COVID-19 FAQS: Juvenile Arthritis

UPDATED 8/21/2020

Question: Is my child with juvenile idiopathic arthritis (JIA) considered "high-risk" for COVID-19 infection or complication?

A: It’s unclear. Every child is unique, and factors such as disease type, disease activity, degree of immunosuppression and organ involvement will affect the risk.

The good news is that current data suggests that children with rheumatic diseases, including those taking immunosuppressant medications, do not appear to be at a higher risk for infection or complications than other children. However, children under a year old tend to have a higher risk of complications, though this risk is still much lower than in adult populations.  

The Childhood Arthritis and Rheumatology Research Alliance (CARRA) has developed a registry to keep tabs of COVID-19 infections in pediatric rheumatic patients. This data will help health care providers learn more about the effects of the novel coronavirus on children with rheumatic disease. Learn more about the registry here and how to get involved here.  

Question: What are the symptoms of COVID-19 in children?

A: Luckily, most children with COVID-19 will either have no symptoms or only have mild symptoms, including low-grade fever cough, sore throat, sneezing, runny nose and fatigue. Others may experience more moderate symptoms including muscle aches, diarrhea, vomiting and fatigue. Some may lose their sense of smell and taste. While these symptoms may be uncomfortable, they are not necessarily signs of severe disease. Call your child’s doctor if you notice any of these symptoms. If symptoms are mild and don’t worsen, your child’s doctor will likely advise you to monitor your child’s symptoms at home, making sure your child stays well hydrated and using a fever reducer, such as acetaminophen, as needed.

On the other hand, if you notice signs of severe infection, such as such as rapid and labored breathing and/or a bluish discoloration of the lips, seek medical care as soon as possible.

Question: How can I best protect my child?

A:  Teaching your child the importance of physical distancing combined with mask wearing and  good hand hygiene is key to protecting your child. Moreover, infection risk is much higher indoors, so do your best to limit how much time your child spends in shared indoor spaces.

Remember, protecting your child is a family affair. Make sure that everyone in your household understands the importance of taking measures to lessen infection risk, including avoiding large groups.

If you are unable to work from home or must venture out often, be sure to give others lots of space, wear a mask and avoid anyone who isn’t wearing one. You may also be eligible for benefits, including extended medical family leave and unemployment benefits, under the Families First Coronavirus Response Act (FFCRA) or the Coronavirus Aid, Relief and Economic Security Act (CARES). For more information, click here. 

If you or someone else in your household gets infected, isolate for least 14 days. Stick to one room in the house and have others use a separate bathroom, if possible. Do not handle or touch shared objects without disinfecting them afterwards. Make sure everyone is wearing a mask when in the same room. Everyone in the household should wash their hands thoroughly and frequently. For more guidance on what to do if you or a family member is sick, check out these CDC guidelines. 

Lastly, keeping your child’s disease well-controlled is critical to reducing your child’s infection risk and keeping him or her healthy during the pandemic. Continue to administer your child’s medications as prescribed and do your best to ensure your child keeps up with healthy behaviors, like getting regular exercise, getting plenty of rest and eating a balanced diet.

Question: Should my child stop taking immunosuppressive medication?

A: The short answer is no. Stopping medication puts your child at a higher risk for disease flares, worsening symptoms and developing joint damage. This applies to all medications, including nonsteroidal anti-inflammatories, or NSAIDs, such as ibuprofen and naproxen.  

Current data shows that children on immunosuppressive medications do not have a higher risk of infection or complications, regardless of which disease-modifying medication they take.

However, certain medications may need to be temporarily stopped if your child has a confirmed infection, has been exposed to someone with a COVID-19 infection or is experiencing common COVID-19 symptoms such as fever, dry cough and shortness of breath. But never stop or change your child’s medication dosage without calling consulting a doctor. This is especially important with corticosteroids, which should never be stopped suddenly. For more information about medication safety for your child during COVID-19, check out the these guidelines from the American College of Rheumatology.

If your child has symptoms of COVID-19 or has been exposed to the virus, contact your child’s doctor immediately. He or she will help you decide the best course of action.

Question: Should my child take an antibody test to check for immunity to COVID-19?

A: Antibodies are proteins that result from the immune system’s fight against a virus. In general, they protect people from getting re-infected with the same virus. But with the novel coronavirus, researchers are unsure whether the presence of antibodies gives someone immunity in the future, and if so, for how long. Currently, the CDC says it’s too early to tell if the presence of antibodies can be used to assess immunity.

Several factors can also affect the accuracy of antibody tests, namely, it can take anywhere from one to weeks for someone to develop antibodies after a COVID-19 infection.

Additionally, many antibody tests have not been evaluated for reliability or authorized for emergency use by the FDA. For more information about the performance of various antibody tests, including those authorized for emergency use, click here.

At this point, a lot more research is needed to determine if these tests are useful to individual patients. As knowledge increases over time, tests will likely improve. If you’re interested in antibody tests for your child, talk to your child’s doctor about the value of testing and choosing a quality test.

Question: Can my child take remdesivir in case of COVID-19 illness?

Doctors may decide to treat children who are hospitalized with severe disease with various drugs, including the investigational anti-viral drug, remedisivir. In May, the Food and Drug Administration issued an emergency use authorization so that remdesivir could be used in adults and children hospitalized with severe disease. But this does not mean the drug has been proven effective for everyone.

Little is known about how remdesivir affects children with autoimmune or inflammatory arthritis. The decision to use this drug in children with severe disease will come after careful consideration from the child’s care team. In general, patients who have poor liver or kidney function are not considered good candidates unless the potential benefits of using the drug outweigh potential risks.

Question: There is a new severe childhood illness related to COVID-19 that looks like Kawasaki disease. What do experts know?

A: Pediatric rheumatologists and adult rheumatologists are being asked to consult on a mysterious new illness thought to be related to COVID-19. The new illness, called multi-system inflammatory syndrome, or MIS-C for short, and leads to a potentially dangerous state of extreme inflammation. It mostly affects children and teens and looks like Kawasaki disease, an arthritis-related rheumatic disease that occurs mostly in children.

The illness almost always presents with a high fever for several days. Other symptoms may include skin rash, red eyes, redness or swelling of the hands and feet, pain the stomach, confusion, bluish lips and difficult staying awake. If you notice any of this symptoms in your child, seek emergency care immediately.

Though serious, it’s worth noting that this complication is still very rare. Most children who get COVID-19 will recover without experiencing serious adverse effects. For more information about MIS-C and what to look for, click here.