Clinical course and seroprevalence of COVID-19 in children with rheumatic diseases—cross-sectional study from a reference centre in Spain

Abstract

SARS-CoV-2 infections in children are frequently asymptomatic or mild and can go unnoticed. This study aimed to describe the seroprevalence and clinical course of SARS-CoV-2 in a cohort of children with rheumatic diseases in a real-life setting and assess possible risk factors. A cross-sectional study was performed in a paediatric rheumatology unit (September 2020 to February 2021). At inclusion, a specific questionnaire was completed and SARS-CoV-2 serology was performed. Demographics, treatment and disease activity of patients with and without laboratory-confirmed SARS-CoV-2 infection were compared. A total of 105 children were included. SARS-CoV-2 infection was demonstrated in 27 patients (25.7%). The mean age was 11.8 years, and most patients were females (72.4%). The most frequent underlying condition was juvenile idiopathic arthritis (70.3%; 19/27). Patients received immunosuppressive treatment in 78% of cases (21/27). Overall, 44.4% (12/27) of infected patients were asymptomatic. A total of 66.7% (18/27) of patients did not require medical assistance. Three patients required hospital admission because of COVID-19. Children with confirmed SARS-CoV-2 infection were less frequently in remission (52% vs 72%; p 0.014). Moderate disease activity and treatment with oral corticosteroids were associated with higher risk for SARS-CoV-2 (OR 5.05; CI 95%: 1.56–16.3 and OR 4.2; CI 95%: 1.26–13.9, respectively). In a cohort of Spanish paediatric patients with rheumatic diseases, clinical course of COVID-19 was mild, with more than one third of asymptomatic cases. Higher disease activity and oral corticosteroids appear to be risk factors for SARS-CoV-2 infection. Key Points • We aimed to investigate the seroprevalence of SARS-CoV-2 infection in a cohort of Spanish paediatric patients with RD, testing both symptomatic and asymptomatic patients. We also compared treatment and disease activity of patients with and without laboratory-confirmed SARS-CoV-2 infection. • In our cohort of 105 paediatric patients with rheumatic diseases, the clinical course of COVID-19 was mild and 44% of cases were asymptomatic. Three cases required hospital admission with no complications. Seroprevalence was 20%. • No association was found between disease activity or treatment with corticosteroids and symptomatic or asymptomatic infection. Higher disease activity and treatment with oral corticosteroids appeared to be risk factors for laboratory-confirmed SARS-CoV-2 infection.

Pediatric Systemic Lupus Erythematous in COVID-19 Era

“…In children with immune rheumatic disease (IRD), Udaondo et al reported that patients with active disease and GCs use had an increased risk of COVID-19, similar to the risk described in adults [ 15 ]. Rituximab use in adult patients with IRD is linked to a higher rate of hospital admission and death due to COVID-19 [ 16 , 24 ].…”

“…They are at the increased risk of developing severe forms of SARS-CoV-2 infection, with frequent complications related to the viral disease and often experiencing flare-ups during and after SARS-CoV-2 infection. The presence of comorbidities, organ related damages, intrinsic immune failure and immunosuppressive treatment amplify the concern of medical practitioners related to these patients [ 14 , 15 ]. The immune dysregulation of the interferon pathway encountered in SLE is another reason of concern, mainly because of its role in the innate immune response during the new coronavirus infection [ 14 , 15 , 16 ].…”

“…The presence of comorbidities, organ related damages, intrinsic immune failure and immunosuppressive treatment amplify the concern of medical practitioners related to these patients [ 14 , 15 ]. The immune dysregulation of the interferon pathway encountered in SLE is another reason of concern, mainly because of its role in the innate immune response during the new coronavirus infection [ 14 , 15 , 16 ].…”

“…Data from the COVID-19 Global Rheumatology Alliance (C19-GRA) has suggested that SLE patients may be at higher risk of hospitalization from COVID-19 compared to those with other rheumatic diseases [ 17 , 18 ]. Children with rheumatic disease in clinical remission may not be considered as a risk population for severe COVID-19 [ 15 ]. Patients with SARS-CoV-2 infection who are known to have a history of autoimmune rheumatic disease and undergoing immunomodulatory treatment are not at high risk of developing severe forms of COVID-19 or complications [ 19 ].…”

Coronavirus disease 2019 (COVID-19) in pediatric patients with autoimmune disorders

“…High-risk signs for admission were fever, dyspnea, chest pain, and rash. The requirement for hospitalization may be influenced by the activity and flare of rheumatic diseases [ 75 ]. In patients with underlying risk factors for hyperinflammation, COVID-19 may cause mortality regardless of the administration of biological Disease-modifying antirheumatic drugs(bDMARD) [ 76 ].…”