Outcomes of SARS-CoV-2 infection among children and young people with pre-existing rheumatic and musculoskeletal diseases

Abstract

ObjectivesSome adults with rheumatic and musculoskeletal diseases (RMDs) are at increased risk of COVID-19-related death. Excluding post-COVID-19 multisystem inflammatory syndrome of children, children and young people (CYP) are overall less prone to severe COVID-19 and most experience a mild or asymptomatic course. However, it is unknown if CYP with RMDs are more likely to have more severe COVID-19. This analysis aims to describe outcomes among CYP with underlying RMDs with COVID-19.MethodsUsing the European Alliance of Associations for Rheumatology COVID-19 Registry, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, and the CARRA-sponsored COVID-19 Global Paediatric Rheumatology Database, we obtained data on CYP with RMDs who reported SARS-CoV-2 infection (presumptive or confirmed). Patient characteristics and illness severity were described, and factors associated with COVID-19 hospitalisation were investigated.Results607 CYP with RMDs <19 years old from 25 different countries with SARS-CoV-2 infection were included, the majority with juvenile idiopathic arthritis (JIA; n=378; 62%). Forty-three (7%) patients were hospitalised; three of these patients died. Compared with JIA, diagnosis of systemic lupus erythematosus, mixed connective tissue disease, vasculitis, or other RMD (OR 4.3; 95% CI 1.7 to 11) or autoinflammatory syndrome (OR 3.0; 95% CI 1.1 to 8.6) was associated with hospitalisation, as was obesity (OR 4.0; 95% CI 1.3 to 12).ConclusionsThis is the most significant investigation to date of COVID-19 in CYP with RMDs. It is important to note that the majority of CYP were not hospitalised, although those with severe systemic RMDs and obesity were more likely to be hospitalised.

Impact of COVID-19 on children with rheumatic diseases: a retrospective cohort analysis

“…For comparing categorical data, Chi-square (X 2 ) test was performed. Exact test was used instead when the expected frequency is less than (10)(11)(12)(13)(14) years. Twenty-nine (59.2%) patients had rheumatologic disease flare at the time of SARS-CoV-2 acquisition while symptoms of the remaining 20 (40.8%) were controlled.…”

“…They observed a hospital admission rate of 7 % and mortality rate of 0.4 %. 12 Another group of investigators compared 152 pediatric patients with rheumatic disorders and COVID-19 to 506 non-rheumatic COVID-19 children. They noted that the presence of rheumatic disease increased the risk of both hospitalization and symptomatic infection but did not increase the mortality risk.…”

Vaccinology in pediatric rheumatology: Past, present and future

“…Even though hospitalizations for COVID-19 among children and young people with AIIRD were found to be rare and treatment with bDMARDs was not associated with more severe COVID-19, patients with pedAIIRD could be at risk for disease flare secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or to withholding anti-inflammatory therapy during the COVID-19 illness ( 62 , 63 ). While vaccination can protect against COVID-19, safety and immunogenicity data regarding COVID-19 vaccines among children with AIIRD are limited.…”

Levelling the playing field of RMD research across Europe to address patients’ needs: the emerging EULAR Research Centre

“…Among the first registry-supported outcomes are several papers providing important evidence. One study, for example, showed that children and young people with arthritis are not at high risk of severe COVID-19 29 30. Another analysis demonstrated that COVID-19-related deaths among people with rheumatic diseases were associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications, including rituximab and corticosteroids), highlighting an association with moderate/high disease activity 31 32…”