Last week, my boyfriend took me camping for my birthday. But while we were out in the woods, he fell and injured himself; we thought his kneecap was dislocated or broken. Either way, he couldn’t walk, was in extreme pain, and his knee was swollen to about 4x its size. Eventually, he went to the hospital, but it took a lot of discussion because of COVID-19 concerns. Like us, many people wonder whether they should be pursuing medical treatment or if they should avoid it based on COVID-19. So far, there are 9.1 million positive diagnoses worldwide. So how do you decide whether you need treatment? According to the American College of Rheumatology (ACR), if you’re a child with a rheumatic disease at risk of uveitis, or a parent with this child, continued ophthalmologic care is necessary.
Recently, the ACR published a set of clinical guidelines for pediatric patients with rheumatic diseases on how to pursue routine treatment during COVID-19. While I’ll go over them below, feel free to check out the full published document here.
Uveitis
Uveitis is a condition characterized by inflammation in the uvea, the middle layer of the eye. There are multiple subsets of uveitis, including:
- Iritis (anterior uveitis): impacts the front of the eye, and is the most common form.
- Cyclitis (intermediate uveitis): affects the ciliary body, or the area between the iris and the choroid.
- Choroiditis (posterior uveitis): affects the retina or optic nerve. This is the rarest form and could result in permanent vision loss.
- Pan-uveitis: impacts all 3 major eye parts.
Uveitis usually occurs in patients between 20 and 60 years old, but can affect those of all ages. Usually, uveitis occurs alongside another condition. The cause is unclear, but has been linked to eye damage or surgery, infection, toxin exposure, eye cancer, or autoimmune or inflammatory disorders such as ankylosing spondylitis or ulcerative colitis.
Symptoms often occur suddenly and without warning. Additionally, symptoms may quickly worsen. These include:
- Severe eye pain
- Eye redness
- Light sensitivity
- Dark spots in vision (“floaters”)
- Blurry vision
- Vision loss
- Headaches
- A small pupil
If you are experiencing these symptoms, please visit a doctor as soon as possible. Without treatment, uveitis can lead to cataracts, glaucoma, retinal detachment, and complete vision loss. Learn more about uveitis here.
ACR Guidelines
When COVID-19 first emerged, people weren’t sure what groups would be most negatively impacted by the virus. In many cases, children have not been experiencing as poor patient outcomes as older adults. However, it is still important to provide patients with education, resources, and support during these trying times.
For pediatric patients with rheumatic diseases, one concern is how their conditions and treatments will affect their health and immune system. Luckily, according to Dr. Jay Mehta, MD, MS:
“The data suggests that children with a rheumatic disease on immunosuppressants are not getting sicker than other children without a rheumatic disease.”
However, in the interim, the ACR guidelines are designed to help patients and their families navigate everything from going back to school or attending summer camp to receiving medical treatment.
Creating the Guidelines
In May 2020, the North American Pediatric Rheumatology Clinical Guidance Task Force formed. Members include:
- Pediatric rheumatologists
- Pediatric infectious disease physicians
- One adult rheumatologist
- One pediatric nurse practitioner
To begin, the group reviewed common questions from patients, families, and rheumatologists. Next, they used these insights to draft a series of clinical questions. Then, through a literature review, evidence report, anonymous voting, and webinars, they created the clinical guidelines, which include 27 recommendations on treatment.
Uveitis & Other Guidelines for Pediatric Patients
In regards to uveitis, the recommendation states:
Routine ophthalmologic surveillance of patients with [pediatric rheumatic disease] at high risk for chronic uveitis or with a history of uveitis should continue on schedule via in-person visits with slit lamp examination (H).
In other words, those at risk of developing uveitis should continue routine eye care to ensure that the condition does not develop. By working with ophthalmologists, patients can ensure safe conditions.
Other guidelines for pediatric patients include that:
- Patients should continue receiving routine vaccinations (such as the flu vaccine) unless it will negatively interact with their drug therapies.
- Those who are diagnosed with COVID-19 should stop taking disease-modifying anti-rheumatic drugs (DMARDs) for a period of time specified by their doctor. They may take IL-1 or IL-6 inhibitors to help with their rheumatic disease, but should talk to their doctor.
- If a patient has a life-threatening condition, they can start taking high-dose glucocorticoids.
Read the source article here.
