Treatment Adherence and Disease Status among Children with Rheumatological Diseases during COVID-19 Pandemic: A Cross-Sectional Study from a Tertiary Care Center

Introduction: There is a reallocation of health-care services across the world in view of the COVID-19 pandemic. This has resulted in the disruption of routine care to children with chronic rheumatological diseases. We studied the treatment adherence and disease status of these children during the COVID-19 pandemic. Methods: We did a cross-sectional observational study of children (<16 years) with rheumatological diseases. Parents of seventy consecutive children with rheumatological diseases were interviewed through the telephone to assess the treatment adherence and disease status from April 2020 to July 2020. Results: In our study cohort, 44.3% (n = 31) had juvenile idiopathic arthritis (JIA), 52.9% (n = 37) had childhood lupus childhood-onset systemic lupus erythematosus (cSLE), 1.4% (n = 1) had juvenile scleroderma, and 1.4% (n = 1) had childhood vasculitis. About 38.6% (n = 27) had poor compliance due to reasons like difficulty in transportation (88.6%) (n = 24), financial constraints (88.6%) (n = 24), fear of acquiring COVID-19 by attending the study center (55.5%) (n = 15), and fear of taking immunosuppressive drugs (18.5%) (n = 5). Thirty percent (n = 21) respondents reported flare of symptoms. Common flare symptoms reported were joint pain (25.7%) (n = 18), skin rashes (1.4%) (n = 1), and oral ulcers (1.4%) (n = 1). One patient with cSLE required admission for acute pancreatitis. Nearly 4.3% (n = 3) experienced influenza like illness. One patient with cSLE developed swab-positive mild COVID-19 illness. cSLE patients experienced significantly less flare symptoms compared to patients with other rheumatological illness (P = 0.03, odds ratio = 0.32, confidence interval = 0.1-0.9). Almost 98.6% (n = 68) of parents were not aware of electronic consultation portals. Conclusion: Although COVID-19 causes less symptomatic disease in children, this study highlights the indirect effects of pandemic like financial constraints and parental misconceptions on children with rheumatological diseases. Furthermore, the awareness about electronic portals in consultation needs to be increased.

Automated summary

During the COVID-19 pandemic, children with rheumatological diseases faced challenges in treatment adherence, with common flare symptoms being joint pain, skin rashes, and oral ulcers. Parental awareness of electronic consultation portals was found to be low.