Children with lupus at higher COVID-19 hospitalization risk vs. those with JIA
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Children and adolescents with rheumatic and musculoskeletal diseases who contract COVID-19 are not likely to require hospitalization, according to data published in the Annals of the Rheumatic Diseases.
However, children with systemic lupus erythematosus, mixed connective tissue disease or vasculitis are more likely to be hospitalized for COVID-19 than those with juvenile idiopathic arthritis who develop COVID-19.
“It remains unknown whether children and young people with [rheumatic and musculoskeletal diseases (RMDs)] who acquire COVID-19 have a more severe COVID-19 course and if there is additional risk attributable to either underlying disease or its therapy,” Lianne Kearsley-Fleet, BSc, MSc, PhD, FHEA, of the University of Manchester, in the United Kingdom, and colleagues wrote.
“It is important to understand the impact of COVID-19 on these individuals to inform national guidelines on protective measures (ie, recommendations to stay home and avoid face-to-face contact), vaccination guidance and address individual decisions regarding heightened social distancing measures for pediatric RMD patients and their families,” they added.
To examine the outcomes of COVID-19 in children and other young people with rheumatic and musculoskeletal diseases, Kearsley-Fleet and colleagues analyzed cases reported to the EULAR COVID-19 Registry, the CARRA Registry and the COVID-19 Global Pediatric Rheumatology Database. All data were submitted by rheumatologists and subsequently collected using REDCap, an online resource for gathering data to support research, according to the authors.
All people aged younger than 19 years at the time of COVID-19 detection were included in the analysis. Patients with JIA who were aged 19 years and younger were included for additional analysis. Data collected for the analysis included demographics, the primary RMD diagnosis, RMD disease activity — characterized as either remission, low, moderate, high or unknown — RMD treatments, which disease-modifying antirheumatic drugs the patient was using during infection, and comorbidities.
COVID-19 data included date of diagnosis, clinical symptoms, whether the case was presumptive or confirmed, whether the patient halted therapies and whether hospitalization or death due to COVID-19 occurred.
In total, 607 patients from 25 countries were included in the data analysis. Among those, 499 patients had confirmed cases of COVID-19. Out of the included patients, 378 had JIA, 78 had autoinflammatory syndromes, 47 had SLE or mixed connective tissue disease (MCTD), 16 had vasculitis and 15 had inflammatory myopathy.
According to the researchers, 43 patients were admitted to the hospital. Hospitalization rates were higher among patients with SLE or MCTD (16%) and systemic JIA (15%), compared with other JIA patients. In addition, there was a similar proportion of hospitalized and non-patients who discontinued DMARD use at the time of COVID-19 diagnosis. Patients who were hospitalized were more likely to have “moderate” (9% vs. 6%) or “high” (7% vs. less than 1%) disease activity at the time of COVID-19 diagnosis, compared with non-hospitalized patients, the researchers wrote.
Other factors associated with hospitalization, compared with JIA, included SLE, MCTD, vasculitis or “other RMD” (OR = 4.3; 95% CI, 1.1-11) and autoinflammatory diseases (OR = 3.0; 95% CI, 1.1-8.6), as well as obesity (OR = 4; 95% CI, 1.3-12).
“The majority of children and young people with RMDs appear to do well and experience mild COVID-19 disease,” Kearsley-Fleet and colleagues wrote. “However, where hospitalizations did occur, they were more likely among those with SLE/MCTD, vasculitis, autoinflammatory syndromes and other pediatric RMDs compared with their peers with JIA.
“The data also showed for the first time that obesity is a relevant comorbidity also in children with RMDs, supporting that protection measures in those children should be strictly followed,” they added. “While mortality has been reported, it appears to occur rarely in high-resource health care areas.”
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