American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID‐19 Pandemic: Version 1

Abstract

Objective To provide clinical guidance to rheumatology providers who treat children with pediatric rheumatic disease (PRD) in the context of the coronavirus disease 2019 (COVID‐19) pandemic. Methods The task force, consisting of 7 pediatric rheumatologists, 2 pediatric infectious disease physicians, 1 adult rheumatologist, and 1 pediatric nurse practitioner, was convened on May 21, 2020. Clinical questions and subsequent guidance statements were drafted based on a review of the queries posed by the patients as well as the families and healthcare providers of children with PRD. An evidence report was generated and disseminated to task force members to assist with 3 rounds of asynchronous, anonymous voting by email using a modified Delphi approach. Voting was completed using a 9‐point numeric scoring system with predefined levels of agreement (categorized as disagreement, uncertainty, or agreement, with median scores of 1–3, 4–6, and 7–9, respectively) and consensus (categorized as low, moderate, or high). To be approved as a guidance statement, median vote ratings were required to fall into the highest tertile for agreement, with either moderate or high levels of consensus. Results The task force drafted 33 guidance statements, which were voted upon during the second and third rounds of voting. Of these 33 statements, all received median vote ratings within the highest tertile of agreement and were associated with either moderate consensus (n = 6) or high consensus (n = 27). Statements with similar recommendations were combined, resulting in 27 final guidance statements. Conclusion These guidance statements have been generated based on review of the available literature, indicating that children with PRD do not appear to be at increased risk for susceptibility to SARS–CoV‐2 infection. This guidance is presented as a “living document,” recognizing that the literature on COVID‐19 is rapidly evolving, with future updates anticipated.

Patients with juvenile idiopathic arthritis on TNF inhibitors exposed to COVID-19 family members

“…Therefore, a careful evaluation of anti-rheumatic drug management assessing multiple factors (current disease activity and treatment, SARS-CoV-2 epidemiology in the patient's area, etc.) is advisable [3,4]. Our findings are in agreement with the hypothesis that JIA patients on TNFi do not show increased risk of severe COVID-19, although they might experience disease reactivation likely due to drug discontinuation [1,5].…”

Pediatric inflammatory multisystem syndrome temporally associated with COVID-19: a spectrum of diseases with many names

“…In July 2020, the American College of Rheumatology (ACR) 13 and Canadian Paediatric Society (CPS) 5 issued clinical guidance for the investigation and management of suspected pediatric inflam matory multisystem syndrome in children. A child with suspected pediatric inflammatory multisystem syndrome should also be evaluated for other infectious and noninfectious causes.…”

“…Use of biologic agents, such as anti-IL-1, are to be considered in patients refractory to IVIG or steroids. 5,13 Treatment response and tapering of immunosuppressive agents should be guided by serial clinical, laboratory and cardiac assessments.…”

Le syndrome inflammatoire multisystémique de l’enfant ayant un lien temporel avec la COVID-19 : multiples visages, multiples appellations

“…En juillet 2020, l'American College of Rheumatology (ACR) 13 et la Société canadienne de pédiatrie (SCP) 5 ont publié des lignes directrices cliniques sur l'évaluation diagnostique et la prise en charge des cas soupçonnés de syndrome inflammatoire multisystémique de l'enfant. Quand il pense être en présence de ce syndrome, le clinicien doit envisager la possibilité d'autres étiologies infectieuses et non infectieuses.…”