The Unyielding Challenge: Unraveling the Complexities of Treatment-Resistant Kawasaki Arthritis

Characteristics of persistent arthritis with refractory Kawasaki disease: a single-center retrospective study

Introduction

Kawasaki disease (KD) is an acute self-limiting vasculitis that primarily affects children. It is characterized by fever, inflammation of blood vessels, and various systemic symptoms. One of the complications of KD is arthritis, which occurs in 4.6-17.6% of patients. However, the clinical features and courses of persistent arthritis beyond the acute phase of KD have not been well studied.

In a recent single-center retrospective study conducted at Yokohama City University Hospital, researchers aimed to investigate the characteristics of persistent arthritis in KD patients who were resistant to intravenous immunoglobulin (IVIG) and other complications. They also evaluated the efficacy of musculoskeletal ultrasonography (MSUS) and biomarkers of joint damage, such as matrix metalloproteinase-3 (MMP-3).

Methods

The researchers examined the medical records of patients with KD who were treated at Yokohama City University Hospital between April 2008 and March 2019. They collected data on demographics, clinical features, treatment, and outcomes of patients with KD and persistent arthritis.

A total of 243 patients were included in the study, of whom 49 (20%) developed arthritis during the course of their KD. Among these patients, 33 (14%) had persistent arthritis beyond the subacute phase of KD.

Results

The results of the study showed that persistent arthritis in KD patients was frequently accompanied by other complications such as coronary artery lesions (15%) and resistant to first-line treatment with IVIG (91%). The majority of patients (73%) complained of arthralgia, and large lower-extremity joints were predominantly affected.

The researchers also found that the serum concentrations of C-reactive protein (CRP) and MMP-3 were significantly higher in patients with active arthritis compared to those in remission. MSUS showed positive power Doppler signals in periarticular soft tissue and joint fluid in most patients.

Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and prednisolone was effective in resolving the arthritis symptoms, and all patients achieved remission within three months. No severe adverse events were reported, and the prognosis for joint health was good.

Discussion

The findings of this study confirm that persistent arthritis is a common complication in refractory KD. It highlights the importance of recognizing and diagnosing arthritis in these patients, as it can significantly impact their quality of life. Prompt and appropriate treatment with NSAIDs and/or glucocorticoids is necessary to alleviate symptoms and prevent long-term joint damage.

The study also emphasizes the potential benefits of using MSUS and biomarkers like MMP-3 for the diagnosis and monitoring of arthritis in KD patients. These tools provide valuable insights into the pathogenesis of arthritis and can help guide treatment decisions.

Editorial and Advice

The results of this study have important implications for clinicians and researchers in the field of Kawasaki disease. It highlights the need for increased awareness and diagnostic accuracy when it comes to arthritis in KD patients. Early recognition and treatment of persistent arthritis can improve outcomes and prevent long-term complications.

The use of MSUS and biomarkers like MMP-3 can aid in the diagnosis and monitoring of arthritis in KD. These tools provide objective measures of joint inflammation and damage, which can help guide treatment decisions and assess the effectiveness of therapy.

It is important for healthcare professionals to stay updated on the latest research and guidelines in order to provide the best care for KD patients. The findings of this study warrant further research to explore the underlying mechanisms and risk factors for persistent arthritis in KD. Future studies should also evaluate the long-term outcomes and quality of life of patients with persistent arthritis.

In conclusion, this study sheds light on the characteristics of persistent arthritis in refractory KD and highlights the importance of early recognition and treatment. It provides valuable insights into the clinical features, diagnostic tools, and treatment options for arthritis in KD patients. By applying these findings in clinical practice, healthcare professionals can improve outcomes and provide better care for patients with KD and persistent arthritis.