What Caught our Eye: Kawasaki Disease…Incomplete, or…not?
Brian Feldman, MD, MSc, FRCPC
I know that the rheumatology service isn’t involved in the treatment of most Kawasaki Disease patients at many centres. At SickKids, though, we are. Our team sees somewhere around 150 patients with KD a year.
I hear commonly, mostly from fellows who join us from other centres, that when it comes to KD, the faculty at SickKids tends to err on the side of over-treatment. How can one over-treat a condition for which randomized trials clearly indicate an important benefit of treatment? The newly arrived fellows imply that we over-diagnose.
Over-diagnosis and treatment with a completely benign therapy wouldn’t be a problem. However, the most commonly used therapy – intravenous immunoglobulin – is both costly and potentially harmful.
The diagnosis of Kawasaki Disease was originally made using the mucocutaneous lymph node syndrome (MCLS) criteria, of which you needed 5 of 6. As a “syndrome”, the call was easy. You either met the syndrome definition, or not.
By the early 1980s, though, it was recognized that there were children, who had developed coronary aneurysms typical for KD, who hadn’t met the MCLS criteria. They were labelled as having “atypical Kawasaki Disease.” A requirement for this diagnosis was having coronary aneurysms. Read More>>
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