Rheumatic diseases in children during the COVID-19 pandemic: what the pediatrician and family physician should know





children, rheumatic diseases, management, vaccination, COVID-19


Purpose - to familiarize general practitioners and pediatricians with the real risks and modern, relevant principles of the observation of children with rheumatic diseases during the COVID-19 pandemic.

It was described which risks should be primarily considered in patients with rheumatic diseases during the COVID-19 pandemic. It was described the data from the literature on the safety of treatment of children with rheumatic diseases and the peculiarities of their management against the background of the pandemic of infection, caused by the SARS-CoV-2 virus. It was generalized the data on the purpose and frequency of the laboratory tests depending on the received therapy is given.

It was focused on the leading issues of monitoring children with rheumatic diseases, adaptation of these patients in the conditions of the COVID-19 pandemic. It was described in detail some differences in the follow-up of patients receiving biological and basic therapy. Emphasis is placed on issues of the monitoring treatment with methotrexate, which is the most often prescribed in pediatric rheumatology. There were discussed the main features of the infectious syndrome in children with rheumatic diseases depending on the prescribed medications (biological drugs and basic treatment). There were proposed the tactics of the first-line doctors in providing medical care to children with rheumatic diseases in the event of the development of an intercurrent infection. It is noted which changes in the treatment of rheumatic disease should be applied to the rheumatic patient in case of the development of an infectious process. Emphasis is placed on the management of pediatric patients with a rheumatic profile in a case of the contact with a patient with COVID-19, asymptomatic carrier or disease of COVID-19. There were described the issues of the vaccination of children with rheumatic diseases. There were added a new data of agreed modern recommendations on calendar and additional vaccine prophylaxis of children with rheumatic diseases, including vaccination against COVID-19.

No conflict of interests was declared by the authors.

Author Biography

O.A. Oshlianska, Shupyk National Healthcare University of Ukraine, Kyiv

SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova of the NAMS of Ukraine», Kyiv


Abinun M. (2018, Feb). Risks of serious infections in children treated with biologic response-modifying rugs. Rheumatology. 57 (2): 211-212. https://doi.org/10.1093/rheumatology/kex228; PMid:28666379

Alunno A, Najm A, Machado PM et al. (2022). 2021 update of the EULAR points to consider on the use of immunomodulatory therapies in COVID-19 Ann Rheum Dis 2022. 81: 34-40. doi: 10.1136/annrheumdis-2021-221366. URL: https://www.nice.org.uk/terms-andconditions# notice-of-rights.

Anders H-J, Vielhauer V. (2011, Jun 29). Renal co-morbidity in patients with rheumatic diseases. Arthritis Res Ther. 13 (3): 222. https://doi.org/10.1186/ar3256; PMid:21722341 PMCid:PMC3218868

Angeles-Han ST, Ringold S, Beukelman T et al. (2019, June). American College of Rheumatology / Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Care & Research. 71 (6): 703-716. https://doi.org/10.1002/acr.23871; PMid:31021540 PMCid:PMC6777949

Bath RK, Brar NK, Forouhar FA et al. (2014, Aug). A Review of Methotrexate-associated Hepatotoxicity. Journal of Digestive Diseases. 15: 10. https://doi.org/10.1111/1751-2980.12184; PMid:25139707

Calvo C, Udaondo C. (2021, Feb). Covid-19 in Children with Rheumatic Diseases in the Spanish National Cohort EPICO-AEP and Rheumatic Diseases EPICO-AEP Working Group. The Journal of Rheumatology. 48 (7): 1190-1192. https://doi.org/10.3899/jrheum.201548; PMid:33526617

Chung ShA, Langford CA, Maz M et al. (2021, Aug). American College of Rheumatology / Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Arthritis Care & Research. 73 (8): 1088-1105. https://doi.org/10.1002/acr.24634; PMid:34235880

Clemente D, Udaondo C, de Inocencio J et al. (2021). Clinical characteristics and COVID-19 outcomes in a regional cohort of pediatric patients with rheumatic diseases. Pediatric Rheumatology 19: 162. https://doi.org/10.1186/s12969-021-00648-5; PMid:34838054 PMCid:PMC8626725

Constantin T, Foeldvari I, Anton J et al. (2018, Aug). Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative. Ann Rheum Dis. 77 (8): 1107-1117. https://doi.org/10.1136/annrheumdis-2018-213131; PMid:29592918 PMCid:PMC6059050

Conway R et al. (2017, Sep). Risk of liver disease in methotrexate treated patients. World J Hepatol. 9 (26): 1092-1100. https://doi.org/10.4254/wjh.v9.i26.1092; PMid:28989565 PMCid:PMC5612840

Curtis JR, Johnson SR, Anthony DD, Arasaratnam RJ, Baden LR, Bass AR et al. (2021, Aug). American College of Rheumatology Guidance for COVID-19 Vaccination in Patients with Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol: 3. URL: https://onlinelibrary.wiley.com/doi/10.1002/art.41928. https://doi.org/10.1002/art.41877; PMid:34128356 PMCid:PMC8427105

Enders FB, Bader-Meunier B, Baildam E et al. (2017). Consensus-based recommendations for the management of juvenile dermatomyositis. Ann Rheum Dis. 76: 329-340. https://doi.org/10.1136/annrheumdis-2016-209247; PMid:27515057 PMCid:PMC5284351

Foeldvari I, Culpo R, Sperotto F et al. (2019, Aug). Consensus-based recommendations for the management of juvenile localised scleroderma. Ann Rheum Dis. 78 (8): 1019-1024. https://doi.org/10.1136/annrheumdis-2018-214697; PMid:30826775 PMCid:PMC6691928

Hausmann J, Kennedy K, Surangiwala S et al. (2022, Feb 14). Early impacts of the COVID-19 pandemic on children with pediatric rheumatic diseases. Eur J Rheumatol. https://doi.org/10.5152/eujrheum.2022.21133

Heijstek MW, Ott de Bruin LM, Bijl M et al. (2011, Oct). ЕULAR recommendations for vaccination in paediatric patients with rheumatic diseases. Ann Rheum Dis. 70 (10): 1704-1712. https://doi.org/10.1136/ard.2011.150193; PMid:21813547

Hsu Ch-Y, Ko Ch-H, Wangn J-L et al. (2019). Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study. Arthritis Research & Therapy. 21: 211. https://doi.org/10.1186/s13075-019-1997-5; PMid:31604447 PMCid:PMC6790041

Hyrich KL, Machado PM. (2021, Feb). Rheumatic disease and COVID-19: epidemiology and outcomes. Nat Rev Rheumatol. 17 (2): 71-72. https://doi.org/10.1038/s41584-020-00562-2; PMid:33339986 PMCid:PMC7747184

Ibrahim A, Ahmed M, Conway R, Carey JJ. (2018, Dec 21). Risk of Infection with Methotrexate Therapy in Inflammatory Diseases: A Systematic Review and Meta-Analysis. J Clin Med. 8 (1): 15. https://doi.org/10.3390/jcm8010015; PMid:30583473 PMCid:PMC6352130

Jansen MHA, Rondaan C, Legger GE et al. (2022). EULAR/PRES recommendations for vaccination of paediatric patients with autoimmune inflammatory rheumatic diseases: update 2021. Ann Rheum Dis: 1-13. https://doi.org/10.1136/annrheumdis-2022-222574; PMid:35725297

Kavadichanda Ch, Adarsh MB, Ajmani S. (2021, Dec). Tuberculosis in Children with Rheumatic Diseases Treated with Biologic Disease-Modifying Anti-Rheumatic Drugs. Mediterr J Rheumatol. 32 (4): 290-315. https://doi.org/10.31138/mjr.32.4.290; PMid:35128322 PMCid:PMC8802205

Kearsley-Fleet L, Chang ML, Lawson-Tovey S et al. (2022, Mar 25). Outcomes of SARS-CoV-2 infection among children and young people with pre-existing rheumatic and musculoskeletal diseases. Ann Rheum Dis. https://doi.org/10.1136/annrheumdis-2022-222241; PMid:35338032 PMCid:PMC8977459

Kevat S et al. (1988, May-Jun). Hepatotoxicity of methotrexate in rheumatic diseases. Med Toxicol Adverse Drug Exp. 3 (3): 197-208. https://doi.org/10.1007/BF03259882; PMid:3041245

Kowal-Bielecka O, Fransen J, Avouac J et al. (2016). Update of EULAR recommendations for the treatment of systemic sclerosis. Ann. Rheum. Das. 76: 8.

Laharie D, Seneschal J, Schaeverbeke Th. (2010, Aug). Assessment of liver fibrosis with transient elastography and FibroTest in patients treated with methotrexate for chronic inflammatory diseases: a case-control study. 53 (6): 1035-1040. Epub 2010, Aug12. https://doi.org/10.1016/j.jhep.2010.04.043; PMid:20801541

Lalevée S, Lebrun-Vignes B, Simon C et al. (2019, Sep). Cytopenia induced by low-dose methotrexate: An analysis of 433 cases from the French pharmacovigilance database the French Network of Regional Centres of Pharmacovigilance database. Eur J Intern Med. 67: 97-101. https://doi.org/10.1016/j.ejim.2019.07.016; PMid:31350129

Landewé RBM, Machado PM, Landewé FK. (2020). EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Ann Rheum Dis. 79: 851-858. https://doi.org/10.1136/annrheumdis-2020-217877; PMid:32503854

News release. (2022). Researchers find lower risk of severe COVID-19 infection in most children with juvenile idiopathic arthritis. Childhood Arthritis and Rheumatology Research Alliance (CARRA). Updated March 31, 2022. Accessed April 12, 2022. URL: https://www.prnewswire.com/news-releases/researchers-find-lower-risk-of-severe-covid-19-infection-in-most-children-with-juvenile-idiopathic-arthritis-301514192.html.

Nicastro E, Verdoni L, Bettini LR et al. (2021). COVID-19 in Immunosuppressed Children. RMD. 7: e001687. https://doi.org/10.1136/rmdopen-2021-001687; PMid:34312307 PMCid:PMC8316693

Nokhatha ShAA, Harrington R, Conway R. (2020, Jul 21). Editor's pick: methotrexate and the lung in rheumatoid arthritis. URL: https://www.emjreviews.com/rheumatology/article/editors-pick-methotrexate-and-the-lung-in-rheumatoid-arthritis/.

Onel KB, Horton DB, Lovell DJ et al. (2022). 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging. Arthritis & Rheumatology. 74 (4): 570-585. https://doi.org/10.1002/art.42036; PMid:35233961

Oshlianska OA. (2012). Peredumovy ta imunopatolohichni mekhanizmy rozvytku revmatychnykh khvorob u ditei z dysplaziiamy spoluchnoi tkanyny. Avtoref. dys. … d.med.n. Kyiv: 31.

Ross P. (2015). Corticosteroids in the Treatment of Childhood Rheumatic Diseases: A Historical Review. Systemic Corticosteroids for Inflammatory Disorders in Pediatrics: 11-18. URL: https://www.researchgate.net/publication/300570634_. https://doi.org/10.1007/978-3-319-16056-6_2

Thiele F, Klein A, Windschall D et al. (2021, Feb 16). Comparative risk of infections among real-world users of biologics for juvenile idiopathic arthritis: data from the German BIKER registry. Rheumatol Int. 41 (4): 751-762. https://doi.org/10.1007/s00296-020-04774-3; PMid:33590331 PMCid:PMC7952348

Vanni KMM, Lyu H, Solomon DH et al. (2020, Apr). Cytopenias among patients with rheumatic diseases using methotrexate: a meta-analysis of randomized controlled clinical trials. Rheumatology (Oxford). 59 (4): 709-717. https://doi.org/10.1093/rheumatology/kez343; PMid:31504937 PMCid:PMC7188347

VOOZ. (2022). Biuleten okhoplennia imunizatsiieiu. URL: https://www.who.int/ru/news-room/fact-sheets/detail/immunization-coverage.

Wahezi DM, Lo MS, Rubinstein TB et al. (2021, June). American College of Rheumatology COVID-19 Clinical Guidance for Pediatric Patients with Rheumatic Disease During the COVID-19 Pandemic: 2. https://doi.org/10.1002/art.41772; PMid:34114365