Vaccinate in Pediatric Rheumatology, but Pass on COVID-19 Antibody Test

In a guidance recently issued for pediatric rheumatic disease patients, the American College of Rheumatology stresses the importance of continuing vaccinations, but forgoing antibody testing for COVID-19--at least for now.

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The American College of Rheumatology (ACR) has issued a clinical guidance for pediatric patients with rheumatic disease with or without COVID-19.

The guidance includes 27 recommendations, one of which includes the continuation of childhood vaccinations, including the annual influenza vaccine unless contraindicated with existing therapies.

The ACR advises against the use of SARS-CoV-2 antibody testing that claims to identify past infections or assess the risk of re-infection.

Other recommendations include:

For patients with a pediatric rheumatic condition who have been exposed to COVID-19 at home, follow general preventative measures, such as social distancing, hand washing and wear a face mask or other covering to reduce the risk of infection.

Keep in mind that it is crucial to control underlying rheumatic disease by following doctor-prescribed treatment. In particular, NSAIDs, HCQ, colchicine, conventional DMARDs, biologic DMARDs, targeted synthetic DMARDs may be continued or initiated, if necessary, to control underlying disease.

Glucocorticoids may be continued, using the lowest dose possible to control underlying disease.

For patients with non-life and/or organ threatening disease, initiation of high dose oral or intravenous glucocorticoids should be delayed for one-to-two weeks, if deemed safe by the patient’s healthcare provider.

But for patients with life and/or organ threatening disease manifestations, initiation of high dose oral or intravenous glucocorticoids should not be delayed.

Recommendations for the ongoing treatment of pediatric rheumatic patients with probable or confirmed symptomatic COVID-19 infection:

NSAIDs, HCQ and colchicine may be continued, if necessary, to control underlying disease.

cDMARDs, bDMARDs (except IL-1 and IL-6 inhibitors), and tsDMARDs should be temporarily delayed or withheld.

IL-1 and IL-6 inhibitors may be continued, if necessary, to control underlying disease.

Glucocorticoids should be continued, with an effort to reduce the dose to the lowest dose possible to control underlying disease and avoid adrenal insufficiency.

For a complete list of the recommendations, visit: "COVID-19 Clinical Guidance for Pediatric Patients with Rheumatic Disease."

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