COVID-19 disease course generally mild in children and adolescents with RMDs
medwireNews: In a pediatric cohort of patients with rheumatic and musculoskeletal diseases (RMDs) who contracted SARS-CoV-2, infection was generally mild with good outcomes and had no significant impact on underlying disease activity, report researchers.
However, “discontinuation of [immunosuppressive] therapy seemed to pose a risk of flare in patients with (moderately) active disease,” point out Claudia Sengler (German Rheumatism Research Center, Berlin) and colleagues.
They report on a cohort of 76 patients included in the German National Paediatric Rheumatology Database who had a laboratory-confirmed diagnosis of COVID-19 between April 2020 and February 2021, and completed the specific SARS-CoV-2 questionnaire implemented in the database.
The median age of the participants was 14 years and nearly two-thirds (58%) had a diagnosis of juvenile idiopathic arthritis (JIA), while 24% had an autoinflammatory disease and 8% had a connective tissue disease. The majority (76%) were taking DMARDs at the time of COVID-19 infection, with 41% of the cohort taking biologics.
Just over three-quarters (76%) of the participants developed COVID-19 symptoms, with rhinitis and fever the most commonly reported symptoms, each in 40%.
Notably, all but two of the 46 symptomatic patients with available data had a mild disease course, report Sengler and team in RMD Open.
Among the 51 patients with available data on COVID-19 outcomes, 78% reported a recovery of their health on the survey at a median 28 days from symptom onset and 20% said they had not yet recovered when asked at a median 26 days after symptom onset, primarily due to a continuing taste and/or smell disorder.
Two patients were hospitalized, one of whom (with polyarticular JIA) developed sinus vein thrombosis and cerebral edema and died from cardiorespiratory failure 8 days after COVID-19-symptom onset, while the other patient (with chronic nonbacterial osteitis) did not have pneumonia, nor did they require oxygen.
Data was available on disease activity of the underlying RMD before and after contracting COVID-19 for 32 patients. The majority (84%) had no or only a minimal increase in disease activity, defined a change of 1 point or less on a 21-item numeric rating scale, while the remaining 16% had a change greater than 1, indicating a relevant increase in disease activity.
A total of 13 patients had their dosing interval altered or treatment discontinued following COVID-19 infection, but 12 of these patients had no relevant increase in disease activity. Of note, the patient who experienced a disease flare after discontinuing tocilizumab for seronegative polyarthritis had moderate disease activity prior to asymptomatic COVID-19 infection, unlike the others, say the study authors.
“Here, the pause in therapy rather than the SARS-CoV-2 infection (especially as asymptomatic) seems to be causative for the flare, particularly since the patient was not in remission before this treatment was stopped,” comment Sengler et al.
And they conclude: “Further studies with larger numbers of cases are needed to better investigate associations between the underlying disease, its drug therapy and the clinical expression and possible consequences of a SARS-CoV-2 infection in these patients.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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