COVID-19 lockdown linked to higher flare rate in patients with JIA
Living under COVID-19 lockdown was associated with a higher rate of joint inflammation in children with juvenile idiopathic arthritis, according to data from an Italian cohort published in Arthritis Care & Research.
“Children affected by juvenile idiopathic arthritis (JIA) might be considered a vulnerable population,” Roberta Naddei, MD, of the University of Naples Federico II, in Naples, Italy, and colleagues wrote. “In the first months of COVID-19 pandemic, JIA patients and their parents had to cope with major challenges in the routine disease management, such as limiting non-essential health care visits and physical activity due to home confinement and the concerns raised by the use of immunosuppressive medications, like conventional disease-modifying antirheumatic drugs (cDMARDs) and biologic disease-modifying drugs (bDMARDs).
“These factors might potentially contribute to disease worsening during the pandemic,” they added. “Current findings on the course of inflammatory rheumatic diseases during lockdown mainly regard adult patients, while physical effects of pandemic on pediatric chronic arthritis have not been widely reported.”
To analyze the rate of disease flare among children with JIA before and during COVID-19 lockdown, Naddei and colleagues conducted a single-center retrospective study of patients admitted to the pediatric unit at University of Naples Federico II. The researchers included 126 patients who presented with inactive JIA between Sept. 1, 2018, and March 9, 2019, characterized as “group A,” as well as 124 similar patients admitted between Sept. 1, 2019, and March 9, 2020, or “group B.”
The researchers collected demographic and clinical data for each included patient. In addition, they compared the rates of JIA flare among patients in group A from March 10, 2019, to June 30, 2019, and for group B from March 10, 2020, to June 30, 2020.
According to the researchers, their statistical analysis did not demonstrate any significant differences among the two groups regarding age, sex, age of JIA onset, JIA subtype, co-occurrence of uveitis, ANA positivity and past or ongoing treatments.
In all, the rate of JIA flare was significantly higher during lockdown at the time of the first wave of the pandemic, at 16.9%, compared with 6.3% during the previous year (P = .009), the researchers wrote.
“This study provides new evidence that COVID-19 lockdown was associated with a higher rate of relapse in JIA children, even in the absence of reduced drug adherence,” Naddei and colleagues wrote. “This finding has considerable clinical implications since restrictive measures are still occurring in several countries as the pandemic evolves. Our data highlight the need for implementing health care management of patients with JIA, including personalized at-home-exercise programs, in case of new lockdowns.”