The spectrum of vasculitis in children

Prediction of renal damage in children with IgA vasculitis based on machine learning

This article is objected to explore the value of machine learning algorithm in predicting the risk of renal damage in children with IgA vasculitis by constructing a predictive model and analyzing the related risk factors of IgA vasculitis Nephritis in children. Case data of 288 hospitalized children with IgA vasculitis from November 2018 to October 2021 were collected. The data included 42 indicators such as demographic characteristics, clinical symptoms and laboratory tests, etc. Univariate feature selection was used for feature extraction, and logistic regression, support vector machine (SVM), decision tree and random forest (RF) algorithms were used separately for classification prediction. Lastly, the performance of four algorithms is compared using accuracy rate, recall rate and AUC. The accuracy rate, recall rate and AUC of the established RF model were 0.83, 0.86 and 0.91 respectively, which were higher than 0.74, 0.80 and 0.89 of the logistic regression model; higher than 0.70, 0.80 and 0.89 of SVM model; higher than 0.74, 0.80 and 0.81 of the decision tree model. The top 10 important features provided by RF model are: Persistent purpura ≥4 weeks, Cr, Clinic time, ALB, WBC, TC, Relapse, TG, Recurrent purpura and EB-DNA. The model based on RF algorithm has better performance in the prediction of children with IgA vasculitis renal damage, indicated by better classification accuracy, better classification effect and better generalization performance.

Vasculitis: Decade in Review

BACKGROUND

In the last decade, we have come to better understand and manage the vasculitides. The classification of vasculitides has been revised. Genome- wide association studies and linkage analyses have been undertaken in hope of better understanding the pathogenesis of vasculitides. Comprehensive genetic studies have highlighted new pathways that may guide us in more targeted therapies. Description of the monogenic forms of vasculitis, such as deficiency of adenosine deaminase type 2 (DADA2), Haploinsufficiency of A20 (HA20), have introduced a new perspective to vasculopathies, and introduced alternative treatments for these diseases.

CONCLUSION

In this review, the important discoveries in pathogenesis and consensus treatment recommendations from the past decade will be summarized.

Pediatric forms of vasculitis

Primary vasculitides that affect children are a challenging and complex group of disorders that may involve any system of the body and lead to significant morbidity and mortality. In recent years, there have been significant advances in the field of childhood vasculitides, including the development of classification criteria and outcome assessment. Although some forms of vasculitis occur in both children and adults, considerable differences exist between childhood and adult vasculitides; we review childhood vasculitides, thus highlighting their differences with the adult forms of the disease. We will also discuss monogenic forms of vasculitis, such as deficiency of adenosine deaminase type 2 (DADA2) and haploinsufficiency of A20 (HA20).

Henoch-Schöenlein purpura and diabetes mellitus in a 9-year-old African-American male

A 9-year-old boy with a past medical history of asthma was admitted from the emergency department (ED) for evaluation of a rash, polyarthralgia, and hyperglycemia noted at the referring hospital. The rash was reported as purpuric "bumps," which started 3 days prior to presentation. The rash had initially presented on the lower extremities and had progressively worsened as well as spread to both upper extremities. He also complained of pain in his right knee and lower extremity swelling with limited flexion bilaterally. There was no history of polyphagia, polydipsia, nausea, vomiting, diarrhea, abdominal pain, headache, or fever. The patient mentioned that he had lost approximately 10 lbs during the past year, but he had been trying to lose weight.

Cranial nerve involvement with juvenile polyarteritis nodosa: clinical manifestations and treatment

Juvenile polyarteritis nodosa, a rare systemic vasculitis, may present with a wide variety of clinical manifestations. Neurologic involvement has been reported in as high as 50% to 70% of patients; however, the incidence of cranial nerve palsies is extremely uncommon. We report here the case of a 20-month-old girl with juvenile polyarteritis nodosa who developed cranial nerve III palsy, demonstrated both clinically and radiographically on MRI despite aggressive management with immunosuppressants. Neurologic manifestations resolved with treatment including corticosteroids and cyclophosphamide; however, persistent fevers, rash, and headaches interfered with attempts at a corticosteroid taper. Subsequent therapy with a combination of mycophenolate mofetil and infliximab proved highly efficacious in inducing disease remission and eventual discontinuation of corticosteroids. Knowledge about the management of refractory juvenile polyarteritis nodosa is limited. Here we report a rare case of cranial nerve involvement, as demonstrated on MRI, and successful management with a regimen of mycophenolate mofetil and infliximab.

Vascular and connective tissue diseases in the paediatric world

Despite the fact that in recent decades many advances have been made in classification, outcomes measurements and therapeutic regimens, connective tissue diseases remain a challenge for paediatric rheumatologists. Corticosteroids are still the first choice therapy in juvenile systemic lupus erythematosus (SLE); however, it is time for a new therapeutic approach with immunosuppressant drugs in order to obtain a more prolonged survival and reduced organ system damage. A prevention of relapse of thromboembolic phenomena using low-dose aspirin is strongly suggested in children with anticardiolipin antibodies, particularly in those with SLE. The long-term prognosis in juvenile dermatomyositis is significantly improved due to a more aggressive treatment with corticosteroids and methotrexate. The treatment of Henoch-Schöenlein purpura is still under debate, and no agreement has been reached regarding the role of corticosteroids in the prevention of renal involvement. The management of the acute phase of Kawasaki disease is now well established, although there is controversy regarding the role of corticosteroids. It is still under debate how and whether to treat patients who do not fulfil the diagnostic criteria. Polyarteritis nodosa is a disease at risk of death and requires an aggressive approach with corticosteroids and immunosuppressants, while cutaneous polyarteritis needs a close control of an underlying streptococcus infection and prophylaxis with benzatin-penicillin to prevent relapses.

The significance of IgA class of antineutrophil cytoplasmic antibodies (ANCA) in childhood Henoch-Schönlein purpura

Antineutrophil cytoplasmic antibodies (ANCA) have been identified in a wide variety of vasculitic disorders, but it is controversial whether ANCA are present in the sera of patients with HSP. This prospective study was designed to assess the place of ANCA, particularly their IgA subclass, in HSP. Thirty-five patients (18 boys, 17 girls) aged 9.4 +/- 4 (3-16) years with a clinical diagnosis of HSP based on American College of Rheumatology (ACR) criteria were enrolled. Thirteen patients (6 boys, 7 girls) aged 8.3 +/- 5.5 (2-21) years with other vasculitides, consisting of classic polyarteritis nodosa (PAN) (n = 2); cutaneous polyarteritis nodosa (n = 1); acute infantile hemorrhagic edema (n = 2); acute urticarial vasculitis (n = 2); hypocomplementemic vasculitis (n = 1); and unclassified vasculitis (n = 5) served as disease controls and 10 healthy children served as normal controls. Twenty-five HSP patients and 7 disease controls were re-evaluated in the resolution phase that was described as 4-6 weeks after all symptoms subsided and all medications were stopped. Blood samples for ANCA and IgA rheumatoid factor (RF) were studied by indirect immunofluorescence (IIF) and ELISA, respectively. IgG ANCA was significantly lower in percentage in HSP patients (2.8%) than in disease controls (40%) (p = 0.002). In contrast, IgA ANCA in cytoplasmic pattern was detected in a significantly higher percentage of HSP patients (82.3%) in the acute phase compared to those in the disease controls (38%) (p = 0.004). In the resolution phase, IgA ANCA was negative in 88% of the patients (p = 0.001 for acute vs resolution phases). Neither IgG nor IgA ANCA were seen in normal controls. No relationship was found between disease severity of HSP and IgA ANCA. Positive IgA rheumatoid factor was present in only two patients with HSP. In conclusion, our results suggest that IgA ANCA may be useful to confirm the diagnosis of HSP in children.