ACR: Children at risk for uveitis should continue ophthalmol
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Children with rheumatic disease who are at high risk for chronic uveitis, or have a history of uveitis, should continue to receive routine ophthalmologic care, according to COVID-19 clinical guidance from the American College of Rheumatology. The ACR announced the “COVID-19 Clinical Guidance for Pediatric Patients with Rheumatic Disease” , alongside another set of guidance for pediatric patients with multisystem inflammatory syndrome associated with COVID-19.

The clinical guidelines include 27 recommendations. They are grouped by topic, and cover ongoing treatment for patients at varying degrees of COVID-19 exposure, including asymptomatic and symptomatic infection. Among the general guidelines is a recommendation that patients at high risk for chronic uveitis, or with a history of uveitis, continue with scheduled, in-person visits with slit-lamp examination.

~ Children with rheumatic disease should also continue to receive routine childhood vaccinations, unless contraindicated by DMARD therapy, including the annual influenza vaccine, according to the guidelines.

~Regarding ongoing treatment of patients without COVID-19 exposure or infection, the guidelines state that NSAIDs, hydroxychloroquine, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, colchicine, conventional DMARDs, biologic DMARDs and targeted synthetic DMARDs may be continued or initiated to control underlying disease. Glucocorticoids may also be continued or initiated, using the lowest dose possible to control underlying disease.

~Further, for pediatric patients with life- or organ-threatening conditions, high-dose oral or intravenous “pulse” glucocorticoids and cyclophosphamide may be initiated to control underlying disease.

~Regarding the ongoing treatment of pediatric patients with asymptomatic COVID-19, the ACR states that NSAIDs, hydroxychloroquine, colchicine, DMARDs, cyclophosphamide or rituximab may be continued, if necessary, to control underlying disease.

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