseases]]
[[Category:Hematology]]
[[Category:Mature chapter]]


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Latest revision as of 20:20, 15 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The signs and symptoms of Henoch-Schönlein purpura (HSP) are skin lesions such as palpable purpura, abdominal pain, melena, bloody diarrhea, hematemesis, duodenal ulcers, arthralgia.

History

Obtaining history gives important information in making a diagnosis of HSP. It provides an insight into the cause, precipitating factors, and associated comorbid conditions. A complete history will help determine the correct therapy and helps in determining the prognosis. The areas of focus should be on onset, duration, and progression of symptoms such as

Signs and Symptoms

Clinical features of HSP:[1][2][3][4][5]

References

  1. Louie CY, Gomez AJ, Sibley RK, Bass D, Longacre TA (April 2018). "Histologic Features of Gastrointestinal Tract Biopsies in IgA Vasculitis (Henoch-Schönlein Purpura)". Am. J. Surg. Pathol. 42 (4): 529–533. doi:10.1097/PAS.0000000000001036. PMID 29438165.
  2. Ebert EC (August 2008). "Gastrointestinal manifestations of Henoch-Schonlein Purpura". Dig. Dis. Sci. 53 (8): 2011–9. doi:10.1007/s10620-007-0147-0. PMID 18351468.
  3. Kim KY (June 2017). "[Henoch-Schönlein Purpura Presenting as Intussusception]". Korean J Gastroenterol (in Korean). 69 (6): 372–376. doi:10.4166/kjg.2017.69.6.372. PMID 28637108.
  4. Mannenbach MS, Reed AM, Moir C (August 2009). "Atypical presentation of Henoch-Schönlein purpura". Pediatr Emerg Care. 25 (8): 513–5. doi:10.1097/PEC.0b013e3181b0a46f. PMID 19687709.
  5. Choong CK, Beasley SW (October 1998). "Intra-abdominal manifestations of Henoch-Schönlein purpura". J Paediatr Child Health. 34 (5): 405–9. PMID 9767498.

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