Analysis On Clinical Characteristics Of Kawasaki Disease With Joint Involvement In Children

Objective:To study the clinical characteristics of Kawasaki disease(KD)children with joint involvement,to provide reference for clinical diagnosis and treatment of Kawasaki disease,and to reduce the incidence of coronary artery lesion.Methods:Gathering 636 Kawasaki disease child patients,received and cured by pediatric department in Bethune First Hospital of Jilin University,from January,2009 to April,2015,among them,31 were KD with joint involvement,the rest 605 were KD without joint involvement.The clinical and auxiliary examination data of the child patients were retrospectively analyzed.According to whether there were the local symptoms of the joints or not,they were divided into joint involvement group and non-joint involvement group.According to the number of joint involvement,they were divided into single joint involvement group and multiple joint(?2 joints)involvement group.Statistically analyzing basic clinical features,coronary artery lesion,immunoglobulin reactivity,etc.,by comparing the ones with joint involvement and the ones without,the ones with single joint involvement and the ones with multiple joint(?2joints)involvement.Results:1.Among 31 KD child patients with joint involvement,26 cases(83.9%)were diagnosed with complete KD and 5 cases(16.1%)were diagnosed with incomplete KD,thus it can be seen that joint involvementwas more common in children with complete KD.2.31 KD child patients with joint involvement are aged from 16 months to 14 years old,the average age was 4.9 years old,6 cases(19.4%)were less than 3 years old,16 cases(51.6%)were 3~ 5 years old,9cases(29.0%)were more than 5 years old,thus it can be seen that 3~5years old was the peak age for KD with joint involvement.3.Among 31 KD child patients with joint involvement,there were20 cases(64.5%)of knee joint involvement,8 cases(25.8%)of ankle joint involvement,5 cases(16.1%)of hip joint involvement,3 cases(9.7%)of elbow joint involvement,2 cases(6.5%)of wrist joint involvement,2cases(6.5%)of shoulder joint involvement,6 cases(19.4%)of finger joint involvement,3 cases(9.7%)of toe joint involvement,and the knee joint involvement was more common.There were 23 cases(74.2%)of less joint(? 4 joints)involvement,including 7 cases(22.6%)of single joint involvement,8 cases(25.8%)of multiple joint(? 5 joints)involvement,and the multiple joint(?2 joints)involvement was more common.4.When joints were involved,the local joint symptom lasted for 1~20 days,tracking follow-ups,no one with joint sequelae,joint involvement was a transient symptom of KD,and there were no sequelae occurred.5.31 KD child patients with joint involvement,the incidences of clinical manifestations in order were as follows:31 cases(100%)of fever,30 cases(96.8%)of bilateral conjunctival hyperemia,29 cases(93.5%)of lips and oral changes,24 cases(77.4%)of extremities changes,22 cases(71.0%)of erythra,22 cases(71.0%)of neck lymphadenopathy,10cases(32.3%)of perianal desquamation,1 cases(3.2%)of bcg scar red.There were 16 cases(51.6%)accompanied with coronary artery lesions(CAL),of which 9 cases(56.25%)had only left coronary artery involvement,it occupied the most,the second was bilateral coronary arteryinvolvement in 6 cases(37.5%).6.There are majority of children with joint involvement ? 3 years old,there are minority of children without joint involvement ? 3 years old,the difference in age composition between two groups was statistically significant(P<0.05).The fever time of the children in joint involvement group was longer than that in non-joint involvement group,and the difference was statistically significant(P<0.05).WBC,neutrophil percentage and C-reactive protein of the children in joint involvement group were higher than those in non-joint involvement group,and the difference was statistically significant(P<0.05).The coronary vascular damage rate of the children in joint involvement group was higher than that in non-joint involvement group,but the difference was not statistically significant(P>0.05).The IVIG non-response rate of the children in joint involvement group was higher than that in non-joint involvement group,and the difference was statistically significant(P<0.05).7.Neutrophil percentage of the children in multiple joint(?2 joints)involvement group was higher than that in single joint involvement group,and the difference was statistically significant(P< 0.05).Conclusion:1.KD with joint involvement mostly occurs in children over 3 years old,3~5 years old is peak age.2.Complete KD is easy to be accompanied with joint involvement.3.When KD accompanies with joint involving,it tends to multiple joint(?2 joints)involvement,and both big and small joints are able to be involved,more common in the big joint,especially in knee joint involvement.4.KD accompanying with joint involvement has no affect on theincidence of coronary artery lesion.5.KD accompanying with joint involvement behaves poor reactivity to immunoglobulin.6.Joint involvement is a transient symptom of KD,without sequelae.