[Rheumatoid purpura]

Schönlein-Henoch purpura is a clinical syndrome characterized by the association of skin, joint and gastrointestinal symptoms consisting respectively in purpura, arthralgia and abdominal pain. The incidence of renal symptoms ranges from 33 to 50%. The long term prognosis is related to the renal disease which is characterized by a glomerular involvement, with hematuria and sometimes proteinuria. In more severe cases, a nephrotic syndrome is present with a decrease in renal function. A renal biopsy is performed when proteinuria is in excess of 1 g/day. It shows a mesangial proliferation and in more severe cases extracapillary proliferation while mesangial IgA deposits are seen by immunofluorescence. Severe forms require a treatment with corticosteroids, started with methylprednisolone pulses. Treatment should be started early in the course of the disease before glomerular crescents become fibrous.