This document summarizes tips for managing pediatric arthritis during the winter holidays. It discusses common triggers for arthritis flares like infections, provides recommendations for preventing infections through vaccinations and avoiding indoor crowds, and offers lifestyle advice for travel, diet, exercise, and managing medications and insurance over the holidays. The goal is to help patients and families reduce arthritis flare risks and maintain healthy routines during the busy winter season.

1. Pediatrics Talk:
Managing Arthritis
During the Holidays
Marla Guzman, MD, FAAP
Pediatric Rheumatologist
November 17, 2021

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 Who and Why?
 What is a flare, and why do we care?
 Infections and the holidays
 Vaccines
 Travel
 Yummy holiday treats
 Weather
 Medications
 R&R
 Insurance
 Questions
Agenda

3. Target Audience (you)
There are many pediatric rheumatologic conditions with arthritis
 Juvenile Idiopathic Arthritis (JIA)
 Several subtypes- oligoarticular, polyarticular, psoriatic, enthesitis
related, systemic
 Systemic lupus erythematosus (SLE/lupus)
 Juvenile Dermatomyositis (JDM)
 Vasculitis
 Periodic fever syndromes
 Other chronic conditions
 Thyroid conditions, IBD (Crohn’s, Ulcerative colitis), Celiac disease
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4. What is a flare, and why do we care?
 Flare = exacerbation of underlying condition
 Can happen after long period of quiet disease activity
 Often from a “trigger”-
 Infection**
 Stress
 Poor medication compliance
 Sun (JDM, SLE)
 Can be mild to severe
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5. Infections (there isn’t just Covid!)
 Respiratory viral infections are common during winter months, especially in children and adolescents
 Common viral illnesses during the winter- RSV, influenza(flu), enterovirus, parainfluenza, human metapneumovirus,
rhinovirus
 Infections not only increase flare risk, but holding medications if ill can also increase the risk of flare
 Easy strategies to avoid getting sick-
 Good handwashing
 Avoiding contact with those who are sick
 Mask wearing
 Vaccinate if possible (annual flu vaccine)
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6. Covid-19
 Mask up! (if you’re 2 or older)
 Continue to social distance and stay 6 feet apart
 Avoid large indoor gatherings if possible
 Consider rapid Covid tests prior to gathering
 Avoid poorly ventilated spaces
 Hand hygiene
 Vaccinate, vaccinate, vaccinate
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https://www.cdc.gov/coronavirus/2019-ncov/index.html

7. Vaccinations
 Annual influenza vaccine
 Anyone 6 months and older
 If on an immunosuppressant the injectable form is acceptable (inactivated)
 Those on immunosuppressants should not get the intra-nasal form (live)
 Contraindications (talk to your doctor first):
 Severe, life-threatening allergic reaction to any ingredient in the flu vaccine
 Severe allergic reaction to flu vaccine in the past
 Egg allergies are ok, but if you are concerned, talk to your doctor first
 Routine childhood vaccinations
 Discuss with your child’s rheumatologist and pediatrician if live vaccines are due and your child is on an
immunosuppressant
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8. Covid-19 Vaccination
 Types
 Pfizer: 2 dose, 12 years and older
 Pfizer child vaccine: 2 dose, ages 5-11
 Moderna: 2 dose, 18 years and older
 Johnson & Johnson: 1 dose, 18 years and older
 Contraindications
 Severe allergic reaction (anaphylaxis) after a previous dose or to a
component the Covid vaccine
 Immediate allergic reaction of any severity to a previous dose or known
(diagnosed) allergy to a component of the vaccine
 Other than that- ok for everyone age eligible!
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9. Covid-19 Vaccine Boosters/Additional Doses
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cdc.gov

10. Traveling During the Holiday Season
 Walking breaks during long car rides
 Before flying:
 Ensure you have enough refills for medications
 Make sure you have rheumatologist’s contact info handy
 Get letter from your child’s rheumatologist if he or she is on an injectable medication
 Allows for sharps during air travel
 Going somewhere warm and sunny?
 Pack the sunscreen and hat!
 Children with JDM or SLE can get disease flares that can be triggered by UV light exposure
 SPF 30 or above
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11. Yummy Holiday Treats: Friend or Foe?
 No hard data on diet’s impact on pediatric autoimmune conditions (e.g. “anti-inflammatory diet”)
 Combine a healthy diet with exercise, physical therapy, and medication for best outcomes
and avoidance of flares
 Fruits, leafy greens
 Foods rich in vitamin D and calcium
 Plant based proteins
 Beans
 Nuts
 Legumes
 Fish and lean meats
 Avoid or limit-
 Foods high in sugar
 Processed foods
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12. Brrr It’s cold!
 Fewer opportunities for exercise
 Outdoor pools closed
 Jogging, cycling, hiking difficult
 Feeling lazy!
 Joint stiffness can be exacerbated by limited movement
 Light activity is always recommended
 Low impact activities such as yoga, swimming, tai chi
 Stationary bike
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13. Other Important Issues to Consider
 New year=new insurance
 Avoid lapses in medication refills, infusions**, doctors visits
 Clarify coverage before new year
 Change in routine
 Missed doses of medications
 Set alarm reminders
 Free time!
 Use this free time to add modalities such as meditation and massage
to your child’s treatment regime
 Use the time to connect virtually with other parents, families, or
patients
 Arthritis Foundation: JA Connect Groups, JA Online Community
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Questions??
Agenda