Increased Relapse Rate During COVID‐19 Lockdown in an Italian Cohort of Children With Juvenile Idiopathic Arthritis

Abstract

Objectives Changes of routine disease management associated with COVID‐19 lockdown might have potentially affected the clinical course of juvenile idiopathic arthritis (JIA). Aim of our study was to assess the rate of disease flare before and during COVID‐19 lockdown to investigate its impact on disease course in JIA children. Methods A single‐center retrospective study was conducted, including patients presenting inactive JIA between September 1 st , 2018 and March 9 th , 2019 (group A) and between September 1 st , 2019 and March 9 th , 2020 (group B). For each patient, demographic and clinical data were collected. The rate of JIA flare from March 10 th , 2019 to June 30 th , 2019 for group A and from March 10 th , 2020 to June 30 th , 2020 for group B was compared. Results Group A included 126 patients and group B 124 patients. Statistical analysis did not show significant differences among the two cohorts with respect to age, sex, age of JIA onset, JIA subtype, co‐occurrence of uveitis, ANA positivity and past or ongoing medications. The rate of disease flare during lockdown at time of first COVID‐19 pandemic wave, was significantly higher in comparison to the previous year (16.9% vs 6.3%, p=0.009). Conclusion Our study showed that COVID‐19 lockdown was associated with a higher rate of joint inflammation in JIA children. This finding has a considerable clinical implication, since restrictive measures may be necessary in order to contain pandemics. Our data highlight the need for rearrangement in the home and healthcare management of JIA children during lockdowns.

Genetic predisposition between coronavirus disease 2019 and rheumatic diseases: A 2‐sample Mendelian randomization study

“…A recent study found 3 of 10 JIA patients reported JIA flare after COVID‐19 infection 40 . A retrospective study comprising 250 subjects further confirmed that JIA flare was significantly higher (16.9%) during the COVID‐19 pandemic than in the previous year (6.3%) ( P = .009) 10 . The current data indicated that immunologically, joints might be another target organ of COVID‐19 infection.…”

“…In recent years, experts have reported an increased risk of rheumatic diseases in COVID‐19 patients, including anti‐neutrophil cytoplasmic antibodies (ANCA)‐associated vasculitis (AAV), juvenile idiopathic arthritis (JIA), primary biliary cholangitis (PBC), primary Sjögren's syndrome (pSS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and so forth, 7–11 demonstrating a potentially close relationship between COVID‐19 and rheumatic diseases. Explorations into the underlying mechanism of COVID‐19 indicated that abnormal adaptive and innate immune responses were related to the genesis and progression of COVID‐19 12,13 .…”

Adherence to treatment of children and adolescents recently diagnosed with auto-immune Rheumatic Diseases during the COVID-19 pandemic

“…Contrary to the findings of the present study, Naddei et al found that there was a worsening in the relapse rate in Italian children with JIA during the lockdown due to COVID-19, when comparing this population to a cohort one year prior to the lockdown, demonstrating the need for changes to home and health management during isolation. 27 This finding may be related to the fact that medical follow-up was stricter during the lockdown in Italy. When compared to the analyzed country, despite the lockdown, neither the follow-up of the Brazilian patients nor the supply of medications in the outpatient clinic and high-cost medication dispensing centers, were interrupted during the pandemic.…”

Comparing parental distress and children’s difficulties between parents of children with rheumatic diseases and parents of healthy children in families facing the COVID-19 pandemic

“…Some measures implemented to avoid the spread of the virus (such as social isolation, the closure of schools and the disruption of daily routine) could negatively affect children's mental health (Trumello et al, 2021). At the same time, changes in the daily disease management routine caused by COVID-19 lockdown might have potentially affected the clinical course of PRDs, bringing fewer physical activity and increased watching TV hours and/or video games playing time (Naddei et al, 2021).…”