POS0049 SARS-COV-2 INFECTION IN CHILDREN WITH RHEUMATIC DISEASE: EXPERIENCE OF A TERTIARY REFERRAL CENTER
Authors: Sözeri B. , Demir F. , Kalin S. , Hasbal Akkuş C. 
Published: May 2021

Background:

Patients with rheumatic diseases are considered at risk for serious infections due to their immune-compromised-status set in their primary systemic disease and the usage of immune-modulating therapies. Although various results have been reported on the subject, it is still unknown whether patients with rheumatic disease, many of whom are on immune-suppression, are at higher risk of severe COVID-19.

Objectives:

We aim to share our clinical SARS-CoV-2 experience in patient with the childhood rheumatic disease during pandemic.

Methods:

We evaluated 4470 patients at our pediatric-rheumatology clinic during the pandemic, from 11-March to 15-October-2020. Demographic and clinical features, treatments, laboratory results, imaging findings, and clinical outcomes of patients diagnosed with COVID-19 and/or multisystem inflammatory syndrome (MIS-C) were review from the medical records. The data of all these patients were compared between groups and presented. A p-value <0.05 was considered statistically significant.

Results:

Among 4470 patients, 87 COVID-19 suspected patients were included in the study. Fifty six (64.4%) patients were hospitalized and 31 were followed without hospitalization. The most common rheumatic diseases among them were juvenile idiopathic arthritis and familial Mediterranean fever (35.6% and 34.5%). The primary disease status of these patients were; 78 (89.6%) were in remission, while 9 (10.3%) had active disease at the time of COVID-19 diagnosis. Twenty six of these patients were treated with biologic DMARDs. SARS-CoV-2 infection (RT-PCR and/or antibody test) was found positive in 84 patients (96.5%). Also, fifty one (58.6%) patients had an epidemiologic contact to a person with COVID-19. Fifty six of 87 (64.3%) had a fever and 20 (23%) had a fever for five or more days. Gastrointestinal system involvement was in 11 (12.6%), the respiratory system was in 40 (46%) and fatigue was in 57 (65.5%) patients. Cutaneous involvement was seen in 5 patients including maculopapular rash in two, vasculitic rash in two, and chilblain in one patient. 63.2% of patients had increased C-reactive protein (CRP), 40.2% had lymphocytopenia (<1500/mm3) and 26.4 % had elevated D-dimer level. SARS-CoV-2 infection was confirmed in 84 patients (96.5%). The diagnosis was confirmed by RT-PCR in 74 patients and by antibody test in 10. 18 patients met the clinical criteria and diagnosed with MIS-C. Nine of them had also hypotension and seven patients admitted the intensive care unit because of shock and severe end-organ illness. COVID-19 outbreak also caused exacerbation of systemic disease in 56 children due to a discontinue of medication, postponed drug switch, or viral infection triggered.

Conclusion:

In conclusion, children with rheumatic disease do not appear to present a higher risk of severe COVID-19. Whether these patients receive biological treatment does not affect the severity of the disease, but it is still not true to say that these drugs are protective. The immunosuppressive treatments can be adjusted in case of infection, otherwise it is not recommended interrupt the treatments. Physicians should be cautious about the hyperinflammatory syndrome associated with COVID-19 in rheumatic children, which may be severe in this group of patients and may be confused with primary diseases.

References:

[1]Wahezi DM, Lo MS, TB Rubinstein, Ringold S, Ardoin SP, Downes KJ, et al. American College of Rheumatology Guidance for the Management of Children with Pediatric Rheumatic Disease During the COVID-19 Pandemic: Version 1. Arth & Rheum 2020;doi:10.1002/art.41455.

Disclosure of Interests:

None declared.