Skip to main content
Download PDF

Impact of the COVID-19 pandemic on the quality of care for juvenile idiopathic arthritis patients: insights from Thailand

Orphanet Journal of Rare Diseases volume 19, Article number: 320 (2024) Cite this article

Abstract

Background

The COVID-19 pandemic has significantly impacted individuals with chronic conditions. This investigation assessed the quality of care provided to pediatric and adolescent patients with juvenile idiopathic arthritis (JIA) during the pandemic in Thailand.

Methods

This cross-sectional analysis enrolled JIA patients aged ≤ 18 years at an academic tertiary care facility from April 2022 to March 2023. Retrospective reviews were performed, complemented by patient and caregiver questionnaires to assess the pandemic’s impact on care quality.

Results

Seventy JIA patients (37 males, 33 females) with a mean age of 13.5 ± 3.1 years were included. A total of 41.4% of the caregivers reported negative impacts on JIA care due to the pandemic and the lockdown, and 31.4% of the patients experienced pandemic-related anxiety. A comparison between the pandemic and prepandemic periods revealed a higher incidence of active disease, although the difference was statistically nonsignificant (37.1% vs 14.2%, p = 0.106). Nonadherence significantly predicted active disease status (adjusted OR 15.04, 95% CI 2.48–91.15, p = 0.03). COVID-19 vaccinations were administered to 85.7% of patients; 52.8% of whom contracted mild COVID-19. Most patients (71.4%) postponed clinic visits; 36% due to lockdowns and 28% due to concerns about COVID-19 exposure in healthcare settings. The majority of patients received telephone JIA management advice from rheumatologists during the lockdown (91.4%).

Conclusions

The COVID-19 pandemic and associated lockdown measures affected the care of JIA patients, impacting both physical and mental health. Nonadherence was a critical factor in disease flare-ups. Telemedicine is indispensable for patient care.

Introduction

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was initially identified in Wuhan, China, in November 2019 [1]. The World Health Organization declared it a global pandemic in March 2020 [2,3,4], which precipitated widespread lockdowns and transportation restrictions that critically impeded access to healthcare facilities [5]. Globally, hospitals responded by restricting outpatient attendance and expanding telemedicine services [6,7,8,9,10,11].

Children and adolescents with juvenile idiopathic arthritis (JIA) are vulnerable during the COVID-19 pandemic for many reasons [12]. The etiology of JIA is multifactorial including genetic predisposition and environmental triggers such as infection leading to immune system dysfunction causing chronic inflammation in the joints. Moreover, the treatment of JIA comprises of non-steroidal anti-inflammatory drug (NSAID), corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs) and biologic agents. These immunomodulators may increase the risk of infection including the COVID-19.

Ensuring high quality of care in patients with JIA is imperative to maintain optimal treatment outcomes, prevent articular and extra-articular damages and good quality of life [13]. High quality of care consists of several aspects including early diagnosis with prompt referral, regular clinic visits and the treat-to-target management strategy [13,14,15]. Children and adolescents with JIA have been notably impacted by the pandemic and ensuing lockdowns, facing obstacles in accessing timely healthcare and specialized medications [16,17,18].

Biologic agents, such as anti-tumor necrosis factor, anti-interleukin-1, and anti-interleukin-6, target cytokines involved in the inflammatory process of JIA which are indicated in patients with JIA who do not respond to the combination of NSAID, DMARDs and/or corticosteroids [19,20,21]. The delayed access to biologic agents in JIA patients can adversely affect disease progression and increase the risk of side effects of prolonged corticosteroids treatment. Therefore, timely initiation of biologic agents is essential to improve the quality of care in patients with JIA.

This situation led to reported increases in JIA flares during the initial phase of the pandemic from 17 to 33% as reported by Conti, et al. and from 6.3 to 16.9% according to a study by Naddei, et al. [22, 23]. Moreover, enforced limitations on physical and social activities contributed to deteriorations in mental health, sleep quality, and overall quality of life [17, 18, 24]. Additionally, a considerable incidence of COVID-19 among children with rheumatic diseases was observed [25], prompting recommendations for COVID-19 vaccination in this population [26], notwithstanding vaccine hesitancy among some patients and caregivers [27].

Considering the potential disparities in healthcare systems between developed and developing nations [28, 29], this study aimed to delineate the impact of the COVID-19 pandemic and lockdown measures on the quality of care for Thai children and adolescents with JIA. Additionally, the study sought to assess attitudes toward the pandemic within the Southeast Asian context.

Materials and methods

This cross-sectional study was undertaken at the Pediatric Rheumatology Clinic of Siriraj Hospital, Mahidol University, in Bangkok, Thailand, the country’s largest academic tertiary care center. We enrolled patients diagnosed with JIA aged 18 years or younger between April 2022 and March 2023. The International League of Associations for Rheumatology criteria [30] were employed for the JIA classifications, and demographic and clinical data were retrospectively collected from electronic health records. Pandemic era was defined by the time beyond January 2020. Clinically inactive disease was defined according to the Wallace criteria [31].

In this study, we used a self-developed structured questionnaire including single-choice responses, multiple-choice responses and rating scales. This encompassed questions on COVID-19 infection and vaccination experiences, care received, and psychological impacts during the pandemic and lockdown periods. Attitudes toward the pandemic’s impact on care quality and satisfaction with rheumatology healthcare communication were gauged using a 5-point Likert scale. It was self-reported completed by patient or caregivers of patients with JIA during clinic appointments as shown in the supplementary file. The Siriraj Institutional Review Board approved the study protocol (COA Si 083/2022) in accordance with the principles of the Declarations of Helsinki. Informed consent and assent were obtained from all participating parents and patients.

All the statistical analyses were performed using IBM SPSS Statistics, Version 20 (IBM Corp, Armonk, NY, USA). The requisite sample size (n) was determined based on the proportion (p) of JIA flares during the pandemic, as reported by Conti et al. (48.7%) [22]. Using the formula n = Z2 × p × (1 − p)/d2 (where the Z score = 1.96, p = 0.487, and margin of error d = 0.12), a minimum sample size of 66 JIA patients was calculated.

Descriptive statistics are presented as counts and percentages, means ± standard deviations, or medians with interquartile ranges. The chi-square test or Fisher’s exact test, as appropriate, was utilized for categorical comparisons between groups. The Mann–Whitney U test was applied to compare nonnormally distributed continuous variables. Factors associated with active disease were first examined using univariable logistic regression, with variables exhibiting p < 0.2 entered into a multivariable logistic regression analysis employing the enter method. Statistical significance was defined as p < 0.05, with confidence intervals set at 95%.

Results

Demographic and clinical characteristics

In this study, we included 70 patients with JIA (37 males and 33 females). The participants had a mean age of 13.5 ± 3.1 years. Enthesitis-related arthritis was the most common JIA subtype, accounting for 32.9% of the cases, followed by systemic JIA at 31.4%. Patients had a median disease duration of 4.5 years (interquartile range 3.1–6.7). The demographic and clinical details are summarized in Table 1.

Table 1 Demographic and clinical characteristics of children and adolescents with juvenile idiopathic arthritis (N = 70)
Full size table

The proportion of patients with active JIA increased from 14.2% (10/70) before the COVID-19 pandemic to 37.1% (26/70) during the pandemic, although this increase did not reach statistical significance (p = 0.106). Of those with active disease during the pandemic, 20 experienced disease flare-ups, while 6 continued from the prepandemic period. Systemic JIA was the most frequently flaring subtype during the pandemic (34.6%), followed by enthesitis-related arthritis (30.7%). Notably, 53.8% of patients with active disease were nonadherent to treatment during the pandemic. Multivariable logistic regression identified nonadherence as a significant predictor of active disease, with an adjusted odds ratio of 15.04 (95% CI 2.48–91.15, p = 0.03; Table 2).

Table 2 Factors associated with active disease in children and adolescents with juvenile idiopathic arthritis during the COVID-19 pandemic
Full size table

COVID-19 vaccination and infection

Sixty patients (85.7%) received COVID-19 vaccinations, 95% of whom received BNT162b2 (Pfizer–BioNTech). Two patients received the BBIBP-CorV (Sinopharm) vaccine, and one received the ChAdOx1 (Oxford–AstraZeneca) vaccine. The vaccine side effects were mild, with 13 patients experiencing low-grade fever and 5 reporting headaches.

Thirty-seven patients (52.8%) contracted COVID-19, all of whom presented with mild symptoms such as fever, cough, and rhinorrhea. Thirteen of these patients were treated with favipiravir. None of the children developed severe complications, such as pneumonia, acute respiratory distress syndrome, myocarditis, or multisystem inflammatory syndrome in children.

Quality of care of JIA during the COVID-19 pandemic

Ophthalmology examinations for uveitis surveillance were slightly less frequent during the pandemic (84.2%) than during the prepandemic period (97.1%, p = 0.176). In contrast, the influenza vaccination rate significantly increased to 88.5% during the pandemic, compared to 62.8% during the prepandemic period (p = 0.019).

Clinic visit postponements occurred for 50 patients (71.4%). The reasons included lockdown-related transportation difficulties (43%), concerns about COVID-19 exposure in the hospital (41%), stable disease status (38%), and family COVID-19 infections during quarantine periods (14%).

Although a telemedicine system was available during the pandemic, only 3 patients used this platform. Instead, 64 patients (91.4%) preferred to seek medical advice via telephone from the rheumatology healthcare team.

Psychological perception and attitude toward pandemic-related quality of care

Twenty-two patients (31.4%) reported feeling anxious due to the pandemic (Fig. 1). Additionally, 29 caregivers (41.4%) perceived the pandemic and lockdown as having a negative impact on the quality of JIA care. Despite these challenges, a substantial majority of caregivers (92.6%) expressed satisfaction with the healthcare services provided by the rheumatology team during the pandemic.

Fig. 1
figure 1

Psychological perceptions during the COVID-19 pandemic and lockdown in children and adolescents with juvenile idiopathic arthritis

Full size image

Discussion

Our study underscores that the COVID-19 pandemic and associated lockdown measures substantially impacted the quality of care for JIA patients, affecting both their physical and mental well-being. A critical insight is the identification of nonadherence as a pivotal factor in JIA flare-ups, highlighting the essential role of continuous communication between patients/caregivers and rheumatology healthcare providers during such crises.

Typical JIA management encompasses both pharmacological interventions and nonpharmacological strategies such as physical therapy and regular exercise [19,20,21]. Naddei et al. observed an increased incidence of JIA flares during lockdowns (16.9%) compared to the preceding year (6.3%) [23]. Conversely, Miserocchi et al. reported no rise in uveitis flares among JIA patients, with no patient advised to cease immunosuppressive medications [32]. Our analysis revealed a higher occurrence of active JIA cases and flares during the pandemic, but without statistical significance.

Our findings implicate nonadherence as the predominant cause of JIA flares in our cohort, potentially exacerbated by disruptions to clinic schedules and transportation constraints during the pandemic. This result concurs with that of Conti et al., who linked JIA flares to nonadherence and extended intervals between clinic visits [22]. Another study also identified medication shortages and difficulties accessing healthcare services as contributing to nonadherence among patients requiring rheumatic and musculoskeletal disease management [5]. Notably, systemic JIA emerged as the subtype most prone to flares in our investigation. This finding is likely due to the necessity for consistent corticosteroids or biologic therapy to manage systemic inflammation, with lapses in treatment adherence leading to disease exacerbations. Horton et al. observed a notable reduction in both clinic attendance and glucocorticoid usage among JIA patients in a cohort in the United States during the first year of the pandemic [33]. Another factor contributing to disease flare-ups could be that the accessibility of tocilizumab was notably constrained during the pandemic’s first year. Tocilizumab, an intravenous humanized monoclonal antibody that targets interleukin-6 and is needed by patients with refractory systemic JIA for infusions every second week, was diverted for treating adults with severe COVID-19 pneumonia [34].

The interaction between COVID-19 infection and its impact on JIA patients warrants attention. Approximately 52.8% of our JIA cohort contracted COVID-19, manifesting primarily with mild symptoms. These findings are consistent with those of Lerkvaleekul et al., who reported similar rates of infection and severity among JIA patients [25]. Boyarchuk et al. found systemic JIA patients to be more susceptible to COVID-19, with an increased risk (odds ratio 6.16, p = 0.028) [35]. Despite ongoing DMARD therapy, the course of COVID-19 in our JIA cohort largely paralleled the general pediatric population’s experience with the virus [35]. None of our JIA patients developed severe COVID-19 complications, such as pneumonia, myocarditis, or multisystem inflammatory syndrome in children. With 85.7% of our cohort receiving COVID-19 vaccinations, this high uptake rate may have contributed to the predominantly mild COVID-19 symptoms observed in our study. Notably, most vaccinated JIA patients received the mRNA COVID-19 vaccine, which, according to a systematic review and meta-analysis by Hamad Saied et al. [36], is significantly associated with a reduced incidence of multisystem inflammatory syndrome in children. Furthermore, the increased rate of annual influenza vaccination observed during the pandemic suggests a growing recognition of the importance of immunization for preventing severe respiratory illnesses, a trend likely spurred by the pandemic context.

The psychological impact during and after the COVID-19 pandemic is noteworthy, with anxiety reported by 31.4% of our JIA patients. Pandemic conditions and associated lockdowns have previously been reported to lead to considerable psychological distress among patients and increased stress among parents, largely due to disruptions in daily life [37]. For example, children experienced sleep disturbances and emotional distress during lockdown periods [38], and a substantial number of JIA patients were reluctant to return to school after lockdown [39]. These findings highlight the importance of continuous postpandemic monitoring of the long-term psychological effects on JIA-affected children and adolescents.

The COVID-19 pandemic led to a rapid surge in the adoption of telemedicine across various medical specialties, including rheumatology [40, 41]. Despite its benefits, challenges such as the lack of comprehensive physical examinations and the limitations of doctor‒patient relationships have been identified [42,43,44]. Furthermore, the effectiveness of telemedicine in addressing psychological concerns in pediatric rheumatology patients remains a concern [45]. Although telemedicine was introduced in our hospital, its usage was limited due to internet access constraints and the difficulties experienced by caregivers in using a technology-based service. Most patients and caregivers preferred telephone communication with the health care team, valuing its simplicity and ubiquity over internet-based options. Other research has shown that caregivers with a relatively high education level, those who had missed appointments, and those facing long travel times (> 1 h) preferred telemedicine [40]. Research from a pediatric rheumatology unit in Italy, which implemented telephone consultations, demonstrates their effectiveness as a component of telemedicine services during the pandemic [32]. Another study in Canada reported high satisfaction levels with outpatient rheumatology phone visits [43]. These observations underscore the need to refine telemedicine to make it more accessible and user friendly and hence sustain its benefits beyond the pandemic [41]. Moreover, pediatric rheumatology education should be promoted for general pediatricians so that they can provide general treatment and support for JIA patients at the local hospitals of the patients' hometown in case they cannot travel to the tertiary center for regular rheumatology appointments [28, 46, 47].

This study has several limitations, particularly, its limited number of participants and single-center design. The risk of recall bias also exists, underscoring the need for a cautious interpretation of the findings. Despite these limitations, our research offers valuable insights into the real-life impact of the COVID-19 pandemic and lockdown measures on healthcare quality and system adaptability within a resource-constrained environment.

Conclusion

In summary, the pandemic has markedly affected the quality of healthcare provided to our JIA patients, impacting both their physical health and mental well-being. Nonadherence was identified as a critical factor exacerbating disease flare-ups. The findings underscore the importance of maintaining effective communication between patients/caregivers and the rheumatology healthcare team. Looking ahead, there is a pressing need to improve telemedicine capabilities, particularly in resource-limited settings, to ensure continuous and effective care for JIA patients in the face of such global health challenges.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request. Due to privacy concerns and to protect the confidentiality of study participants, the data cannot be openly shared.

Abbreviations

COVID-19:

Coronavirus disease 2019

DMARD:

Disease-modifying anti-rheumatic drug

JIA:

Juvenile idiopathic arthritis

NSAID:

Nonsteroidal anti-inflammatory drug

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

References

  1. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395:565–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Phelan AL, Katz R, Gostin LO. The novel coronavirus originating in Wuhan, China: challenges for global health governance. JAMA. 2020;323:709–10.

    Article  CAS  PubMed  Google Scholar 

  3. Petersen E, Koopmans M, Go U, Hamer DH, Petrosillo N, Castelli F, et al. Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics. Lancet Infect Dis. 2020;20:e238–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91:157–60.

    PubMed  PubMed Central  Google Scholar 

  5. Fouad AM, Elotla SF, Elkaraly NE, Mohamed AE. Impact of COVID-19 pandemic on patients with rheumatic and musculoskeletal diseases: disruptions in care and self-reported outcomes. J Patient Exp. 2022;9:23743735221102680.

    PubMed  PubMed Central  Google Scholar 

  6. Gheita TA, Salem MN, Eesa NN, Khalil NM, Gamal NM, Noor RA, et al. Rheumatologists’ practice during the Coronavirus disease 2019 (COVID-19) pandemic: a survey in Egypt. Rheumatol Int. 2020;40:1599–611.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Akintayo RO, Akpabio AA, Kalla AA, Dey D, Migowa AN, Olaosebikan H, et al. The impact of COVID-19 on rheumatology practice across Africa. Rheumatology (Oxford). 2021;60:392–8.

    Article  CAS  PubMed  Google Scholar 

  8. Nune A, Iyengar KP, Ahmed A, Bilgrami S, Sapkota HR. Impact of COVID-19 on rheumatology practice in the UK-a pan-regional rheumatology survey. Clin Rheumatol. 2021;40:2499–504.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kwok TSH, Kuriya B, King LK, Eder L, Thorne JC, Li Z, et al. Changes in service delivery and access to rheumatologists before and during the COVID-19 pandemic in a Canadian Universal Healthcare Setting. J Rheumatol. 2022;50:944–8.

    Article  PubMed  Google Scholar 

  10. Howden K, Glidden C, Romanescu RG, Hatala A, Scott I, Deleemans J, et al. A cross-sectional survey exploring the impact of the COVID-19 pandemic on the cancer care of adolescents and young adults. Curr Oncol. 2021;28:3201–13.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Yazicioglu B, Bakkaloglu SA, European Society for Pediatric N. Impact of coronavirus disease-2019 on pediatric nephrology practice and education: an ESPN survey. Pediatr Nephrol. 2022;37:1867–75.

    Article  PubMed  Google Scholar 

  12. Bansal N, Pasricha C, Kumari P, Jangra S, Kaur R, Singh R. A comprehensive overview of juvenile idiopathic arthritis: from pathophysiology to management. Autoimmun Rev. 2023;22:103337.

    Article  PubMed  Google Scholar 

  13. Bingham CA, Harris JG, Qiu T, Gilbert M, Vora SS, Yildirim-Toruner C, et al. Pediatric rheumatology care and outcomes improvement network’s quality measure set to improve care of children with juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2023;75:2442–52.

    Article  PubMed  Google Scholar 

  14. Chausset A, Pereira B, Echaubard S, Merlin E, Freychet C. Access to paediatric rheumatology care in juvenile idiopathic arthritis: what do we know? A systematic review. Rheumatology (Oxford). 2020;59:3633–44.

    Article  PubMed  Google Scholar 

  15. Ravelli A, Consolaro A, Horneff G, Laxer RM, Lovell DJ, Wulffraat NM, et al. Treating juvenile idiopathic arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2018;77:819–28.

    PubMed  Google Scholar 

  16. Kaya Akca U, Atalay E, Cuceoglu MK, Balik Z, Sener S, Ozsurekci Y, et al. Impact of the COVID-19 pandemic on the frequency of the pediatric rheumatic diseases. Rheumatol Int. 2022;42:51–7.

    Article  CAS  PubMed  Google Scholar 

  17. Ihara BP, Lindoso LM, Setoue DND, Tanigava NY, Helito AC, Simon JR, et al. COVID-19 quarantine in adolescents with autoimmune rheumatic diseases: mental health issues and life conditions. Clin Rheumatol. 2022;41:3189–98.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hausmann JS, Kennedy K, Surangiwala S, Larche MJ, Sinha R, Durrant K, et al. Early impacts of the COVID-19 pandemic on children with pediatric rheumatic diseases. Eur J Rheumatol. 2022;9:185–90.

    Article  PubMed  Google Scholar 

  19. Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, et al. 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis: recommendations for nonpharmacologic therapies, medication monitoring, immunizations, and imaging. Arthritis Care Res (Hoboken). 2022;74:505–20.

    Article  PubMed  Google Scholar 

  20. Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, et al. 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for oligoarthritis, temporomandibular joint arthritis, and systemic juvenile idiopathic arthritis. Arthritis Rheumatol. 2022;74:553–69.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ringold S, Angeles-Han ST, Beukelman T, Lovell D, Cuello CA, Becker ML, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for non-systemic polyarthritis, sacroiliitis, and enthesitis. Arthritis Care Res (Hoboken). 2019;71:717–34.

    Article  PubMed  Google Scholar 

  22. Conti G, Galletta F, Carucci NS, La Mazza A, Mollica SA, Alibrandi A, et al. Negative effect of lockdown on juvenile idiopathic arthritis patients. Clin Rheumatol. 2021;40:3723–7.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Naddei R, Alfani R, Bove M, Discepolo V, Mozzillo F, Guarino A, et al. Increased relapse rate during COVID-19 lockdown in an Italian Cohort of Children with juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2023;75:326–31.

    Article  CAS  PubMed  Google Scholar 

  24. Durcan G, Barut K, Haslak F, Doktur H, Yildiz M, Adrovic A, et al. Psychosocial and clinical effects of the COVID-19 pandemic in patients with childhood rheumatic diseases and their parents. Rheumatol Int. 2021;41:575–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Lerkvaleekul B, Charuvanij S, Sukharomana M, Pirojsakul K, Kamolwatwong M, Vilaiyuk S. Outcomes in children with rheumatic diseases following COVID-19 vaccination and infection: data from a large two-center cohort study in Thailand. Front Pediatr. 2023;11:1194821.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Curtis JR, Johnson SR, Anthony DD, Arasaratnam RJ, Baden LR, Bass AR, et al. American College of Rheumatology guidance for COVID-19 vaccination in patients with rheumatic and musculoskeletal diseases: version 3. Arthritis Rheumatol. 2021;73:e60–75.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Akgun O, Kayaalp GK, Demirkan FG, Cakmak F, Tanatar A, Guliyeva V, et al. Exploring the attitudes, concerns, and knowledge regarding COVID-19 vaccine by the parents of children with rheumatic disease: cross-sectional online survey. Vaccine. 2022;40:1829–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Scott C, Chan M, Slamang W, Okong’o L, Petty R, Laxer RM, et al. Juvenile arthritis management in less resourced countries (JAMLess): consensus recommendations from the Cradle of Humankind. Clin Rheumatol. 2019;38:563–75.

    Article  PubMed  Google Scholar 

  29. Tangcheewinsirikul S, Tang SP, Smith N, Sukharomana M, Charuvanij S, Vilaiyuk S, et al. Delivery of paediatric rheumatology care: a survey of current clinical practice in Southeast Asia and Asia-Pacific regions. Pediatr Rheumatol Online J. 2021;19:11.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390–2.

    PubMed  Google Scholar 

  31. Wallace CA, Giannini EH, Huang B, Itert L, Ruperto N, Childhood Arthritis Rheumatology Research A, et al. American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2011;63:929–36.

    Article  PubMed  Google Scholar 

  32. Miserocchi E, Giuffre C, Modorati GM, Cimaz R. Management of juvenile idiopathic arthritis-associated uveitis duringthe COVID-19 pandemic in a pediatric referral center in Lombardy. Ocul Immunol Inflamm. 2020;28:1305–7.

    Article  CAS  PubMed  Google Scholar 

  33. Horton DB, Yang Y, Neikirk A, Huang C, Crystal S, Davidow A, et al. Impact of the COVID-19 pandemic on the management of juvenile idiopathic arthritis: analysis of United States Commercial Insurance Data. J Clin Rheumatol. 2023;29:388–95.

    PubMed  Google Scholar 

  34. Verma AA, Pai M, Saha S, Bean S, Fralick M, Gibson JL, et al. Managing drug shortages during a pandemic: tocilizumab and COVID-19. CMAJ. 2021;193:E771–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Boyarchuk O, Predyk L, Yuryk I. COVID-19 in patients with juvenile idiopathic arthritis: frequency and severity. Reumatologia. 2021;59:197–9.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Hamad Saied M, van der Griend L, van Straalen JW, Wulffraat NM, Vastert S, Jansen MHA. The protective effect of COVID-19 vaccines on developing multisystem inflammatory syndrome in children (MIS-C): a systematic literature review and meta-analysis. Pediatr Rheumatol Online J. 2023;21:80.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Johnson MS, Skjerdingstad N, Hoffart A, Ebrahimi OV, Johnson SU. Triggered by worry: a dynamic network analysis of COVID-19 pandemic-related anxiety and parental stress. J Affect Disord. 2024;346:329–37.

    Article  PubMed  Google Scholar 

  38. Picca M, Manzoni P, Corsello A, Ferri P, Bove C, Braga P, et al. Persistence of lockdown consequences on children: a cross-sectional comparative study. Children (Basel). 2022;9:1927.

    PubMed  Google Scholar 

  39. Quere B, Lemelle I, Lohse A, Pillet P, Molimard J, Richer O, et al. Juvenile idiopathic arthritis and COVID-19 pandemic: good compliance with treatment, reluctance to return to school. Front Med (Lausanne). 2021;8:743815.

    Article  PubMed  Google Scholar 

  40. Kayaalp GK, Akgun O, Demirkan FG, Tanatar A, Cakmak F, Ayaz NA. Parent views on telemedicine in pediatric rheumatology: a survey study. Telemed J E Health. 2023;29:1548–56.

    Article  PubMed  Google Scholar 

  41. Waqar-Cowles LN, Chuo J, Weiss PF, Gmuca S, LaNoue M, Burnham JM. Evaluation of pediatric rheumatology telehealth satisfaction during the COVID-19 pandemic. Pediatr Rheumatol Online J. 2021;19:170.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Pooni R, Pageler NM, Sandborg C, Lee T. Pediatric subspecialty telemedicine use from the patient and provider perspective. Pediatr Res. 2022;91:241–6.

    Article  PubMed  Google Scholar 

  43. Goldhar HA, Gazel U, Ivory C, Maltez N, Humphrey-Murto S, Milman N, et al. Factors affecting patient satisfaction with outpatient rheumatology phone visits during the COVID-19 pandemic. Clin Rheumatol. 2022;41:2839–44.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Makhlouf Y, Nessib DB, Ferjani H, Triki W, Maatallah K, Dhia K, et al. The concept of telemedicine in pediatric rheumatology in Tunisia: parents’ perceptions. J Pediatr Nurs. 2023;69:6–9.

    Article  PubMed  Google Scholar 

  45. Balmuri N, Onel KB. Glitches in the utilization of telehealth in pediatric rheumatology patients during the COVID-19 pandemic. Pediatr Rheumatol Online J. 2020;18:78.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Sukharomana M, Charuvanij S. Implementation and assessment of a structured curriculum for a 4-week pediatric rheumatology rotation for pediatric residents. BMC Med Educ. 2024;24:83.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Sukharomana M, Charuvanij S. The Thai translation of the pediatric gait, arms, legs, spine tool is useful for pediatric residents in detecting musculoskeletal abnormalities in children. J Clin Rheumatol. 2021;27:e323–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors extend their sincere appreciation to the participating patients and their families for their cooperation. Special thanks to Ms. Julaporn Pooliam, MSc (Statistics), for her invaluable support with the statistical analyses. The authors gratefully acknowledge the professional English editing by Mr. David Park.

Funding

Open access funding provided by Mahidol University. This study was financially supported by the Siriraj Research Development Fund, Faculty of Medicine Siriraj Hospital, Mahidol University (Grant Number [IO] R016531036).

Author information

Authors and Affiliations

  1. Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand

    Rattakorn Pinpattanapong, Maynart Sukharomana & Sirirat Charuvanij

Authors
  1. Rattakorn Pinpattanapong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maynart Sukharomana
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sirirat Charuvanij
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RP conceptualized and designed the study, engaged in data collection and analysis, interpreted the findings, drafted the initial manuscript, and participated in manuscript revision. MS was involved in the study design, data collection and analysis, interpretation and summarization of the results, reviewed and provided critical revisions of the manuscript with suggestions for important intellectual content, and is the essentially intellectual contributor. SC conceptualized and designed the study, engaged in data collection and analysis, interpreted and summarized the findings, drafted and critically revised the manuscript, and is the corresponding author. All the authors have read and approved the manuscript for publication, meet the International Committee of Medical Journal Editors criteria for authorship, and assume full responsibility for the work’s integrity.

Corresponding author

Correspondence to Sirirat Charuvanij.

Ethics declarations

Ethics approval and consent to participate

The Ethics Committee for Research in Humans of the Siriraj Institutional Review Board authorized the study protocol (COA Si 083/2022). Informed consent and assent were obtained from all participating parents and patients.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pinpattanapong, R., Sukharomana, M. & Charuvanij, S. Impact of the COVID-19 pandemic on the quality of care for juvenile idiopathic arthritis patients: insights from Thailand. Orphanet J Rare Dis 19, 320 (2024). https://doi.org/10.1186/s13023-024-03330-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13023-024-03330-7

Keywords

Orphanet Journal of Rare Diseases

ISSN: 1750-1172