Original article
Arthritis presenting during the acute phase of Kawasaki disease

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Objective

To define the prevalence, pattern, and clinical course of arthritis presenting at the time of diagnosis of Kawasaki disease.

Study design

A single-center, retrospective study of 414 consecutive patients diagnosed with Kawasaki disease between January 1997 and December 2002 was performed. Standardized clinical assessments, laboratory and imaging test results, and treatment regimens were reviewed. The clinical, laboratory, treatment response, and coronary outcome data were analyzed for children with and without arthritis.

Results

The prevalence of arthritis was 7.5% (31/414). In the 31 children with arthritis, 55% had oligoarticular involvement and 45% had polyarticular involvement. In both of these groups, the large joints were predominantly involved. Some 88% of the children with arthritis responded to standard intravenous immunoglobulin therapy for acute Kawasaki disease and did not require additional medications. The children with arthritis had significantly increased levels of inflammatory markers, but their demographical and clinical features were otherwise similar to those of the children without arthritis, including coronary outcome, with the same proportion (13%) of children from each group having coronary artery lesions (z-score ≥ 2.5).

Conclusions

Arthritis is a short-lived phenomenon included in the clinical spectrum of acute Kawasaki disease. Children with arthritis have evidence of increased systemic inflammation but otherwise share the same clinical features, response to treatment, and coronary outcomes as patients without arthritis. Most cases of arthritis resolve without additional therapeutic intervention.

Section snippets

Methods

This single-center retrospective study identified 414 patients diagnosed with Kawasaki disease at The Hospital for Sick Children between January 1997 and December 2002. All patients with possible Kawasaki disease were seen in consultation with a pediatric rheumatologist. Children with suspected Kawasaki disease underwent standardized assessments that included complete clinical examination along with detailed musculoskeletal assessment, laboratory testing, electrocardiograhy, and

Patient Characteristics

A total of 414 children with Kawasaki disease were included in this study, of whom 266 were boys and 148 were girls. The majority of children (84%) had classical Kawasaki disease, and 16% had incomplete Kawasaki disease. The median age at diagnosis was 3.23 years (range, 0.19 to 17.72 years). The demographic and clinical features of these children are summarized in Table I. The children with arthritis and those without arthritis shared the same demographic characteristics and clinical features.

Discussion

Kawasaki disease is a multisystemic disease that includes inflammatory arthritis in its clinical spectrum. The prevalence of arthritis in acute Kawasaki disease in our study was 7.5%, compared with a previously reported prevalence of 31%.9 Similar proportions of patients had oligoarticular and polyarticular involvement, with predominantly large joints affected regardless of the pattern of involvement. However, 88% of affected children experienced a dramatic and rapid resolution of arthritis

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    • Rae S. M. Yeung is supported by a New Investigator Award from the Arthritis Society of Canada and the Canadian Institute of Health Research.

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