Higher Relapse Rate Observed After COVID-19 in Pediatric Autoimmune Rheumatic Diseases

Pediatric patients with autoimmune rheumatic diseases were found to have higher relapse rates after COVID-19 infection compared with after vaccination, according to study results published in Pediatric Rheumatology.

The clinical presentation and outcomes of COVID-19 have been shown to be milder among children than adults; however, data on the effect of COVID-19 specifically on pediatric autoimmune rheumatic diseases are limited.

In a single-center prospective study, researchers aimed to evaluate the rate of relapse among children with autoimmune rheumatic diseases after COVID-19 infection and vaccination.

Between March 2020 and April 2022, data on demographics, disease activity, clinical presentation, and serology were collected from patients in Sweden with autoimmune rheumatic diseases with COVID-19 infection and vaccination.

Relapse was defined as worsening of disease in 8 weeks after infection or vaccination.

A total of 115 patients with pediatric autoimmune rheumatic diseases were included in the study, of whom 92 had COVID-19 infection, 47 received vaccination, and 24 had both. All vaccinated patients received 2 doses of the Pfizer vaccine 3.7 (SD, 1.4) weeks apart. The most common diagnosis in both groups was juvenile idiopathic arthritis.

Results showed that the clinical presentation of COVID-19 infection was asymptomatic in 14 (14%) patients, mild in 69 (67%) and moderate in 19 (18%). One patient was hospitalized due to COVID-19-related infection and was unvaccinated.

Of 103 infections, 10 (10%) resulted in relapse of disease. The majority of relapses were of mild or moderate severity, with 1 case of severe relapse requiring hospitalization. The difference in relapse rate was not statistically significant (P =.76) between those who had COVID-19 infection and those who received vaccination.

Study limitations included the age differences (range, 2-23 years) among eligible participants and the study’s single-center design.

Overall, the study authors concluded, “There is a trend towards a higher relapse rate in [pediatric autoimmune rheumatic diseases] after infection compared to vaccination and connection between the severity of COVID-19 and vaccination status is plausible.”