CORONAVIRUS DISEASE AND IMMUNOTHERAPY IN JUVENILE IDIOPATHIC ARTHRITIS
Abstract
The COVID-19 pandemic was a huge challenge to paediatricians around the world. Patients with juvenile idiopathic arthritis (JIA) and COVID-19 infection could present a potential ethical and medical dilemma. Here we discuss the results of a medical survey made on the parents of children with JIA. Our primary aim was to determine if there was a significant difference in the number of flares of JIA after COVID-19 infection between the group of children who were receiving biological drugs and children not receiving biologicals. Other goals were to investigate the parents’ motivation to vaccinate children against SARS-CoV-2 and to determine the most frequent symptoms of COVID-19 infection in these children. A retrospective study was based on the data of a telephone survey conducted between March 10, 2022, and May 12, 2022, including 65 paediatric patients with JIA. The data were provided from the Heliant Health information system database. In children who tested positive for SARS-CoV-2, the most frequent symptom was fever, followed by upper respiratory symptoms. Four flares of JIA were observed in the group of children on biological therapy, while in the group without biologicals two flares followed the COVID-19 infection. The parents’ motivation for vaccination against SARS-CoV-2 was extremely low. Our survey-based research did not find a significant difference regarding the COVID-19 infection between children with JIA on biologicals and children with JIA not receiving biologicals, but it did emphasise the parents’ hesitancy about vaccination. We propose building a unique database for patients with the diagnosis of JIA which could improve the quality of life of these patients.
References
Alsohime F, Temsah MH, Al-Nemri AM, Somily AM, Al-Subaie S. COVID-19 infection prevalence in pediatric population: Etiology, clinical presentation, and outcome. J Infect Public Health 2020;13(12):1791-6. [CrossRef] [PubMed]
Barello S, Maiorino G, Palamenghi L, Torri C, Acamora M, Gagliardi L, et al. Exploring the Motivational Roots of Getting Vaccinated against COVID-19 in a Population of Vaccinated Pediatric Healthcare Professionals: Evidence from an Italian Cross-Sectional Study. Vaccines (Basel) 2022;10(3):467. [CrossRef] [PubMed]
Barut K, Adrovic A, Şahin S, Kasapçopur Ö. Juvenile Idiopathic Arthritis. Balkan Med J 2017;34(2):90-101. [CrossRef] [PubMed]
Borch L, Holm M, Knudsen M, Ellermann-Eriksen S, Hagstroem S. Long COVID symptoms and duration in SARS-CoV-2 positive children - a nationwide cohort study. Eur J Pediatr 2022;181(4):1597-607. [CrossRef] [PubMed]
Cimaz R, Maioli G, Calabrese G. Current and emerging biologics for the treatment of juvenile idiopathic arthritis. Expert Opin Biol Ther 2020;20(7):725-40. [CrossRef] [PubMed]
Elmas B, Çavdaroğlu PD, Orhan MF, et al. Evaluation of taste and smell disorders in pediatric COVID-19 Cases. Rev Assoc Med Bras (1992) 2021;67(6):789-94. [CrossRef] [PubMed]
Evans S, Klas A, Mikocka-Walus A, German B, Rogers GD, Ling M, et al. "Poison" or "protection"? A mixed methods exploration of Australian parents' COVID-19 vaccination intentions. J Psychosom Res 2021; 150:110626. [CrossRef] [PubMed]
Fernández-Sarmiento J, De Souza D, Jabornisky R, Gonzalez GA, Arias López MDP, Palacio G. Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): a narrative review and the viewpoint of the Latin American Society of Pediatric Intensive Care (SLACIP) Sepsis Committee. BMJ Paediatr Open 2021;5(1): e000894. [CrossRef] [PubMed]
Giles JT, Bathon JM. Serious infections associated with anticytokine therapies in the rheumatic diseases. J Intensive Care Med 2004;19(6):320-34. [CrossRef] [PubMed]
Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19 [published correction appears in Nat Rev Microbiol 2022 Feb 23;:]. Nat Rev Microbiol 2021;19(3):141-54. [CrossRef] [PubMed]
Hügle B, Krumrey-Langkammerer M, Haas JP. Infection with SARS-CoV-2 causes flares in patients with juvenile idiopathic arthritis in remission or inactive disease on medication. Pediatr Rheumatol Online J 2021;19(1):163. [CrossRef] [PubMed]
Jackson CB, Farzan M, Chen B, Choe H. Mechanisms of SARS-CoV-2 entry into cells. Nat Rev Mol Cell Biol 2022;23(1):3-20. [CrossRef] [PubMed]
Kirtipal N, Bharadwaj S, Kang SG. From SARS to SARS-CoV-2, insights on structure, pathogenicity and immunity aspects of pandemic human coronaviruses. Infect Genet Evol 2020; 85:104502. [CrossRef] [PubMed]
Lee JJY, Schneider R. Systemic Juvenile Idiopathic Arthritis. Pediatr Clin North Am 2018;65(4):691-709. [CrossRef] [PubMed]
Naddei R, Alfani R, Bove M, Discepolo V, Mozzillo F, Guarino A, et al. Increased relapse rate during COVID-19 lockdown in an Italian cohort of children with juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2021; 75(2): 326-31. [CrossRef] [PubMed]
Naso J, Rojas S, Peng J, Marquez C, Conteras M, Castellanos E, R, et al. High Parental Vaccine Motivation at a Neighborhood-Based Vaccine and Testing Site Serving a Predominantly Latinx Community. Health Equity 2021;5(1):840-6. [CrossRef] [PubMed]
Pan F, Zhao H, Nicholas S, Maitland E, Liu R, Hou Q. Parents' Decisions to Vaccinate Children against COVID-19: A Scoping Review. Vaccines (Basel) 2021;9(12):1476. [CrossRef] [PubMed]
Paris C, Bénézit F, Geslin M, Polard E, Baldeyrou M, Turmel V, et al. COVID-19 vaccine hesitancy among healthcare workers. Infect Dis Now 2021;51(5):484-7. [CrossRef] [PubMed]
Prakken B, Albani S, Martini A. Juvenile idiopathic arthritis. Lancet 2011;377(9783):2138-49. [CrossRef] [PubMed]
Qi K, Zeng W, Ye M, Zheng L, Song C, Hu S, et al. Clinical, laboratory, and imaging features of pediatric COVID-19: A systematic review and meta-analysis. Medicine (Baltimore) 2021;100(15):e25230. [CrossRef] [PubMed]
Salesi M, Shojaie B, Farajzadegan Z, Salesi N, Mohammadi E. TNF-α Blockers Showed Prophylactic Effects in Preventing COVID-19 in Patients with Rheumatoid Arthritis and Seronegative Spondyloarthropathies: A Case-Control. Rheumatol Ther 2021;8(3): 1355-70. [CrossRef] [PubMed]
Thiele F, Klein A, Windschall D, Hospach A, Foeldvari I, Minden K, et al. Comparative risk of infections among real-world users of biologics for juvenile idiopathic arthritis: data from the German BIKER registry. Rheumatol Int 2021;41(4):751-762. [CrossRef] [PubMed]
Thunström L, Ashworth M, Finnoff D, Newbold SC. Hesitancy Toward a COVID-19 Vaccine. Ecohealth 2021;18(1):44-60. [CrossRef] [PubMed]
Tripathi K, Godoy Brewer G, Thu Nguyen M, et al. COVID-19 and Outcomes in Patients With Inflammatory Bowel Disease: Systematic Review and Meta-Analysis Inflamm Bowel Dis 2021; 28(8): 1265-79. [CrossRef] [PubMed]
Verwoerd A, Ter Haar NM, de Roock S, Vastert SJ, Bogaert D. The human microbiome and juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2016;14(1):55. [CrossRef] [PubMed]
Welzel T, Winskill C, Zhang N, Woerner A, Pfister M. Biologic disease modifying antirheumatic drugs and Janus kinase inhibitors in paediatric rheumatology - what we know and what we do not know from randomized controlled trials. Pediatr Rheumatol Online J 2021;19(1):46. [CrossRef] [PubMed]
Winthrop KL, Chiller T. Preventing and treating biologic-associated opportunistic infections. Nat Rev Rheumatol 2009;5(7):405-10. [CrossRef] [PubMed]
Wise J. Covid-19: Global death toll may be three times higher than official records, study suggests. BMJ 2022;376:o636. [CrossRef] [PubMed]
Xu X, Chen P, Wang J, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci 2020;63(3):457-60. [CrossRef] [PubMed]