Study authors described the prevalence and outcomes of SARS-CoV-2 infection in children with rheumatic diseases included in the Spanish national cohort, in a letter to the editor published in The Journal of Rheumatology.
Although SARS-CoV-2 infection in children is relatively mild, the effect of the virus and its complications in children with rheumatic diseases remains unclear.
Study authors extracted pediatric data from the national Spanish registry, EPICO-AEP, which included information from 49 hospitals in the country. Between the start of the pandemic and June 30, 2020, a total of 350 children were admitted to participating hospitals for the treatment of COVID-19. Of these children, 48 (13.7%) required intensive care admission and 4 (1.1%) died.
A total of 8 hospitalized patients (2.2%; 100% girls; median age, 12.1 years) had a history of a rheumatic disease. One of these patients had severe juvenile dermatomyositis that required mechanical ventilation prior to infection with SARS-CoV-2 and died. The most common rheumatic disease diagnosis among hospitalized patients was juvenile idiopathic arthritis. Two patients were diagnosed with rheumatic disease at the time of hospitalization for COVID-19, suggesting that SARS-CoV-2 infection may play a role in rheumatic disease onset. While the 7 surviving patients had good clinical outcomes, 2 experienced complications, including 1 with deep vein thrombosis and pulmonary bacterial superinfection and the other with deep vein thrombosis and adrenal hemorrhage. Immunosuppressive therapy was not fully suspended in any of the 8 patients during COVID-19 treatment, though 1 patient was withdrawn from azathioprine.
Data from pediatric populations with COVID-19 are limited. Previous research has indicated that while the use of biologics is not associated with worse outcomes from COVID-19, poorly controlled rheumatic disease and the use of corticosteroids may increase the risk for severe disease. In the Spanish national EPICO-AEP cohort, children with rheumatic disease accounted for only 2.2% of hospitalized children with COVID-19.
Rheumatic disease did not appear to sufficiently worsen COVID-19 outcomes; however, the small cohort size limited the generalizability of these data. In addition, one-quarter of children with rheumatic disease experienced thrombotic complications with COVID-19.
“More prospective studies are needed to characterize risk factors in this population,” the authors wrote. “Two patients had COVID-19 at the time of onset of [rheumatic disease], which leads us to the hypothesis of COVID-19 possibly having a role with triggering the disease.”
Calvo C, Udaondo C; Rheumatic Diseases EPICO-AEP Working Group. COVID-19 in children with rheumatic diseases in the Spanish national cohort EPICO-AEP. Letter. J Rheumatol. Published online February 1, 2020. doi:10.3899/jrheum.201548