Negative effect of lockdown on juvenile idiopathic arthritis patients

Giovanni Conti; Francesca Galletta; Nicolina Stefania Carucci; Antonella La Mazza; Salvatore Antonio Mollica; Angela Alibrandi; Carmela Visalli

doi:10.1007/s10067-021-05694-8

Negative effect of lockdown on juvenile idiopathic arthritis patients

Clin Rheumatol. 2021 Sep;40(9):3723-3727. doi: 10.1007/s10067-021-05694-8. Epub 2021 Mar 17.

Authors

Giovanni Conti¹, Francesca Galletta², Nicolina Stefania Carucci², Antonella La Mazza², Salvatore Antonio Mollica², Angela Alibrandi³, Carmela Visalli⁴

Affiliations

¹ Pediatric Nephrology and Rheumatology Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", AOU Policlinic G Martino, University of Messina, Via Consolare Valeria, 98124, Messina, Italy. giovaniconti@hotmail.com.
² Pediatric Nephrology and Rheumatology Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", AOU Policlinic G Martino, University of Messina, Via Consolare Valeria, 98124, Messina, Italy.
³ Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy.
⁴ Division of Radiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.

Abstract

Introduction: The aim of this study is to evaluate a possible negative action of lockdown, during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, in the follow-up of juvenile idiopathic arthritis (JIA) patients.

Methods: We compared the number of JIA reactivations in the period March-July 2020 to the same months of 2018 and 2019.

Results: A total of 10 JIA reactivations have been documented on 58 patients (17%) visited in the period March-July 2018; 10 reactivations on 61 patients (16%) in the period March-July 2019; and 19 reactivations on 39 patients (49%) in the period March-July 2020, with a statistically significant increase (p <0.001). The other 19 patients who should have been visited during the same period, contacted by phone, indicated remission. Therefore, we hypothesize that the effective number of reactivations in the period March-July 2020 would be 19/58 patients (33%) which remains significantly greater than in the previous 2 years (p < 0.05). Among the 19 JIA patients reactivated in 2020, 3 spontaneously stopped the basic treatment due to parents' choice for fear of serious complications in case of SARS-CoV-2 infection and 4 had poor compliance with underlying treatment. In addition, 14/19 reactivated JIA patients did not perform the scheduled check according to the follow-up. In fact, the mean time interval between two follow-up visits was significantly greater in 2020 (157 ± 53 days, p < 0.0001) vs 2018 (108 ± 68 days) and 2019 (107 ± 40 days).

Conclusions: We have found a significant increase in JIA reactivations in the period March-July 2020 compared to the same interval of 2018 and 2019. This increase may have been caused by poor compliance with background treatment, as documented in 7/19 JIA patients reactivated, and by a greater interval in follow-up checks. Therefore, it is necessary, in occasion of a new pandemic and lockdown, to implement greater controls using more appropriate telemedicine tools. Key Points • COVID-19 pandemic lockdown had a negative effect on the follow-up of JIA patients. • A significant increase in JIA reactivations was found during the lockdown. • Poor therapeutic compliance and follow-up checks have been proven during the lockdown. • It is necessary to improve telemedicine tools and scientific information during a pandemic and lockdown.

Keywords: COVID-19 pandemic; Juvenile idiopathic arthritis; Lockdown; SARS-CoV-2; Telemedicine tools.

MeSH terms

Arthritis, Juvenile* / drug therapy
Arthritis, Juvenile* / epidemiology
COVID-19*
Communicable Disease Control
Humans
Pandemics
SARS-CoV-2