2020 Pediatric Rheumatology Research in Review

Dr. von Scheven

ACR CONVERGENCE 2020—This has been a busy year for research publications covering a number of pediatric rheumatic diseases, including the emerging multi-system inflammatory syndrome (MIS-C) associated with SARS CoV-2.

Despite the many challenges brought about by the COVID-19 pandemic, a healthy collection of publications covering a wide range of pediatric rheumatology research topics were published in 2020. These research publications advanced our knowledge of the pathophysiological basis of pediatric rheumatic diseases and treatment options and influenced the practice of pediatric rheumatology.

During the ACR Convergence 2020 session Pediatric Rheumatology: The Year in Review Emily von Scheven, MD, MAS, chief of rheumatology, director of the Child and Adolescent Chronic Illness Center, and a pediatric rheumatologist at the University of California, San Francisco, Benioff Children’s Hospital, and Grant Schulert, MD, PhD, assistant professor of pediatrics in the Division of Rheumatology at Cincinnati Children’s Hospital Medical Center and in the Department of Pediatrics at the University of Cincinnati College of Medicine, discussed a selection of 2020 publications addressing clinical research, as well as basic and translational research in pediatric rheumatology.

Clinical Research Review

Dr. von Scheven began by describing her process for reviewing clinical pediatric rheumatology publications. She conducted a systematic PubMed review, then a manual review, identifying themes and articles. To visually illustrate common themes in 2020 pediatric rheumatology publications, Dr. von Scheven generated a word cloud with titles of papers, which revealed COVID-19 as a dominating theme, “reinforcing really what we are all feeling—that this pandemic that we are living in today seems to be dominating all aspects of our lives,” she said.

Dr. von Scheven discussed a collection of publications that investigated MIS-C in children with COVID-19. A study by Feldstein et al. investigated the epidemiology and clinical features of MIS-C through targeted surveillance between March 15 and May 20, and concluded MIS-C associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children.¹ She also discussed the ACR’s Clinical Guidance on MIS-C by Henderson et al., which provides 40 clinical guidance statements covering such key topics as MIS-C diagnosis, comparison to Kawasaki disease, management of cardiac manifestations and immunomodulatory treatment strategies.² Dr. von Scheven noted the rapid response the ACR took to release this document and stressed that it is a living document reflecting currently available evidence. The guidance document will be revised as further evidence emerges.

Dr. von Scheven’s discussion of other key themes in 2020 pediatric rheumatology research covered several papers on juvenile idiopathic arthritis (JIA) treatment modalities, including starting, switching and stopping biologics. For example, in a systematic review and meta-analysis by Cabrera et al. on the risk-benefits of using biologic agents to treat JIA, investigators found therapeutic success without serious adverse events is typical with systemic JIA patients.³