COVID-19 quarantine in adolescents with autoimmune rheumatic diseases: mental health issues and life conditions

Abstract

Objectives To assess mental health and life conditions in adolescents with autoimmune rheumatic diseases (ARDs) and healthy controls quarantined during COVID-19 pandemic. Method A cross-sectional study included 155 ARD adolescents and 105 healthy controls. Online survey included selfreported strengths and difficulties questionnaire (SDQ), and a semi-structured questionnaire with demographic data, daily home and school routine, physical activities, and COVID-19 information during the pandemic. Results Among patients, 56% had juvenile idiopathic arthritis (JIA), 29% juvenile systemic lupus erythematosus (JSLE), and 15% juvenile dermatomyositis (JDM). No differences were found regarding sex, ethnicity, and current age between ARD patients and controls (p > 0.05). Abnormal emotional SDQ (38% vs. 35%, p = 0.653) were similar in both groups. Logistic regression analyses in ARD patients demonstrated that female (OR = 2.4; 95%CI 1.0-6.0; p = 0.044) was associated with severe emotional SDQ dysfunction, whereas sleep problems were considered as a risk factor for both worse total SDQ (OR = 2.6; 95%CI 1.2-5.5; p = 0.009) and emotional SDQ scores (OR = 4.6; 95%CI 2.2-9.7; p < 0.001). Comparisons between ARD patients with and without current prednisone use showed higher median scores of peer problems in the first group [3 (0-10) vs. 2 (0-7), p = 0.049], whereas similar median and frequencies between JIA, JSLE, and JDM (p > 0.05). Conclusions Approximately one third of JIA, JSLE, and JDM patients presented abnormal total and emotional scores of SDQ during COVID-19 quarantine. Sleep problems were the main factor associated with emotional difficulties in these ARD adolescents. The knowledge of mental health issues rates in adolescents with ARD supports the development of prevention strategies, like sleep hygiene counseling, as well as the references of the affected patients to specialized mental health services, as necessary. Key Points• One third of ARD patients presented mental health issues during COVID-19 quarantine • Sleep problems were associated with emotional difficulties. • It is necessary to warn pediatric rheumatologists about the importance of sleep hygiene counseling.

Evaluation of depressive and anxiety symptoms in childhood-onset systemic lupus erythematosus: Frequency, course, and associated risk factors

“…Similar mental health behaviours were found to be worse in those with cSLE and other childhood rheumatic diseases during the pandemic. 36 We did find that socio-demographic factors such as having a first-degree relative with a psychiatric condition and experiencing neighborhood-level material deprivation increased the risk for depressive symptoms in cSLE patients. However, this association was not observed for anxiety symptoms.…”

The impact of the COVID-19 pandemic on patients with juvenile idiopathic inflammatory myopathies

“…Accumulating evidence suggests an increased emotional burden experienced by patients with chronic disease throughout the pandemic [ 7 , 17 , 18 ]. This burden has been compounded by limited access to medical care, fears related to underlying illness and risks related to COVID-19, as well as stressors related to quarantine and social distancing.…”

A Review Pertaining to SARS-CoV-2 and Autoimmune Diseases: What Is the Connection?

“…Other sources report a higher susceptibility to infection in patients with autoimmune diseases, either because of active autoimmune disease or because of the drugs used to treat them [7]. On the other hand, the results of other studies do not show an association between more severe COVID-19 trajectories in people with autoimmune diseases [6,7,87,88,90,92]. However, the results of some studies have suggested that people with autoimmune diseases may have a protective factor that would protect them from the most severe complications of COVID-19 as a result of taking medication [2,7,90].…”

“…Since the outbreak of the COVID-19 pandemic, many questions have been raised about the risk of SARS-CoV-2 infection and associated complications in people with autoimmune diseases [14,87]. It is still unclear whether or not autoimmune diseases pose a high risk of severe complications [2,6,7,14,15].…”

“…Steroid use is also thought to increase the risk of COVID-19 infection due to immune suppression [1,88]. The antirheumatic drug tocilizumab, which is used for the treatment of RA, is thought to effectively improve the clinical symptoms of COVID-19 [14,87]. Janus kinase inhibitors (JAK inhibitors), such as filgotinib, ruxolitinib, baricitinib and upadacitinib, which are used in the treatment of psoriasis, rheumatoid arthritis, myelofibrosis and chronic inflammatory bowel disease, act by inhibiting tyrosine kinase, which is involved in viral transmission, to reduce viral infectivity and thereby prevent more severe inflammation.…”