Updates on the diagnosis, prognosis, and management of IgA vasculitis in adults: A narrative review.

Abstract

IgA vasculitis (IgAV) is classically associated with children, yet it is not uncommon in adults. Adult IgAV remains difficult to diagnose and manage because most existing criteria and therapeutic recommendations were developed for pediatric populations, leaving uncertainty around how to best diagnose and treat adult patients. To provide clinically useful, evidence-based guidance, we reviewed current literature on adult IgAV, including clinical features, diagnostic approaches, prognostic indicators, treatment strategies, and monitoring recommendations. Compared with pediatric cases, adults generally experience a more severe disease course, with higher rates of renal and gastrointestinal involvement and greater risk of long-term morbidity. Diagnostic evaluation in adults is complicated by the lack of adult-specific diagnostic criteria and variable direct immunofluorescence findings. Prognostic analyses consistently identified renal and gastrointestinal involvement, older age, and medical comorbidities as predictors of adverse outcomes. Treatment evidence remains limited, as randomized controlled trials are lacking. Monitoring recommendations emphasize prolonged renal follow-up, as abnormalities may appear several months after initial presentation. Overall, adult IgAV constitutes a distinct clinical entity with greater severity and management challenges than pediatric disease, underscoring the need for dedicated adult-focused research and the development of standardized diagnostic and treatment guidelines.