Rheumatology - Henoch-Schonlein Purpura Flashcards
What is Henoch-Schonlein Purpura?
IgA vasculitis that presents with a purpuric rash affecting the lower limbs
Why does organ inflammation occur in HSP?
IgA deposits in blood vessels
What is affected by HSP?
Skin
Kidneys
GI tract
What causes HSP?
Often triggered by URTI or gastroenteritis
When is HSP most common?
Children under 10
What are the 4 classic features of HSP?
Purpura 100%
Joint pain 75%
Abdominal pain 50%
Renal involvement 50%
What causes the purpuric rash in HSP?
Inflammation and leaking of blood from small blood vessels under the skin
Where are children affected by purpura?
Starts on legs and spreads to buttocks
Can affect trunk and arms
In severe cases, skin ulceration and necrosis can occur
In HSP what joints are most commonly affected?
Knees
Ankles
Joints become swollen and painful with reduced ROM
What does abdominal pain indicate in HSP?
GI involvement
In severe cases can lead to:
- GI haemorrhage
- Intussusception
- Bowel infarction
What is the impact on the kidneys in HSP?
IgA nephritis
Can lead to microscopic or macroscopic haematuria and proteinuria
If there is more than 2+ protein on the urine dipstick, the child has developed a nephrotic syndrome and will have some oedema
How is HSP diagnosed?
Exclude serious pathology
- Meningococcal sepsis
- Leukaemia
- Idiopathic thrombocytopenic purpura
- Haemolytic uraemic syndrome
What investigations are done to diagnose HSP?
Investigations are used to exclude other pathology and assess organ involvement
- FBC and blood film- thrombocytopenia, sepsis and leukaemia
- Renal profile
- Serum albumin - nephrotic syndrome
- CRP - sepsis
- Blood culture- sepsis
- Urine dip - proteinuria
- ACR - proteinuria
- Blood pressure
What criteria are used for HSP diagnosis?
EULAR
PRINTO
Requires patient to have palpable purpura and at least one
- Diffuse abdominal pain
- Arthritis or arthralgia
- IgA deposits on histology
- Proteinuria or haematuria
How is HSP managed?
Supportive
Simple analgesia, rest and hydration
Steroid use is debatable, can be considered if severe GI pain or renal involvement
Close monitoring during active illness
