European consensus-based recommendations for diagnosis and treatment of immunoglobulin A vasculitis-the SHARE initiative
Language English Country Great Britain, England Media print
Document type Consensus Development Conference, Journal Article, Practice Guideline, Research Support, Non-U.S. Gov't
PubMed
30879080
DOI
10.1093/rheumatology/kez041
PII: 5382174
Knihovny.cz E-resources
- Keywords
- IgA vasculitis (Henoch–Schönlein purpura), childhood/paediatric, diagnosis, management, recommendations, systemic vasculitis,
- MeSH
- Analgesia methods MeSH
- Biopsy MeSH
- Child MeSH
- Gastrointestinal Diseases diagnosis etiology MeSH
- Glucocorticoids therapeutic use MeSH
- Glomerulonephritis, IGA diagnosis drug therapy etiology pathology MeSH
- IgA Vasculitis complications diagnosis drug therapy pathology MeSH
- Immunoglobulin A analysis MeSH
- Angiotensin-Converting Enzyme Inhibitors therapeutic use MeSH
- Skin pathology MeSH
- Kidney pathology MeSH
- Humans MeSH
- Evidence-Based Medicine methods MeSH
- Severity of Illness Index MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Consensus Development Conference MeSH
- Research Support, Non-U.S. Gov't MeSH
- Practice Guideline MeSH
- Names of Substances
- Glucocorticoids MeSH
- Immunoglobulin A MeSH
- Angiotensin-Converting Enzyme Inhibitors MeSH
OBJECTIVES: IgA vasculitis (IgAV, formerly known as Henoch-Schönlein purpura) is the most common cause of systemic vasculitis in childhood. To date, there are no internationally agreed, evidence-based guidelines concerning the appropriate diagnosis and treatment of IgAV in children. Accordingly, treatment regimens differ widely. The European initiative SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) aims to optimize care for children with rheumatic diseases. The aim therefore was to provide internationally agreed consensus recommendations for diagnosis and treatment for children with IgAV. METHODS: Recommendations were developed by a consensus process in accordance with the EULAR standard operating procedures. An extensive systematic literature review was performed, and evidence-based recommendations were extrapolated from the included papers. These were evaluated by a panel of 16 international experts via online surveys and subsequent consensus meeting, using nominal group technique. Recommendations were accepted when ⩾80% of experts agreed. RESULTS: In total, 7 recommendations for diagnosis and 19 for treatment of paediatric IgAV were accepted. Diagnostic recommendations included: appropriate use of skin and renal biopsy, renal work-up and imaging. Treatment recommendations included: the importance of appropriate analgesia and angiotensin-converting enzyme inhibitor use and non-renal indications for CS use, as well as a structured approach to treating IgAV nephritis, including appropriate use of CS and second-line agents in mild, moderate and severe disease along with use of angiotensin-converting enzyme inhibitors and maintenance therapy. CONCLUSION: The SHARE initiative provides international, evidence-based recommendations for the diagnosis and treatment of IgAV that will facilitate improvement and uniformity of care.
Department of Paediatric Rheumatology Alder Hey Children's NHS Foundation Trust Liverpool UK
Department of Paediatric Rheumatology Bicêtre University Hospital Paris France
Department of Paediatric Rheumatology University Children's Hospital Ljubljana Ljubljana Slovenia
Department of Paediatrics Hacettepe University Ankara Turkey
Gaslini Children's Hospital Genoa Italy
General University Hospital and 1 Faculty of Medicine Charles University Prague Czech Republic
Hospital for Children and Adolescents University of Helsinki Helsinki Finland
Meir Medical Centre Tel Aviv University Tel Aviv Israel
Necker Hospital Assistance Publique Hôpitaux de Paris Paris France
Sophia Children's Hospital Erasmus University Medical Centre Rotterdam The Netherlands
The Hospital for Sick Children University of Toronto Toronto Canada
Wilhelmina Children's Hospital University Medical Center Utrecht
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