Long-Term Risk of Comorbidity after IgA Vasculitis in Childhood: A Population-Based Cohort Study
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ORIGINAL RESEARCH
Long-Term Risk of Comorbidity after IgA Vasculitis in Childhood: A Population-Based Cohort Study Johannes Nossent
. Warren Raymond . Helen Keen .
Charles Inderjeeth . David Preen
Received: July 20, 2020 / Accepted: September 22, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: Patients with IgA vasculitis (IgAV) may require aggressive treatment and are prone to disease relapses, and IgA deposition in tissues can persist. We investigated whether these factors predispose to long-term morbidity in children with IgAV. Methods: Observational cohort study comparing rates for comorbidity development by Charlson comorbidity index (CCI) and rates for hospitalization, procedures, and emergency department (ED) visits over a 20-year period for IgAV patients \ 20 years (n = 494) and matched Electronic Supplementary Material The online version of this article (https://doi.org/10.1007/s40744020-00239-y) contains supplementary material, which is available to authorized users. J. Nossent (&) W. Raymond H. Keen C. Inderjeeth Rheumatology Section, Medical School, University Western Australia, Perth, Australia e-mail: [email protected] J. Nossent C. Inderjeeth Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia H. Keen Department of Rheumatology, Fiona Stanley Hospital, Perth, Australia D. Preen School of Population and Global Health, University Western Australia, Perth, Australia
hospital-based controls (n = 1385). Odds (OR) for events and rate ratios (RR) for event rates per 1000 person-years were derived from maximum likelihood estimates. Results: Patient survival (99.1 vs. 99.7%, p = 0.6) and overall comorbidity accrual CCI (0.21 vs. 0.23, p = 0.7) were similar for IgAV patients and hospital-based controls after 20 years. IgAV patients did not develop other rheumatic diseases, but more often were diagnosed with peptic ulcer and end-stage renal failure. Hospitalization rates were three times higher for IgAV patients (RR 3.41 CI 3.04–3.82) in the first year following diagnosis, while ED attendance rates were higher in subsequent years (RR 1.29; 1.02–1.04; p \ 0.01) for IgAV patients. Conclusions: Childhood IgAV patients have good long-term prognosis despite the occurrence of end-stage renal failure and compared to hospital-based controls are at not at increased risk for other comorbidity or rheumatic disease. Keywords: IgA vasculitis; Longitudinal; Morbidity; Procedures; Readmissions
Rheumatol Ther
Key Summary Points Why carry out this study? Little is known about the long-term risk of developing comorbid conditions other than renal failure in patients presenting with IgA vasculitis (IgAV) in childhood. Using the prognostically important Charlson Comorbidity Index we investigated the risk and type of comorbid conditions during more than 20 years follow-up of childhood IgAV patients. What was learned from the study? IgAV vasculitis in children does not increase the risk of other rheumatic disease or diabetes mellitus over the next 20 years. With current management o
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