Arthritis Persisting After IVIG Treatment in Kawasaki Disease Without Coronary Artery Aneurysms

In acute Kawasaki disease, some patients develop arthritis that does not fully resolve following IVIG therapy. When coronary artery aneurysms are absent, this persistent arthritis represents a distinct clinical scenario with a specific evidence-based management approach aimed at achieving resolution of joint inflammation.

Clinical scenario: Arthritis persisting after IVIG treatment, with absence of coronary artery aneurysms.
Therapeutic goal: Resolution of arthritis.

Treatment approach

An anti-inflammatory strategy using NSAIDs is conditionally recommended for this scenario, with specific guidance on concurrent aspirin management. The complete clinical algorithm, course details, and prescribing considerations are available in the full structured protocol.

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References

DOI: 10.1002/art.42041

For patients with acute KD who have arthritis that persists after IVIG treatment and who do not have coronary artery aneurysms, using nonsteroidal antiinflammatory drugs (NSAIDs) to treat arthritis is conditionally recommended over not using NSAIDS.

For patients without coronary artery aneurysms who do not require long-term use of aspirin and who have arthritis requiring additional therapy, aspirin can be temporarily suspended and a short course (3–4 weeks) of NSAIDs can be used as needed.

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