The State of Clinical Science for Pediatric Rheumatology in 2021

ACR Convergence 2021—The Pediatric Rheumatology Year in Review began with a fascinating talk by Mara Becker, MD, MSCE, a professor of Pediatrics and vice chair of faculty at Duke University School of Medicine, Durham, N.C.

Dr. Becker began by describing her search strategy to select high-yield clinical science publications in pediatric rheumatology from the past year. She queried the Medline search database, gathered content from the Pediatric Rheumatology Symposium (PRSYM), held earlier this year, and added a few of her favorite articles to identify important themes and publications. Although COVID-19 continued to dominate much of her literature search, she identified several other relevant topics, and her selections fell into these distinct themes: COVID-19 and multi-system inflammatory syndrome in children (MIS-C), disparities in pediatric rheumatology, and therapeutic optimization and innovation.

COVID-19 & MIS-C

Dr. Becker

To begin the discussion of COVID-19 and MIS-C, Dr. Becker highlighted the two clinical guidance documents developed by the ACR. These provide recommendations for recognizing and treating children with MIS-C and on managing primary COVID-19 infection in children with rheumatic disease.^1,2 She applauded the efforts of the ACR, Henderson et al. and Wahezi et al. for developing these guidance documents and for continuing to update the recommendations as new data emerge.

Dr. Becker continued by highlighting a publication by Son et al. that looked at initial therapy and outcomes in children treated with immunomodulating therapy for MIS-C. This study analyzed data from more than 500 patients from 58 hospitals in the U.S. The investigators used propensity score matching to compare outcomes between patients treated with intravenous immunoglobulin (IVIG) alone vs. those treated with IVIG plus glucocorticoids.

The researchers found that treatment with IVIG plus glucocorticoids was associated with a lower risk of adverse cardiovascular outcomes, and overall, the patients who received this combination treatment required less subsequent adjunctive immunomodulatory therapy. These results were published in the New England Journal of Medicine.³

The next COVID-19 article Dr. Becker covered was a review by Wahezi et al. discussing how the pandemic has affected the field of pediatric rheumatology.⁴ In addition to reviewing the abridged ACR guidelines, this paper also discussed advances in telerheumatology, post-COVID-19 sequelae, the impact of psychologic distress related to the pandemic and inequities that have emerged since the onset of the pandemic.

Her final selection from the COVID-19 pediatric literature was a study from Children’s Mercy Hospital, Kansas City, Mo., investigating the use of saliva to test for SARS-CoV-2. Researchers used paired testing of nasopharyngeal swabs and saliva in a small cohort of children receiving standard-of-care testing for COVID-19. Saliva samples demonstrated a high sensitivity and specificity, as well as a significant amount of viral load, suggesting that saliva testing may be a reasonable alternative to nasopharyngeal swabs for pediatric COVID-19 testing.⁵