No Delays or Increased Severity at Presentation Among Patients With JIA During the COVID-19 Pandemic

In patients with juvenile idiopathic arthritis (JIA) in Canada, the COVID-19 pandemic did not appear to delay presentation to pediatric rheumatology care or increase disease severity at presentation, according to findings of an analysis published in Rheumatology (Oxford).

Timely diagnosis and initiation of therapy are critical to improving long-term outcomes and preventing irreversible joint damage in patients with JIA.

The researchers sought to characterize the impact of the COVID-19 pandemic on the presentation of patients with JIA to pediatric rheumatology care in Canada. Researchers also aimed to explore the impact of the pandemic on JIA clinical research.

Data obtained from the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) National JIA Registry were examined. The CAPRI Registry, which was initiated in 2017, includes children with JIA within 3 months of their diagnosis, with follow-up at every clinic visit. The registry prospectively collects and shares data on the disease course of JIA, adverse events, and patient outcomes.

The researchers compared data from the prepandemic year (ie, March 11, 2019, through March 10, 2020) and the pandemic year (ie, March 11, 2020, through March 10, 2021).

To evaluate the impact of the pandemic, they compared the time from symptom onset to first pediatric rheumatology appointment in both groups. Disease severity at presentation was evaluated using active joint count and limited range of motion joint count, extra-articular manifestations, elevated erythrocyte sedimentation rates, C-reactive protein levels, and the presence of uveitis.

Disease markers included the Physician Global Assessment (PGA) of disease activity and the clinical Juvenile Arthritis Disease Activity Score 10 (cJADAS10). Parent- and patient-reported well-being at presentation were compared using the parent global assessment, patient pain scale, Juvenile Arthritis Quality of Life Questionnaire (JAQQ) score, Quality of My Life (QoML) score, and Child Health Assessment Questionnaire (CHAQ). Recruitment in the registry was also evaluated.

Results of the study showed that the median time from onset of symptoms to first evaluation was 138 days (range, 64-365 days) in the prepandemic period compared with 146 days (range, 83-359 days) in the pandemic. The JIA category frequencies remained stable overall (oligoarticular JIA: 44% prepandemic vs 46.8% pandemic); however, for systemic JIA, 12 cases were presented in the prepandemic period compared with 1 case that presented during the pandemic.

Disease activity based on the cJADAS10, disability based on the CHAQ, and quality of life based on JAQQ scores were similar between the 2 cohorts. A total of 225 patients enrolled in the CAPRI registry prepandemic compared with 111 during the pandemic. The most significant decrease in enrollment in the registry was reported from March 2020 to June 2020.

The researchers concluded that the findings from the analysis demonstrate that anticipated delays in presentation and increased disease severity among patients with JIA were not observed.

They added, “…within Canada, [pediatric] rheumatology teams adapted to provide ongoing support and care to new patient consults and avoided significant negative [effects]. Research disruption was associated with a 50% enrollment decrease in the pandemic year, most significantly from March to June 2020, consistent with a limit in non-essential research staff presence in hospitals at that time. Recruitment has since recovered to near pre-pandemic rates.”

Reference

Dushnicky MJ, Campbell C, Beattie KA, et al; CAPRI Registry Investigators. Impact of the COVID-19 pandemic on juvenile idiopathic arthritis presentation and research recruitment: results from the CAPRI Registry. Rheumatology (Oxford). Published online October 29, 2021 doi:10.1093/rheumatology/keab812