The ACR has released new clinical guidance for pediatric patients with rheumatic disease in the context of the COVID-19 pandemic. Jay Mehta, MD, an attending physician in the Division of Rheumatology and director of the Pediatric Rheumatology Fellowship at the Children’s Hospital of Philadelphia (CHOP), chaired the task force charged with developing the guidance.
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The majority of serious and life-threatening outcomes of COVID-19 have occurred in adults, and in April the ACR released clinical guidance for the care of adult patients with rheumatic diseases during the pandemic. In the earlier stages of the pandemic, it appeared children were less likely to develop severe manifestations of SARS-CoV-2. But as case reports accumulated of children exhibiting multisystem inflammatory syndromes with features similar to Kawasaki disease, the ACR decided to develop pediatric-focused clinical guidance as well, Dr. Mehta says. It made sense, he reasoned, to set up two task forces: one to address clinical guidance for pediatric patients with rheumatic disease, and another to provide guidance regarding children with multisystem inflammatory syndrome (MIS-C) associated with SARS-CoV-2 and hyperinflammation in COVID-19.
Dr. Mehta and his two lead task force physicians recently shared the processes they followed for their work, which took place over a very short period of time, from mid-May to mid-June. Characterized by even-handed and reassuring language, both guidance documents have now been submitted to Arthritis & Rheumatology and are undergoing review. In addition, Dr. Mehta notes, the guidance documents are very much living documents and will be revisited and updated as evidence evolves.
Dawn M. Wahezi, MD, associate professor in the Department of Pediatrics and division chief in Pediatric Rheumatology, Children’s Hospital at Montefiore, The Bronx, N.Y., was selected to lead the ACR COVID-19 Pediatric Rheumatology Clinical Guidance Task Force. The Bronx was one of the first pandemic hot spots in the U.S., and Dr. Wahezi was chosen in part due to her direct experience with the virus. Following her initial conversation with Dr. Mehta, Dr. Wahezi recalls that “everything happened fairly quickly.” When inviting possible task force participants, she says, “we intentionally included pediatric rheumatologists from across the country [with varied] expertise and from areas with [varying] prevalence of COVID-19.”
She and Dr. Mehta drafted general, clinical questions based on issues they and other providers had encountered with patients, families and other providers. Evidence to date is limited, she notes, so they also looked to the Centers for Disease Control & Prevention and other online sources for clinical questions to address.