The coronavirus disease 2019 (COVID-19) pandemic has affected pediatric rheumatology practice in several ways, including delays in clinic appointments, concerns regarding the use of immunosuppressive therapies, and the increased use of virtual technologies, according to survey results published in Seminars in Arthritis & Rheumatism.

While most children with COVID-19 have presented with a milder form of the disease, some children may develop a serious hyperinflammatory syndrome that can resemble Kawasaki disease shock syndrome. Children with rheumatic disorders are primarily treated with immunomodulatory or immunosuppressive therapies and may be particularly vulnerable to the complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

As limited data are available on the infection rate and course of COVID-19 in children with rheumatic diseases, the Emerging Rheumatologists and Researchers (EMERGE) group of the Pediatric Rheumatology European Society (PReS) conducted a survey to investigate the impact of the COVID-19 pandemic on pediatric rheumatology practice.

The online survey included 18 questions, using the SurveyMonkey software, which was electronically sent in May 2020 to members of the PReS, and it was posted on PreS website. The survey was also sent to members of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) and the Pediatric Rheumatology Bulletin Board.


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A total of 493 pediatric rheumatologists (67% women; 80.3% in pediatric rheumatology practice for ≥5 years) from 70 countries worldwide responded to the survey.

More than 70% of the survey respondents disagreed that the pandemic had led to a decrease in prescription of nonsteroidal anti-inflammatory drugs, conventional synthetic or biologic disease-modifying antirheumatic drugs (DMARDs). A total of 84.2% of respondents reported there was no change in their management of patients receiving biologic DMARDs.

Approximately 90% of respondents reported there was no change in their attitude towards prescribing hydroxychloroquine. However, 38.9% and 8.9% of respondents noted that patients had difficulties obtaining hydroxychloroquine and tocilizumab, respectively, due to shortages. Survey respondents admitted that they hesitated most to initiating treatment with cyclophosphamide (36.3%) and rituximab (23.1%) during the pandemic.

Survey results showed that many scheduled appointments with established or new patients were cancelled or postponed, with 47% of the respondents reporting shifting to video consultations for patient care. In addition, 20% to 30% of the respondents reported that their patients experienced a flare or delay in diagnosis or intervention due to postponed appointments. Approximately 20% of the respondents noted that the COVID-19 pandemic resulted in delays in changing a major immunosuppressant drug when a patient experienced a flare.

Survey respondents reported an increase in the number of patients with Kawasaki disease (30%), macrophage activation syndrome (15.6%), unusual vasculitic rashes (31.4%), and hyperinflammation (33.5%) during the pandemic.

Study limitations included the fact that the stage of the pandemic in different countries was not taken into account, and respondent bias.

“Better understanding of the challenges imposed by the COVID-19 pandemic on the community of pediatric rheumatologists will help tailor future updated recommendations regarding the management of our patients during the pandemic, school and social attendance according to the needs of routine clinical practice,” the researchers concluded.

Reference

Batu ED, Lamot L, Sag E, Ozen S, Uziel Y. How the COVID-19 pandemic has influenced pediatric rheumatology practices: Results of a global, cross-sectional, online survey. Semin Arthritis Rheum. Published online September 28, 2020. doi:10.1016/j.semarthrit.2020.09.008