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Children with rheumatic disease have no greater risk of a COVID-19 infection

Presented by
Dr Jonathan S. Hausmann, Harvard Medical School and Boston Children’s Hospital, USA
ACR 2020
A large international survey including data on 427 children demonstrated that all of them had mild COVID-19 disease, despite the intake of immunosuppressive medication. Besides, few children contracted COVID-19.

Globally, fewer cases of COVID-19 have been reported in children (0-17 years) compared with adults. Hospitalisation rates are significantly lower in children than in adults, suggesting that children may have a less severe disease course from COVID-19. However, children with rheumatic diseases face unknown risks in the setting of the pandemic. “Early in the pandemic, we were very concerned about how COVID-19 would affect children with rheumatic diseases,” Dr Jonathan S. Hausmann (Harvard Medical School and Boston Children’s Hospital, USA) explained [1]. They may have an elevated risk of infection due to the underlying disease and also the medications used to treat them. “Early in the pandemic, we were receiving phone calls from worried parents wondering whether they should continue immunosuppressive drugs, because of the unknown risk that their children faced with COVID-19,” Dr Hausmann said.

To get a better understanding of the impact of COVID-19 on children with rheumatic diseases, Dr Hausmann and colleagues analysed data from the international COVID-19 Global Rheumatology Alliance Patient Experience Survey. They sent surveys to parents of children with rheumatic diseases through patient support organisations and social media. Parents provided information on their child’s rheumatic disease diagnosis, medications, disease activity (as measured by a visual analogue scale from 0-10), whether or not the child ever developed COVID-19, and any outcomes they experienced if they were infected. Furthermore, the parents completed a questionnaire that assessed the general well-being of the child.

In the survey, data from 3 April to 8 May 2020 was collected. Most of the 427 children (<18 years) lived in the Americas, were White, female, and 5-14 years old. The majority of patients had juvenile idiopathic arthritis (40.7%), and most were taking conventional synthetic DMARDs and/or biologic DMARDs. The median disease activity score was 3. The survey also included children with other paediatric rheumatic diseases such as lupus, dermatomyositis, and autoinflammatory diseases. Within this group, only 5 children (1.2%) were diagnosed with COVID-19, 3 through self-diagnosis and 2 physician-diagnosed based on symptoms. None required hospitalisation or had severe outcomes.

“Surprisingly, only 4.0% of families had stopped medication due to concern of immunosuppression,” Dr Hausmann said. The data showed that –similar to otherwise healthy children– those with rheumatic diseases do not seem to be at greater risk of developing COVID-19 or COVID-19-related complications, even when taking immunosuppressive medications.

“Our study suggests that children with rheumatic diseases should continue their immunosuppressive drugs during the pandemic, as it does not appear to place them at an increased risk of COVID-19-related complications,” Dr Hausmann concluded.

Limitations of the study are that the data were self-reported responses from parents who were engaged in social media or who were willing to fill out a survey, which may not fully represent all children with paediatric rheumatic diseases. Other studies have shown that juvenile SARS-CoV-2 infection is associated with a poorly defined multisystem inflammation syndrome in children (MIS-C) where active viral replication is usually not detectable, which is another example of the comparative resiliance of this group to severe COVID-19 disease [2].

  1. Hausmann JS. Impact of the COVID-19 pandemic among children with rheumatic diseases from around the globe. P1685, ACR Convergence 2020, 5-9 Nov.
  2. Feldstein LR, et al. N Engl J Med 2020;383:334-346.

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