Survey: Children with Rheumatic Disease Have Not Faced Worse COVID-19 Risk

Jonathan Hausmann, MD (Boston's Children Hospital)

An international survey revealed that, despite significant concerns over immunosuppression due to therapy, children with rheumatic disease have not been particularly susceptible to SARS-CoV-2 infection.

New data presented at the American College of Rheumatology (ACR) Convergence 2020 revealed coronavirus 2019 (COVID-19) diagnoses among children with rheumatic disease were not significantly greater than children overall in the early phases of the first US outbreak.

Led by co-author Jonathan Hausmann, MD, Instructor in Medicine at Harvard Medical School and a pediatric rheumatologist at Boston Children’s Hospital, a team of North American investigators conducted an analysis of pediatric data from the COVID-19 Global Rheumatology Alliance (C19-GRA) Patient Experience Survey, which collected feedback data from adults and patients with rheumatic disease, with or without COVID-19 infection.

In the observed time period of response—April through May of this year—patients faced uncertainties with heightened stakes.

“At the time, parents and physicians did not know whether to continue a child’s immunosuppressive medications to prevent COVID-19 and related complications,” Hausmann said in a statement.

Indeed, data also presented at ACR 2020 this week indicated that patients put it upon themselves to discontinue immunosuppressant therapy at the beginning of the COVID-19 pandemic.

The survey data’s contribution on children with rheumatic disease included input from parents on behalf of their children, including information on diagnosis, medications, disease activity, medications, disease activity, and their COVID-19 status.

Rheumatic disease activity was measured on a visual analog scale of rising severity from 0-10. Parents also provided answers to the PROMIS Parent Proxy Scale v1.0 – Global Health 7.

Hausmann and colleagues reported on data in children aged ≤18 years old from April 3 to May 8 of this year.

Their analysis included 427 children, mostly from the Americas (64.9%), white (73.3%), female (63.0%), and between the ages of 5-14 (64.9%). The most common rheumatic disease diagnoses included juvenile idiopathic arthritis (40.7%), systemic juvenile idiopathic arthritis (26.9%), autoinflammatory disease (17.3%), and systemic lupus erythematosus (11.7%).

A majority of patients were taking corticosteroid disease-modifying antirheumatic drugs (cSDMARDs) or biologic DMARDs (54.6%, 51.8%, respectively) at the time of assessment. Median disease activity score was 3, and median T-score of the PROMIS metric was 43.9.

Investigators observed a COVID-19 diagnosis in just 5 children (1.2%). Among them, none were hospitalized for symptoms from COVID-19. Three of the children were not diagnosed with COVID-19 based on physician assessment of symptoms.

Hausmann and colleagues concluded they did not observe an increased risk of COVID-19 development or even related symptoms in rheumatic children—even while taking immunosuppressive therapy.

“Our study suggests that children with rheumatic disease should continue their immunosuppressive drugs during the pandemic, as it does not appear to place them at increased risk of COVID-19 related complications,” Hausmann said. “Our findings support the recent ACR guidelines for managing immunosuppression during the pandemic.”

That said, investigators also conceded study limitations of a convenience sample of parents based on social media engagement, as well as self-reported, unverified data.

Future assessment of associations between patients with rheumatic disease and COVID-19 should include long-term patient data, as well as a look into how many patients are burdened by pediatric COVID-19 complications including Multisystem Inflammatory Syndrome in Children.

The study, “Impact of the COVID-19 Pandemic Among Children with Rheumatic Diseases from Around the Globe,” was presented at ACR 2020.