Talk:Henoch–Schönlein purpura

note

Majority of medical information completed. Andrewr47 02:29, 13 April 2006 (UTC)

Working on this

henoch schonlein purpura is a systemic vasculitis and the cause is vibrio cholerae. After Arcadian's request I'm working my way through this page. I hadn't watched it for some time. For some reason the reference on which I based my initial 2004 version (Saulsbury 2001) was deleted, but I'm gradually sourcing it back.

I will update the diagnosis section further with the Rai 1999 paper (specifically the appearance of kidney biopsies). I will leave the pathophysiology section unchanged, as it is based on Saulsbury, but will do a literature search to ensure it is still up-to-date. The treatment section is largely from Saulsbury, but I will see if there are recent trials or Cochrane reviews that will improve this. JFW | T@lk 12:03, 16 December 2007 (UTC)

Source or perish

I could not find sources for the following content:

HSP accounts for about 3% of end-stage renal disease in children. The renal prognosis is excellent in most patients, especially those who have focal glomerular involvement with transient hematuria or proteinuria that resolves over several months. Renal prognosis is poor in those with nephrotic syndrome, renal insufficiency, and tubulointerstitial nephritis. Spontaneous recovery is possible even in those with more severe renal involvement.

We are already citing nephrotic syndrome and crescents are negatively prognostic, but none of my sources stated that complete recovery is possible. Whoever added the content is invited to return it with sources. JFW | T@lk 16:05, 23 December 2007 (UTC)

Immunofluorescence photo

At JFW's request, I searched through my photos and found a half-decent one of a positive IF. It's in. Emmanuelm (talk) 16:18, 29 February 2008 (UTC)

Perfect. Exactly what we needed. JFW | T@lk 00:56, 3 March 2008 (UTC)

Begin review notes for GA status

Ok then. I'll jot notes here: Cheers, Casliber (talk · contribs) 20:43, 6 April 2008 (UTC)

• Ok working through the text, would be nice to prosify the first sentence a bit more, and try to keep parentheses use to a minimum, as there are some spots where they are fine and they can be reserved for these. For:

  • Henoch-Schönlein purpura (HSP, also known as allergic purpura) is a systemic vasculitis (inflammation of blood vessels) characterized by deposition of immune complexes containing the antibody IgA especially in the skin and kidney.

  • Could try to make a bit smoother like:

    "Henoch-Schönlein purpura, also known as allergic purpura and commonly abbreviated to HSP, is a systemic vasculitis (inflammation of blood vessels) characterized by deposition of immune complexes containing the antibody IgA in the skin and kidney."

    •  Done
• With one or two concise adjectives clarify the age of children affected in the lead.
  • •  Done
• Should purpura be pluralised in the lead?
  • • I think so; the word is rarely ever used in singular form. JFW | T@lk 12:02, 7 April 2008 (UTC)
• but the disease may relapse (in 33% of cases) and cause irreversible kidney damage (in 1%) - parentheses redundant here.
  • •  Done
• In Presentation, I'd italicize classic triad, not quotes, as it isn't a quotation but particular emphasis on a way the terms are used.
  • •  Done
• purpura again - either its a collective noun, in which case "occur" should be "occurs" or pluralized (?)
  • • Purpura are a collective noun. An individual purpurus would not be cause for concern. JFW | T@lk 12:02, 7 April 2008 (UTC)
• this occurs in 33% of cases (sometimes but not necessarily due to intussusception). - again, parentheses unnecessary
  • •  Done
• I'd rename Renal disease subsection Renal involvement as it more aptly describes what is discussed
  • • Agree, but used "kidney involvement" for consistency  Done
• are the cause of the purpura (idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura). - again, try:
  • are the cause of the purpura, such as idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura.
    •  Done
• I tweaked "in which the" to "where" here to improve flow
  • • OK
• purpura (such as vasculitis due to cryoglobulinemia); - and again, a comma is fine here.
  • •  Done
• HSP can develop after infections with streptococci (β-haemolytic, Lancefield group A), hepatitis B, herpes simplex virus, parvovirus B19, Coxsackievirus, adenovirus, Helicobacter pylori,[1] measles, mumps, rubella, mycoplasma and numerous others.[5] Drugs linked to HSP, usually as an idiosyncratic reaction, include vancomycin, ranitidine, streptokinase, cefuroxime, diclofenac, enalapril and captopril. - this is a bit listy and can be improved by categorising slightly such as:
  • "Drugs linked to HSP, usually as an idiosyncratic reaction, include the antibiotics vancomycin and cefuroxime, antihypertensive ACE inhibitors enalapril and captopril, antiinflammatory agent diclofenac, as well as ranitidine and streptokinase."
    •  Done
  • Tried to split first bit into bacteria and viruses but doesn't work as well as I thought.
    • The sources are not very clear about the relative distribution of these causes, so I'm hesitant to prioritise any of another. JFW | T@lk 12:02, 7 April 2008 (UTC)
• In Treatment could mention whether analgesia is needed and if so, what type.
  • •  Done Totally agree - sources don't mention this. Therefore, I'll remain silent on the type although I would avoid NSAIDs (kidneys). JFW | T@lk 12:02, 7 April 2008 (UTC)
• In Recovery and recurrence, how old are the kids?
  • • I believe Saulsbury uses 10 as a cutoff. JFW | T@lk 12:02, 7 April 2008 (UTC)
• Given two subheadings with same name, rename Kidney involvement to Kidney failure or Kidney disease
  • •  Done
• Although not a deal-breaker for GA, would be nice to enlarge History section. Was there an official discussion to use the current name rather than the english one. Odd as the other antedated it, which in biology would give it precedence. Also, might be good to have any advances in investigation, old theories etc. here.
  • • On my travels I did not find many historical sources. I would respectfully ask for GA promotion while I delve into this further. It is not always known why certain names stick and others don't. It bears remembering that William Osler had to practice medicine without Medline, and was therefore restricted to the sources he could easily access. The common pattern is: (1) some old doc makes an observation, (2) a few decades later some other old doc sees a similar case and coins the eponym of his predecessor, (3) much later some younger docs discover that the observation had actually been made much earlier still. This is certainly the case in Crohn's disease and possibly Behcet's disease. JFW | T@lk 12:02, 7 April 2008 (UTC)

Overall, not too hard to get to GA. Easy fixes. Cheers, Casliber (talk · contribs) 21:15, 6 April 2008 (UTC)

Most recommendations actioned, variances annotated. Thanks Casliber. Hope we can promote this shortly. JFW | T@lk 12:02, 7 April 2008 (UTC)

Yes indeedy. GA it is. I'll try to think of anything else for FA...Cheers, Casliber (talk · contribs) 17:42, 7 April 2008 (UTC)

PS: I just realised I meant to suggest beefing up the lead a little. I added a line and was going to use as examples the infections and/or meds most associated with HSP but I wasn't sure which they were. Probably worth using the term classic triad in hte lead as it is a pretty fundamental concept in the syndrome. Cheers, Casliber (talk · contribs) 17:56, 7 April 2008 (UTC)

Thanks mate. I'm quite happy with your addition of causes to the lead, which I had forgotten to do. Given that the sources are vague on the proportions of these causes (and it may actually be unknown in the literature) I don't think we should pretend that we know.

Given that not all patients meet the classic triad, I'm a bit hesitant to push it in the lead. JFW | T@lk 18:08, 7 April 2008 (UTC)

Survey

WP:Good article usage is a survey of the language and style of Wikipedia editors in articles being reviewed for Good article nomination. It will help make the experience of writing Good Articles as non-threatening and satisfying as possible if all the participating editors would take a moment to answer a few questions for us, in this section please. Would you like any additional feedback on the writing style in this article? If you write a lot outside of Wikipedia, what kind of writing do you do? Is your writing style influenced by any particular WikiProject or other group on Wikipedia? At any point during this review, let us know if we recommend any edits, including markup, punctuation and language, that you feel don't fit with your writing style. Thanks for your time. - Dan Dank55 (talk) 15:34, 9 April 2008 (UTC)

P.S. The survey will end on April 30. - Dan Dank55 (talk) 01:38, 12 April 2008 (UTC)

This article has already been promoted. Your advice is obviously welcome. JFW | T@lk 18:17, 13 April 2008 (UTC)

hsp with ulcerativ colitis

would like to know any association in hsp and ulcerative colitis. the sister of this patient has muscular dystrophy. mail at rajivpahwa@yahoo.com —Preceding unsigned comment added by 203.94.197.48 (talk) 14:53, 28 August 2008 (UTC)

Normally, questions not directly related to the article should go on the reference desk. I am unaware of a link, and the diseases are immunologically quite distinct as UC is a disorder of the innate immune system while HSP is an IgA-mediated (and hence acquired immune system-related) vasculitis. Muscular dystrophy is a completely unrelated condition too. JFW | T@lk 19:53, 28 August 2008 (UTC)

Name change

There is nothing in our policies to start adding abbreviations to article names, per this rename of "Henoch-Schönlein Purpura" to "Henoch-Schönlein Purpura (HSP)". The stated reason of "Searching for this page by typing in HSP does not bring this page up. It is common to call this disease HSP even in the medical field and by attaching HSP to the title should" is wrong, for medicine does not have priority on wikipedia and HSP lists a large range of perfectly valid possibilities. But I am quite certain no one will search the page typing full "Henoch-Schönlein Purpura (HSP)". Else are we to have "Myocardial infarction (MI)" as "MI" alone goes to MI disambig page, "Diabetes mellitis (DM1, DM2, GM)" where there is a DM disambig page and bizzarely DM1 redirects to an article on a protein etc etc ? I will revert the move. David Ruben ^Talk 20:26, 8 May 2009 (UTC)

Finally the "Purpura" is not part of a proper name and so should remain in lowercase, per policy WP:TITLE#Lowercase. David Ruben ^Talk 20:33, 8 May 2009 (UTC)

I agree. Thanks for informing the new user about the concept of disambiguation. JFW | T@lk 09:41, 10 May 2009 (UTC)

Useful sources

Saulsbury has updated his review on HSP: doi:10.1097/BOR.0b013e32833af608

This might be an opportunity to update the article and get rid of some primary sources (mostly mine!)

• PMID 19885685 - renal views, article on PMC
• doi:10.1007/s00431-009-1101-2 - general paediatrics review
• PMID 17974746 - systematic review of steroids (2007)
• PMID 18190875 - review on immunobiology
• PMID 20388738 and PMID 20413568 - recent classification

Let's see if I find the time to fix this one up. JFW | T@lk 11:26, 22 November 2010 (UTC)

May need updating soon

A free 2009 review by the AAFP [1]Doc James (talk · contribs · email) 23:40, 7 January 2011 (UTC)

Anyone that is diagnosed with disease?

I was diagnose with this at the age of 31, I was a healthy male, one month after I received a Hepatitis B vaccine injection I came down with this disease. My daughters friend received her booster shot for hepatitis in kindergarten and a month later also came down with this disease. I was placed on 32mg Medrol by my Dr for a year. 20 yrs later I still show blood and protein in my urine but the doctor said i would always have that because of the biopsy they did for diagnosis. —Preceding unsigned comment added by 184.18.97.218 (talk) 13:53, 26 March 2011 (UTC)

Please see WP:TALK. I have no idea what exactly you want, but this is not the place. Persistent haematuria due to renal biopsies is rare. JFW | T@lk 20:55, 26 March 2011 (UTC)

My 6 year old daughter was diagnosed in April 2011. Her kidney involvement did not show until a month after the other symptoms began. She still has protein and blood in urine. Protein levels have decreased but blood had increased this week. She had strep throat and that is what caused HSP. I have heard there has been a rash of cases lately. — Preceding unsigned comment added by 68.228.182.12 (talk) 20:42, 24 June 2011 (UTC)

Again, please see WP:TALK. JFW | T@lk 00:06, 26 June 2011 (UTC)

Streptococci

I have temporarily removed the explicit discussion of streptococcal disease. The source (Internet Journal of Rheumatology) is weak and the journal isn't indexed on Pubmed. Much of the work seems to have been done by a single group in the 1990s (although Bywaters first suggested the association in 1957 in PMID 13432141). I don't think we should specifically discuss the use of complement in distinguishing between possible aetiologies. JFW | T@lk 21:56, 7 June 2016 (UTC)