The researchers found that treatment with IVIG plus glucocorticoids [in children with MIS-C] was associated with a lower risk of adverse cardiovascular outcomes, & overall, the patients who received this combination treatment required less subsequent adjunctive immunomodulatory therapy.
Disparities
Dr. Becker transitioned to a discussion on disparities in pediatric rheumatology. The first paper she reviewed was a study by Rubinstein et al. investigating the association of adverse childhood experiences (ACEs) with the development of juvenile idiopathic arthritis (JIA). ACEs are experiences associated with chronic stress, including abuse, neglect, violence, and household dysfunction.
Using cross-sectional data from the 2016 National Survey of Children’s Health, the investigators compared ACEs in healthy children, children with chronic arthritis and children with other acquired chronic physical disease, such as allergies, asthma, diabetes and epilepsy. The results showed children with ACEs had increased odds of having chronic arthritis when compared with both healthy peers and peers with other acquired chronic physical disease. Children with arthritis had a higher prevalence of eight of the nine specific ACE categories. Moreover, children with at least four ACEs were 9.4 times more likely to have arthritis as healthy children and 3.7 times more likely to have arthritis as children with other chronic physical disease.6
Another study by Chang et al. looked at the longitudinal assessment of racial disparities in JIA with a treat-to-target intervention using the clinical juvenile arthritis disease activity score (cJADAS). Data from this study show higher cJADAS scores at the index visit in Black children when compared with other racial and ethnic groups. With the treat-to-target intervention, all racial groups had statistically significant improvement in disease activity over time. Black children continued to have higher disease activity scores than other groups, but the rates of improvement were similar across all groups, suggesting treat to target may be equally effective across all racial groups.7
Dr. Becker then discussed a study on clinical outcome disparities among Black children with Kawasaki disease. Padilla et al. conducted a single-center retrospective study of children admitted with Kawasaki disease. In a cohort of 369 patients, the researchers found no significant difference in time to admission, time to diagnosis, time to treatment or the presence of coronary artery abnormalities in Black children versus white children. However, Black children had higher markers of inflammation, lower rates of response to IVIG therapy, received more adjunctive therapies, required longer hospital stays and exhibited a higher proportion of persistent coronary artery aneurysms on follow-up echocardiograms.
