Mini Review - International Journal of Clinical Rheumatology (2023) Volume 18, Issue 4

What paediatric rheumatology practise has learned from the COVID-19 pandemic Results of a worldwide, cross-sectional, online investigation

Josef Suzie*

Department of Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel

*Corresponding Author:
Josef Suzie
Department of Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel

Received: 03-April-2023, Manuscript No. Fmijcr-23-96756; Editor assigned: 06-April-2023, Pre-QC No. Fmijcr-23-96756 (PQ); Reviewed: 20-Apri -2023, QC No. Fmijcr-23-96756; Revised: 22- April -2023, Manuscript No. Fmijcr-23-96756 (R); Published: 29- April -2023, DOI: 10.37532/1758-4272.2023.18 (4).78-80



The COVID- 19 epidemic is a global health problem. We, as the EMERGE (Arising RheumatoloGists and experimenters) group of PReS (Pediatric Rheumatology European Society) anatomized how the epidemic has affected pediatric rheumatology practice.


An online check was developed to assess changes in pediatric rheumatology practice due to the epidemic. Results were anatomized using descriptive statistics.


From 70 countries, 493 pediatric rheumatologists (80.3 in pediatric rheumatology practice for ≥ 5 times) responded to the check. Around 70 dissented that the epidemic led to reduced tradition of nonsteroidalanti-inflammatory medicines, conventional synthetic and birth complaint- modifying antirheumatic medicines. Nearly partial were more likely to taper corticosteroids briskly. One- fifth dithered to switch the major immunosuppressant during a flare. Cases encountering difficulties carrying hydroxychloroquine and Tocilizumab due to dearths were noted by 192(38.9) and 44(8.9), independently. Twenty to 30 indicated that their cases had endured a flare or detention in opinion/ intervention due to laid over movables .53 mentioned uses of phone calls smartphone operations while 47 shifted towards videotape consultations for patient care. Repliers indicated an increased number of cases with Kawasaki complaint (30), macrophage activation pattern (15.6), unusual vasculitis rashes (31.4), and hyperinflammation (33.5) during the epidemic.


This is the largest check to date addressing changes in pediatric rheumatology practice due to the COVID- 19 epidemic. Primary changes were due to detainments in clinic movables, increase in use of virtual technologies, and enterprises about the use of immunosuppressive curatives. An increased number of cases with Kawasaki complaint/ hyperinflammation mentioned by the repliers is noteworthy.


COVID- 19 • Epidemic • Pediatric rheumatology • Survey • Kawasaki complaint • Macrophage activation pattern


A new coronavirus, SARS- CoV- 2(severe acute respiratory pattern coronavirus 2), caused a severe outbreak that surfaced in China in December 2019. This infection, nominated COVID- 19(coronavirus complaint 2019) by the World Health Organization (WHO), snappily spread worldwide, and it was declared an epidemic on March 11, 2020. As of July 13, 2020, there were verified cases and 566,654 deaths credited to the COVID- 19 worldwide (WHO situation report 175) for a mortality rate of around4.4. Most affected individualities have a mild infection. Still, it can also lead to a cytokine storm and acute respiratory torture pattern, which are the major causes of mortality in severe cases. COVID- 19 affects senior individualities, smokers, and cases with habitual conditions similar as diabetes mellitus more oppressively. On the other hand, children are infected less frequently and with a milder form of the complaint. Still, we, in the pediatric rheumatology community started to fete that children may display a serious hyper inflammatory pattern frequently suggesting Kawasaki complaint shock pattern. As pediatric rheumatologists, we take care of children with rheumatic conditions who are treated primarily with immunomodulatory or immunosuppressive curatives. The vulnerable dysregulation caused by both the rheumatic complaint itself and the specifics used to treat it, put our cases in a vulnerable group during the COVID- 19 epidemic. We're also sharing in the multidisciplinary operation of COVID- 19 cases, as several aspects of COVID- 19 act rheumatic conditions. Also, some medicines that are used by our cases are presently being used or tested for treatment of COVID- 19. Data regarding the infection rate and course of COVID- 19 in children with rheumatic conditions are lacking. The recent report from the COVID- 19 Global Rheumatology Alliance Physician Reported Registry (n = 600), didn't include any pediatric COVID- 19 cases with a rheumatic complaint. In the global ongoing check (The EULAR COVID- 19 database- in collaboration with PReS), only 1 of the affected rheumatology cases with COVID- 19 are below 18 times of age. The transnational rheumatology societies similar as ACR (American College of Rheumatology), EULAR (European League against Rheumatism), and Press (Pediatric Rheumatology European Society) recommend continuing immunosuppressive curatives for effective complaint control in cases with rheumatic conditions. Still, there may be enterprises about the use of moderate- to-high boluses of corticosteroid or several immunosuppressants, because these might intrude with the effective concurrence of the SARS- CoV- 2 in the original phase of COVID- 19. In this study, we anatomized how the COVID- 19 epidemic has affected pediatric rheumatology practice, especially regarding the use of antirheumatic medicines and changes in clinical care [1, 2, 3].

Material and Methods

We, as the EMERGE (Arising RheumatoloGists and Researchers) group of PReS (Pediatric Rheumatology European Society) conducted an online check conforming of 18 questions using the Survey Monkey online software. Pediatric rheumatologists, including fellows in- training, were invited to complete the check by E-mail. In May 2020, the check was electronically transferred to the members of PReS, and it was posted on the PReS website. It was also transferred to the members of CARRA (Childhood Arthritis and Rheumatology Research Alliance) and the Pediatric Rheumatology Bulletin Board, a worldwide electronic listserv. The repliers completed the check freely and anonymously [4].

Maturity of the questions had a multiple- choice answer with free textbook allowed for specific fields. Also, repliers could use free textbook when answering to the questions about the adaptations made to their clinical practice, while four questions regarding the influence of the COVID- 19 epidemic to defining some of the specifics had answers on a 5- point Likert scale, ranging from explosively agree to explosively differ. The first five questions collected demographic information (age, coitus, place of practice, country of practice) and times in pediatric rheumatology practice. Eight questions were about the changes in clinical practice with defining nonsteroidalanti-inflammatory medicines (NSAIDs), conventional synthetic complaintmodifying antirheumatic medicines (csDMARDs), and birth DMARDs. Two questions were about the effect of COVID- 19 on academy conditioning of pediatric rheumatology cases, and one question was about the adaptations made in clinical practice due to COVID- 19. There was one question about the difficulties that pediatric rheumatology cases endured due to the epidemic and the other about the increased number of cases with certain conditions since it began [5]. Results were anatomized using descriptive statistics. Figures and probabilities were used to present the data.


Worldwide, 493 pediatric rheumatologists (67 ladies) from 70 countries (Supplementary Table 1) responded to the check. The responses to individual questions in the check are presented in the Supplementary Table 2. Around 70 of the repliers were ≥ 40 times of age and were rehearsing in a university sanitarium. Utmost repliers (n = 396; 80.3) had been in pediatric rheumatology practice for at least five times [6].


The results of the current check study reflect the perspectives of pediatric rheumatologists during the COVID- 19 epidemic. At present, this is the largest check study addressing the goods of the epidemic on pediatric rheumatology practice. Response rate of nearly 500 pediatric rheumatologists is considered veritably grandly, and highlights the influence and the effect of the epidemic on the caring croakers. Nearly half of the repliers were more likely to taper corticosteroids briskly, and one- fifth dithered to switch a case's major immunosuppressant medicine during a flare. In addition, 15 agreed that the COVID- 19 epidemic had led to the reduced tradition of birth DMARDs. Pediatric rheumatology cases endured detainments in the opinion of a rheumatic complaint or in entering an intraarticular corticosteroid injection. Some cases had difficulties carrying HCQ and Tocilizumab, substantially due to delayed clinical movables and dearths of the medicines due to their use for COVID- 19 treatment or prophylaxis. A shift towards the use of virtual technologies for routine clinical care was observed [7, 8].


The results of the check suggested that the COVID- 19 epidemic had indeed affected pediatric rheumatology practice. Utmost changes arose from detainments in clinic movables, enterprises about the immunosuppressive goods of antirheumatic curatives, the use of antirheumatic medicines for COVID- 19 treatment/ prophylaxis, and increased use of virtual technologies to minimize face to face visits. In addition, an increase in the number of cases with Kawasaki complaint or hyperactive inflammation pattern was mentioned by a substantial number of repliers was noteworthy and harmonious with the increased reports in the literature. More understanding of the challenges assessed by the COVID- 19 epidemic on the community of pediatric rheumatologists will help knitter future streamlined recommendations regarding the operation of our cases during the epidemic, academy and social attendance according to the requirements of routine clinical [9,10].

Conflict of Interest

The authors declare no conflict of interest.




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