A large international survey showed that only few children with rheumatic diseases contracted COVID-19. None of these children required hospitalization or had severe disease outcomes, despite the intake of immunosuppressive medication [1].
Globally, fewer cases of COVID-19 have been reported in children (0-17 years) compared with adults. Hospitalization rates in children are significantly lower than hospitalization rates in adults, suggesting that children may have less severe illness 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. They 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 also 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 analyzed 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 organizations 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. In addition, the parents completed a questionnaire that assessed the general wellbeing 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 pediatric rheumatic diseases such as lupus, dermatomyositis, and autoinflammatory diseases. Within this group, only 5 children (1.2%) were diagnosed with COVID-19, and none required hospitalization 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 pediatric rheumatic diseases.
Hausmann JS. Impact of the COVID-19 pandemic among children with rheumatic diseases from around the globe. P1685, ACR Convergence 2020 Virtual Annual Meeting, 5-9. November 2020.
