COVID-19 in children with rheumatic diseases (RD) in the spanish national cohort EPICO-AEP

Objectives

SARS-CoV-2 infection in adults with rheumatic diseases (RD) is a cause for concern. Data in the pediatric population are practically absent. We aimed to describe the prevalence of patients with RD and their complications among children admitted with COVID-19 in the Spanish national cohort EPICO-AEP; a multicenter prospective national study.

Methods

Children <18 years old with RD and COVID-19 enrolled in EPICO-AEP were included in this study.

Results

By June 30th 2020, 350 children were admitted in secondary and tertiary hospitals of Spain with SARS-CoV-2 infection. A total of 8 patients presented RD (2.2% of those hospitalized). All were female. The median age was 12.1 years (IQR 8.3-14.5). The diagnosis related with COVID-19 were febrile syndrome and/or upper respiratory infection (4 cases) and pneumonia (4 cases). One of the 8 (12.5%) patients with a severe juvenile dermatomyositis (JDM) with interstitial lung disease died. Juvenile idiopathic arthritis (JIA) was the most frequent diagnosis in 3/8 (37.5%) patients. In 5/8 (62.5%) cases, the RD was not fully controlled, and all patients except one received corticosteroid treatment.

Conclusions

Children with RD have accounted for 2.2% of hospitalized patients with COVID-19 in our series. The evolution has been moderately favorable, with one deceased. In case of active disease and use of corticosteroids patients should be managed with caution.

What is already known about this subject?

• Studies in adults with rheumatic disesases (RD) show that immune-mediated inflammatory disease and use of biologics are not associated with worse COVID-19.

• Poorly controlled active RD or some treatments such as corticosteroids, may have an increased risk of infection and serious disease in adults. No data in children.

What does this study add?

• Pediatric data from the national EPICO-AEP registry in Spain are presented, where children with RD and COVID-19 were 2.2% of those hospitalized.

• Active disease and the use of corticosteroids could be considered risk factors in the pediatric population as well as in adults.

How might this impact on clinical practice or future developments?

• The rheumatologist pediatrician must be very careful in the management of children with COVID-19 infection, especially if they receive corticosteroid treatment or have active RD.