Utility of telemedicine in pediatric rheumatology during the COVID-19 pandemic

Background During the COVID-19 pandemic, telemedicine has provided an alternative to in-person visits for patients practicing social distancing and undergoing quarantine. During this time, there has been a rapid expansion of telemedicine and its implementation in various clinical specialties and settings. In this observational study we aim to examine the utility of telemedicine in a pediatric rheumatology clinic, for 3 months during the COVID-19 pandemic. Methods A review of outpatient pediatric rheumatology telemedicine encounters were conducted from April–June 2020. Telemedicine visits (n = 75) were compared to patients seen in practice over the prior year in office-based visits (March 2019–March 2020) (n = 415). Patient characteristics, information on no-show visits, completed visits, new patient or follow-up status, and if new patients had received a visit within 2 weeks of calling to schedule an appointment were analyzed by chart review. An independent sample t-test and Chi Square statistic was used to determine statical significance between the two groups. A two-proportion z-test was used to compare visit metrics. Results The percentage of new patients utilizing telemedicine (60%) was lower and statistically significant compared to the percentage of new patient office visits (84%) the previous year (p < 0.0001). There was no change in no-show rate between groups and patient characteristics were similar. Conclusions This study demonstrates a statistically significant decrease in new patient visits during the pandemic with telemedicine-only appointments compared to in-office visits over the previous year. This suggests a possible hesitation to seek care during this time. However, there was no significant difference among patient characteristics between telemedicine visits during the pandemic and during in-office visits in the previous year. In our experience, patient visits were able to be conducted via telemedicine with a limited physical exam using caregiver’s help during the pandemic. However, further studies will need to ascertain patient satisfaction and preference for telemedicine in the future.

Case Report: Post SARS-CoV2 Infection Erythema Nodosum

Background: Although, preliminary reports of Post SARS-CoV2 Infection Erythema Nodosum suggest it may be due to dysregulated immune response caused by coronavirus.Case presentation: The patient was a 9-year-old boy who referred to the pediatric Rheumatology clinic of Shiraz University of Medical Sciences due to bilateral painful erythematous nodules on his bilateral calves. He reported a history of fever from 4 days before his referral which was followed by erythema, warmth, stiffness, and swelling of his calves. The patient’s father had afflicted COVID-19 two months prior to the incidence. In his course of admission, COVID-19 serology tests were performed for him which was positive for SARS-CoV-2 IgG and negative for SARS-CoV-2 IgM.Conclusion: Another etiologic factor for EN might be coronaviruses such as SARS-CoV-2 which is important to be taken into consideration during the COVID-19 pandemic.

Utility of telemedicine in pediatric rheumatology during the COVID-19 pandemic

Background: During the COVID-19 pandemic, telemedicine has provided an alternative to in-person visits for patients practicing social distancing and undergoing quarantine. During this time, there has been a rapid expansion of telemedicine and its implementation in various clinical specialties and settings. In this observational study we aim to examine the utility of telemedicine in a pediatric rheumatology clinic, for 3 months during the COVID-19 pandemic.Methods: A review of outpatient pediatric rheumatology telemedicine encounters were conducted from April-June 2020. Telemedicine visits (n=75) were compared to patients seen in practice over the prior year in office-based visits (March 2019-March 2020) (n=415). Patient characteristics, information on no-show visits, completed visits, new patient or follow-up status, and if new patients had received a visit within 2 weeks of calling to schedule an appointment were analyzed by chart review. An independent sample t-test and Chi Square statistic was used to determine statical significance between the two groups. A two-proportion z-test was used to compare visit metrics.Results: The percentage of new patients utilizing telemedicine (60%) was lower and statistically significant compared to the percentage of new patient office visits (84%) the previous year (p<0.0001). There was no change in no-show rate between groups and patient characteristics were similar.Conclusions: This study demonstrates a statistically significant decrease in new patient visits during the pandemic with telemedicine-only appointments compared to in-office visits over the previous year. This suggests a possible hesitation to seek care during this time. However, there was no significant difference among patient characteristics between telemedicine visits during the pandemic and during in-office visits in the previous year. In our experience, patient visits were able to be conducted via telemedicine with a limited physical exam using caregiver’s help during the pandemic. However, further studies will need to ascertain patient satisfaction and preference for telemedicine in the future.

Juvenile Idiopathic Arthritis in Jordan: Single-Center Experience

Background: Juvenile idiopathic arthritis (JIA) is a heterogeneous group of disorders, including all forms of arthritis, begin in children who are less than 16 years old. This study aims to evaluate the clinical and laboratory features of JIA in Jordanian children in a single center.Methods: A retrospective analysis of the medical records of pediatric patients who were diagnosed as JIA based on the International League of Associations for Rheumatology (ILAR) criteria from 2015 through 2019 at a pediatric Rheumatology clinic in Queen Rania Children Hospital. All patients were below the age of 14 at the time of diagnosis. Collected data included age, gender, age at initial presentation and diagnosis, JIA subtypes, and laboratory data.Results: A total of 210 patients were included in this cohort (94 males and 116 females) with a mean age at diagnosis 5.33 ± 3.4 years and the mean age at onset of the disease was 5.08 ± 3.4 years (range 7 months – 14 years). Oligoarticular JIA was the commonest subtype (54.7%), followed by systemic arthritis (17.1%), polyarticular (12.3%). ANA was positive in 70 patients (33.6%). Uveitis occurred in thirty (14.2%) patientsConclusion: To the best of our knowledge, this cohort is the first report on JIA in Jordan, in comparison with other regional and international published reports, Oligoarticular JIA found to be the most common Subtype in our experience. To have more details about JIA characteristics, a population-based rather than a single-center study needs to be conducted in Jordan

The Pattern of Juvenile Idiopathic Arthritis in a Single Tertiary Center in Saudi Arabia

Introduction.Juvenile Idiopathic Arthritis (JIA) is the most common chronic arthritis in children. Our aim is to describe demographic, clinical, and laboratory characteristics and treatment of JIA patients followed up in Pediatric Rheumatology clinic in a tertiary center in Saudi Arabia.Methods. Medical records of all patients who are followed up between January 2007 and January 2015 were retrospectively reviewed. Data were collected about demographic, clinical, and laboratory features and treatment.Results.Total patients were 82, males were 31 (37.8%), and mean age of JIA onset was 7.1 ± 3.6 yr. Mean follow-up duration was 2.67±1.6 yr. Systemic onset JIA (SoJIA) was the commonest (36.5%), followed by polyarticular in 29.2% and oligoarticular in 28%. Large and small joints are involved in 76 (92%) and 30 (36.6%), respectively. Main extra-articular feature was fever in 34 (41.4%). Uveitis was diagnosed in 7 (8.5%) and in 5 (21.7%) of oligoarticular JIA. Anemia was found in 49 (59.7%), high ESR in 45 (54.8%), and leukocytosis and thrombocytosis in 33 (40.2%). Positive ANA was found in 30 (36.5%) mainly in oligoarticular subtype as 12 (52%) patients (out of 23) had this positive test. 9 patients (10.9%) required NSAIDs only, 6 patients (7.3%) required NSAIDs and intra-articular steroids only, and 19 (23%) required NSAIDs, methotrexate, steroids, and biologics.Conclusion.SoJIA is the most common JIA subtype in our study. A population based rather than a single center study will give more details about JIA characteristics in Saudi Arabia