First name
Tamar
Middle name
B
Last name
Rubinstein

Title

American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID-19 Pandemic: Version 2.

Year of Publication

2021

Date Published

2021 Jun 10

ISSN Number

2326-5205

Abstract

<p><strong>OBJECTIVE: </strong>To provide clinical guidance to rheumatology providers who treat children with pediatric rheumatic disease (PRD) in the context of the coronavirus disease 2019 (COVID-19) pandemic.</p>

<p><strong>METHODS: </strong>The task force, consisting of 7 pediatric rheumatologists, 2 pediatric infectious disease physicians, 1 adult rheumatologist, and 1 pediatric nurse practitioner, was convened on May 21, 2020. Clinical questions and subsequent guidance statements were drafted based on a review of the queries posed by the patients as well as the families and healthcare providers of children with PRD. An evidence report was generated and disseminated to task force members to assist with 3 rounds of asynchronous, anonymous voting by email using a modified Delphi approach. Voting was completed using a 9-point numeric scoring system with predefined levels of agreement (categorized as disagreement, uncertainty, or agreement, with median scores of 1-3, 4-6, and 7-9, respectively) and consensus (categorized as low, moderate, or high). To be approved as a guidance statement, median vote ratings were required to fall into the highest tertile for agreement, with either moderate or high levels of consensus.</p>

<p><strong>RESULTS: </strong>To date, 39 guidance statements have been approved by the task force. Those with similar recommendations were combined to form a total of 33 final guidance statements, all of which received median vote ratings within the highest tertile of agreement and were associated with either moderate consensus (n&nbsp;=&nbsp;5) or high consensus (n&nbsp;=&nbsp;28).</p>

<p><strong>CONCLUSION: </strong>These guidance statements have been generated based on review of the available literature, indicating that children with PRD do not appear to be at increased risk for susceptibility to SARS-CoV-2 infection. This guidance is presented as a "living document," recognizing that the literature on COVID-19 is rapidly evolving, with future updates anticipated.</p>

DOI

10.1002/art.41772

Alternate Title

Arthritis Rheumatol

PMID

34114365

Title

American College of Rheumatology Guidance for the Management of Children with Pediatric Rheumatic Disease During the COVID-19 Pandemic: Version 1.

Year of Publication

2020

Date Published

2020 Jul 23

ISSN Number

2326-5205

Abstract

<p><strong>OBJECTIVE: </strong>To provide clinical guidance to rheumatology providers who treat children with PRD in the context of the COVID-19 pandemic.</p>

<p><strong>METHODS: </strong>The task force, consisting of 7 pediatric rheumatologists, 2 pediatric infectious disease physicians, one adult rheumatologist and one pediatric nurse practitioner, was convened on May 21, 2020. Clinical questions and subsequent guidance statements were drafted based on review of queries posed by patients, families and healthcare providers of children with PRD. An evidence report was generated and disseminated to task force members to assist with three rounds of asynchronous, anonymous voting by email using a modified Delphi approach. Voting was completed using a 9-point numeric scoring system with predefined levels of agreement ("disagreement"; "uncertain"; "agreement") and consensus. To be approved as a guidance statement, median votes were required to fall into the highest tertile for agreement with "moderate" (M) or "high" (H) levels of consensus.</p>

<p><strong>RESULTS: </strong>33 guidance statements were drafted and voted upon during rounds two and three of voting. Of these statements, all received median votes within the highest tertile of agreement and were associated with moderate (n=6) or high consensus (n=27). Statements with similar recommendations were combined, resulting in 27 final guidance statements.</p>

<p><strong>CONCLUSION: </strong>These guidance statements have been generated based on review of the available literature, indicating that children with PRD do not appear to be at increased risk for susceptibility to SARS-CoV-2 infection. This guidance is presented as a "living document," recognizing that the literature on COVID-19 is rapidly evolving, with future updates anticipated.</p>

DOI

10.1002/art.41455

PMID

32705780

Title

Prioritized Agenda for Mental Health Research in Pediatric Rheumatology from the Childhood Arthritis and Rheumatology Research Alliance Mental Health Workgroup.

Year of Publication

2020

Date Published

2020 Jan 15

ISSN Number

0315-162X

Abstract

<p><strong>OBJECTIVE: </strong>Mental health problems are prevalent in youth with rheumatologic disease. Gaps in knowledge exist regarding their impact, as well as strategies for detection and effective treatment. To address these gaps, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mental Health Workgroup developed and prioritized an agenda of research topics.</p>

<p><strong>METHODS: </strong>We systematically reviewed the literature and identified 5 major research domains in further need of study: (A) mental health burden and relationship to pediatric rheumatologic disease, (B) impact of mental health disorders on outcomes, (C) mental health awareness and education, (D) mental health screening, and (E) mental health treatment. Research topics within these areas were developed by workgroup leaders and refined by the workgroup. Members were surveyed to prioritize the topics by importance, feasibility of study, and actionability.</p>

<p><strong>RESULTS: </strong>Fifty-nine members (57%) completed the survey. Among the proposed research topics, 31/33 were rated as highly important and 4/33 were rated highly for importance, feasibility, and actionability. Topics rated most important related to (A) mental health burden and relationship to rheumatologic disease, and (B) the impact of mental health on outcomes. Topics rated most feasible and actionable were related to (D) mental health screening.</p>

<p><strong>CONCLUSION: </strong>Addressing gaps in knowledge regarding mental health in youth with rheumatologic disease is essential for improving care. We have identified high priority research topics regarding mental health of pediatric rheumatology patients in need of further investigation that are feasible to study and believed to lead to actionable results in patient care.</p>

DOI

10.3899/jrheum.190361

Alternate Title

J. Rheumatol.

PMID

31941805

Title

Depression And Anxiety In Patients With Juvenile Idiopathic Arthritis: Current Insights And Impact On Quality Of Life, A Systematic Review.

Year of Publication

2019

Number of Pages

237-252

Date Published

2019

ISSN Number

1179-156X

Abstract

<p>Depression and anxiety are prevalent in children with rheumatologic diseases, including juvenile idiopathic arthritis (JIA). However, prevalence rates and the relationship with disease outcomes, including quality of life are conflicting in the early literature. To review the current literature, determine gaps in our knowledge, and identify areas in need of further investigation, we conducted a systematic review of studies examining depression and anxiety symptoms among children with JIA and the impact these symptoms may have on disease outcomes and quality of life. Six electronic databases were searched up until January 2019. Of 799 potential articles, 60 articles were included with the main focus on 28 articles from 2009 to 2019, to concentrate on the most current evidence. We found that JIA patients experience symptoms of depression and anxiety similar to other childhood chronic diseases and at higher rates than in healthy children. Patients who experience these symptoms have worse quality of life, with some evidence pointing to depression and anxiety symptoms having a greater impact on quality of life than other disease features, such as active joint count. Family members of JIA patients experience high rates of anxiety and depression symptoms which may impact their child's mental health and pain symptoms related to JIA. Conflicting reports of associations between depression/anxiety symptoms and disease features/disease outcomes and a paucity of longitudinal studies investigating the impact of treatment on mental health symptoms indicate areas in need of further research to effectively identify patients at greatest risk of depression and anxiety and to better understand how to treat and prevent these symptoms in youth with JIA. Family mental health should also be considered in investigations concerning mental health and disease outcomes of children with JIA.</p>

DOI

10.2147/OARRR.S174408

Alternate Title

Open Access Rheumatol

PMID

31807093

Title

Mental health care for youth with rheumatologic diseases - bridging the gap.

Year of Publication

2017

Number of Pages

85

Date Published

2017 Dec 28

ISSN Number

1546-0096

Abstract

<p>Youth with rheumatologic diseases have a high prevalence of comorbid mental health disorders. Individuals with comorbid mental health disorders are at increased risk for adverse outcomes related to mental health as well as their underlying rheumatologic disease. Early identification and treatment of mental health disorders has been shown to improve outcomes, but current systems of care fall short in providing adequate mental health services to those in need. Pediatric rheumatologists are uniquely positioned to provide mental health screening and intervention for youth with rheumatologic diseases due to the frequency of patient encounters and ongoing therapeutic relationship with patients and families. However, additional training is likely required for pediatric rheumatologists to provide effective mental health care, and focusing efforts on providing trainees with mental health education is key to building competency. Potential opportunities for improved mental health education include development of clinical guidelines regarding mental health screening and management within pediatric rheumatology settings and incorporation of mental health didactics, workshops, and interdisciplinary clinic experiences into pediatric rheumatology fellowship curricula. Additional steps include mental health education for patients and families and focus on system change, targeting integration of medical and mental health care. Research is needed to better define the scope of the problem, determine effective strategies for equipping pediatric rheumatologists with skills in mental health intervention, and develop and implement sustainable systems for delivery of optimal mental health care to youth with rheumatologic diseases.</p>

DOI

10.1186/s12969-017-0214-9

Alternate Title

Pediatr Rheumatol Online J

PMID

29282086

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