Arthritis in the Subacute Stage of Kawasaki Disease after Responding to Intravenous Immunoglobulin Treatment

We evaluated the clinical and laboratory characteristics of five children with Kawasaki disease who had showed arthritis after responding to intravenous immunoglobulin(IVIG) treatment. Age distribution was between 13 months and six years of age(mean $3.2{\pm}1.6$ years). There were two males and three females. Arthritis occurred when acute symptoms were subsiding, with the average onset on day $5.8{\pm}1.8$ after final IVIG treatment. Arthritis was pauciarticular in three, and polyarticular in two. Regarding laboratory findings, one child was positive in rhematoid factor and changed to negative after two months. Three patients were examined for HLA B27 and all showed negative results. High dose aspirin(two cases), anti-inflammatory drug(ibprofen, three cases), and corticosteroids(methyprednisolon pulse therapy, one case) were used for this type of arthritis. Symptoms and signs of arthritis in all patients were improved by these therapies. There was no relapse or complications within six months. Arthritis after responding to IVIG therapy was rarely observed in children with Kawasaki disease. This type of arthritis responded well to anti-inflammatory drugs including corticosteroids, and showed no relapses.

가와사끼병에서 정맥용 면역글로불린에 반응 후 아급성기에 발생한 관절염

저자들은 가와사끼병으로 IVIG 치료로 해열을 보인 후, 급격히 발병한 관절염을 보인 5명의 환아에 대해 임상적 경과, 실험실 소견 등을 조사하였다. IVIG 치료에 반응 후 평균 5.8일 후에 관절염 증상이 나타났으며, 임상적 분류상 소수 관절형 형이 3례, 다수관절형이 2례로 나타났다. 검사실 소견에서 류마토이드 인자는 1례에서 양성을 보였으나 이 후 음성으로 전환되었다. 3명에서 조사된 HLA B27은 모두 음성을 보였다. 치료로는 고용량 아스피린(2례), 비스테로이드성 소염제(이부프로펜, 3례), 스테로이드제(메틸프레드니솔론, 1례)를 사용하였다. 가와사끼병의 경과 중 정맥용 면역글로불린 치료 후 관절염이 드물게 관찰된다. 이러한 관절염은 스테로이드제를 비롯한 항염증제에 양호한 반응을 보였고 재발은 관찰되지 않았다.