Juvenile Idiopathic Arthritis and COVID-19 Pandemic: Good Compliance With Treatment, Reluctance to Return to School

Abstract

Objective: The SARS-CoV-2 pandemic has induced an exceptional sanitary crisis, potentially having an impact on treatment continuation, for juvenile idiopathic arthritis (JIA) patients receiving immunosuppressive therapies. After national lockdowns, many patients were also concerned about their safety at school. We evaluated the impact of the pandemic on the optimal continuation of treatment and on the return to school in JIA patients.Methods: JIA patients under 18 years of age, usually treated with disease-modifying anti-rheumatic drugs (DMARDs) were prospectively included during their outpatient visit and completed a standardized questionnaire. The primary outcome was DMARD treatment modification in relation to the context of the pandemic but we also evaluated the pandemic's impact on the schooling.Results: One hundred and seventy three patients from 8 different expert centers were included between May and August 2020. Their mean age was 11.6 years (± 4.1 years), and most of them 31.2% (54/173) had a rheumatoid factor-negative polyarticular JIA. Fifty percent (86/172) were treated with methotrexate, and 72.5% (124/171) were treated with bDMARDs. DMARD treatment modification in relation to the pandemic was observed in 4.0% (7/173) of participants. 49.1% (81/165) of the patients did not return to school due to a personal/parental decision in 69.9% (55/81) of cases. Two patients were diagnosed positive for SARS-CoV-2 infection.Conclusion: This study suggests that JIA patients treated with DMARDs continued their treatment during the pandemic and were rarely affected by symptomatic COVID-19. In contrast, parents' reluctance was a major obstacle for returning to school. Therefore, more solidified school reopening strategies should be developed.

Impact of the COVID-19 Pandemic on the Management of Juvenile Idiopathic Arthritis: Analysis of United States Commercial Insurance Data

“…These findings contrast with our hypothesis of pandemic-related treatment disruptions and suggest that patients and families were comfortable continuing to use immunosuppressants in the early months of the pandemic, even as rates of new DMARD initiations appeared to dip. These results conform to findings of a survey of 173 French patients and families affected by JIA, the vast majority of whom reported not withdrawing DMARDs because of the pandemic 35 . In one survey of mostly US adults with rheumatic diseases, the majority of whom had chronic inflammatory arthritis, interruption of DMARDs not prompted by illness or COVID-19 occurred more commonly in the early months of the pandemic than later in 2020 and then accelerated in early 2021 10 .…”

“…These results conform to findings of a survey of 173 French patients and families affected by JIA, the vast majority of whom reported not withdrawing DMARDs because of the pandemic. 35 In one survey of mostly US adults with rheumatic diseases, the majority of whom had chronic inflammatory arthritis, interruption of DMARDs not prompted by illness or COVID-19 occurred more commonly in the early months of the pandemic than later in 2020 and then accelerated in early 2021. 10 While this study did not specify the duration of interruptions, such interruptions were reportedly associated with the risks of subsequent severe flares.…”

Safety of the COVID-19 vaccination in children with juvenile idiopathic arthritis—A observational study from two pediatric rheumatology centres in Poland

“…Although adult and pediatric patients with rheumatic diseases treated with DMARDs do not seem to present a greater risk of COVID-19 or a worse disease outcome compared to the general population (3)(4)(5), some reports indicate a possible more severe course of the disease (6,7).…”

“…The course of SARS-CoV-2 infection in patients with JIA is similar to the course of COVID-19 in the general pediatric population, despite JIA patients receiving immunosuppressive therapy. However, observations indicate that SARS-COV-2 infection may cause exacerbation of the disease, which required escalation of therapy (3,7).…”