Management of childhood-onset autoinflammatory diseases during the COVID-19 pandemic

Abstract

Concerns regarding the comorbidity as a significant risk factor for Coronavirus Disease-2019 (COVID-19), gave rise to an urgent need for studies evaluating patients with chronic conditions such as autoinflammatory diseases (AIDs). We prepared a web-based survey investigating the clinical findings and contact histories among pediatric patients with AIDs. Confirmed COVID-19 cases, patients with contact history and those with symptoms which were highly suggestive of COVID-19 were called via phone or recruited to a video or face to face appointment. Data of AIDs were obtained from their medical records, retrospectively. Laboratory and screening findings were confirmed by our national health registry website. There were 404 patients (217 female) eligible for the enrollment. During pandemic, 375 (93%) were on colchicine treatment and 48 (11.8%) were receiving biologic treatment. Twenty-four out of 404 patients were admitted to hospital due to COVID-19 suspicion. Severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) was identified through rhinopharyngeal swabs in seven patients, six of whom were only on colchicine treatment. Only one patient with no finding of any severe respiratory complications was hospitalized. All of seven patients recovered completely. Among patients on biologic drugs, neither a symptom nor a positive polymerase chain reaction test for COVID 19 was detected. In conclusion, pediatric patients with AIDs, those receiving biologic treatment and/or colchicine, may not be at increased risk for neither being infected nor the severe disease course.

Does immunosuppressive treatment entail an additional risk for children with rheumatic diseases? A survey-based study in the era of COVID-19

“…Moreover, SLE, a prototype of the autoimmune diseases, is considered to create a predisposition for SARS-CoV-2 and associated with a more complicated disease course due to ACE-2 hypomethylation and overexpression [15]. In a recent study from Turkey, no risk of severe disease or infection in terms of COVID-19 disease was detected in patients diagnosed with autoinflammatory diseases using biologic treatment and/or colchicine therapy [34]. The limited resources available indicate that rheumatic diseases, generally heterogeneous and associated with immune dysregulation, and various immunosuppressive drugs used in their treatment do not pose a risk for COVID-19.…”

Public interest in rheumatic diseases and rheumatologist in the United States during the COVID-19 pandemic: evidence from Google Trends

“…This finding that indicates the increased need for rheumatologists during the COVID-19 pandemic may be attributable to two factors: (a) patients with a rheumatic disease and/or receiving immunosuppressive treatments wanted to consult rheumatologists on their disease/treatments [30]; (b) patients consult rheumatologists on properties of several anti-inflammatory and immunomodulatory drugs that are being used in the treatment of COVID-19 because rheumatologists are experts in the use of these drugs [1,7]. Rheumatic patients may be at a higher risk of receiving COVID infection with worse outcomes, as many of them tend to be susceptible from their underlying rheumatic disease or immunocompromised due to their treatment [9][10][11][12][13][14][15][16]. Thus, this pandemic has put great responsibility on the shoulders of the rheumatologists for caring for this vulnerable patient group.…”

“…Since rheumatologists have substantial knowledge in the benefits and adverse effects of these drugs as well, rheumatologists are playing a significant role in this pandemic. Besides fighting COVID-19, the rheumatologists also have an essential role in caring for their rheumatic patients who may express concerns about their potential increased risk of acquiring COVID-19 infection due to their underlying disease itself and any immunosuppressive treatments they may be on [9][10][11][12][13][14][15][16].…”

Coronavirus global pandemic: An overview of current findings among pediatric patients

“…A web‐based study of 404 children with autoinflammatory diseases, among whom 375 were on colchicine and 48 were receiving biologic drugs found only 7 confirmed and mild cases of COVID‐19, all having a favorable outcome. No infected child was on biologic treatment 196 . In a retrospective study of 182 children, 43 were suffering from allergies, including allergic rhinitis ( n = 28), drug allergy ( n = 3), atopic dermatitis (n = 3), allergic rhinitis and drug allergy ( n = 5), allergic rhinitis and atopic dermatitis ( n = 1), allergic rhinitis and food allergy ( n = 1), allergic rhinitis and food allergy and drug allergy ( n = 1), asthma and urticaria and drug allergy ( n = 1); there were no differences in COVID‐19 clinical features and disease course between atopic and non‐atopic children 91 .…”