Pediatric Arthritis & Other Rheumatic Diseases

Henoch-Schonlein Purpura (HSP)

What is Henoch-Schönlein purpura (HSP)?

Henoch-Schönlein purpura (HSP) is a form of vasculitis, a condition which involves inflammation of the blood vessels. It is one of the most common forms of vasculitis in childhood. HSP is seen most frequently in children between the ages of two and 11 years, and occurs more frequently in boys. A family connection has been noted with HSP, where the disease has happened to two or more siblings of the same family, either at the same time, or one after another.

What causes Henoch-Schönlein purpura?

As with the other forms of vasculitis, the cause of HSP is not known. HSP may be associated with an upper respiratory tract infection or possibly an allergic reaction. Most children with HSP recover completely.

What are the symptoms of Henoch-Schönlein purpura?

The following are the most common symptoms of Henoch-Schönlein purpura. However, each child may experience symptoms differently. Symptoms may include:

• purpura - hemorrhage (bleeding) into the skin, mucous membranes, internal organs, and other tissues.
  
  
• arthralgia - pain in the joints.
  
  
• inflammation of the joints.
  
  
• abdominal pain
  
  
• gastrointestinal bleeding - bleeding in the gastrointestinal, or GI, tract, which includes the mouth, esophagus, stomach, and intestines.
  
  
• nephritis - inflammation of the kidneys.
  
  
• subcutaneous edema - swelling just below the skin.
  
  
• encephalopathy - dysfunction of the brain.
  
  
• orchitis - inflammation of the testicle(s).

The symptoms of Henoch-Schönlein purpura may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is Henoch-Schönlein purpura diagnosed?

Henoch-Schönlein purpura is diagnosed based on criteria established by the American College of Rheumatology. These criteria include:

• palpable purpura - hemorrhage (bleeding) into the skin or mucous membranes and other tissues.
  
  
• at onset of the disease, the patient is younger than 20 years of age.
  
  
• bowel angina, or pain in the abdomen which is worse after meals, or bowel ischemia (decreased blood flow to an area), which may result in bloody diarrhea, among other signs.
  
  
• the presence of certain cells when a tissue sample from the purpura is examined under the microscope.

In addition, ultrasound (a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs) may be used to examine the gastrointestinal tract for presence of the disease.

Treatment for Henoch-Schönlein purpura:

Specific treatment for Henoch-Schönlein purpura will be determined by your child's physician based on:

• your child's overall health and medical history
• extent of the condition
• your child's tolerance for specific medications, procedures, and therapies
• expectation for the course of the disease
• specific organs that are affected
• your opinion or preference

Treatments for HSP may include:

• adequate hydration, or fluid intake
• careful attention to nutrition
• pain control with medications such as acetaminophen
• glucocorticoids (to control inflammation)