News Release 

Global survey reveals that few children with rheumatic disease report contracting COVID-19

American College of Rheumatology

Research News

ATLANTA -- Results from a large, international survey shows that only a small fraction of children with rheumatic diseases reported contracting COVID-19. Those who did become infected with COVID-19 all had benign outcomes and did not develop significant complications, despite the fact that most children were taking immunosuppressive medications. The research was presented at ACR Convergence, the American College of Rheumatology's annual meeting (ABSTRACT #1685).

The most common pediatric rheumatic disease is juvenile idiopathic arthritis (JIA), which is a group of chronic conditions that cause arthritis (joint swelling and inflammation) affecting children and teenagers. JIA may involve one or many joints, may also affect the eyes, and cause other symptoms, such as fevers or rash.

As the COVID-19 pandemic surged worldwide in early 2020, the risk of COVID-19 and serious complications or death was unknown for children with rheumatic diseases. Many of these patients are treated with immunosuppressive medications that leave them more susceptible to infections.

"At the time, parents and physicians did not know whether to continue a child's immunosuppressive medications to prevent COVID-19 and related complications," says the study's co-author, Jonathan S. Hausmann, MD, Instructor in Medicine at Harvard Medical School and a pediatric rheumatologist at Boston Children's Hospital.

To learn more about the impact of COVID-19 on children with rheumatic diseases, Dr. Hausmann and his fellow researchers analyzed data from the international COVID-19 Global Rheumatology Alliance Patient Experience Survey, a global patient registry. 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, whether or not the child ever developed COVID-19 and any outcomes they experienced if they were infected.

The study collected data from April 3 to May 8, 2020 and includes 427 children under age 18. Most of the children in the study lived in the Americas, and were white, female and between 5 and 14 years old. Most had JIA, and they were taking either conventional synthetic or biologic disease-modifying antirheumatic drugs (DMARDs). Both classes of drugs suppress the immune system and help to control the arthritis, while also making children at increased risk of infection. The survey also included children with other pediatric rheumatic diseases such as lupus, dermatomyositis, and autoinflammatory diseases.

Among the 427 children in the study, only five, or 1.2%, were diagnosed with COVID-19, none of whom required hospitalization or had severe outcomes. Because the study is based on self-reported responses from parents who were engaged in social media or who were willing to fill out a survey, it may not fully represent all children with pediatric rheumatic diseases, and it may be more likely to include a healthier population, the researchers say.

"These findings are important as policymakers and educators contemplate reopening schools with the pandemic still ongoing, and with parents and physicians struggling to make decisions of whether to send their children back to school," says Dr. Hausmann. "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. Our findings support the recent ACR guidelines for managing immunosuppression during the pandemic."

Next, this research group plans to develop a prospective, international registry of people with rheumatic disease of all ages to assess long-term outcomes of the COVID-19 pandemic, explore the willingness to receive and assess the efficacy of a vaccine, assess the impact of the environment on COVID-19, and track the effects of the pandemic on the physical and mental health of participants over time, he adds.

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About ACR Convergence

ACR Convergence, the ACR's annual meeting, is where rheumatology meets to collaborate, celebrate, congregate, and learn. Join ACR for an all-encompassing experience designed for the entire rheumatology community. ACR Convergence is not just another meeting - it's where inspiration and opportunity unite to create an unmatched educational experience. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official hashtag (#ACR20).

About the American College of Rheumatology

The American College of Rheumatology (ACR) is an international medical society representing over 7,700 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.

ABSTRACT: Impact of the COVID-19 Pandemic Among Children with Rheumatic Diseases from Around the Globe

Background/Purpose:

Children with rheumatic diseases face unknown risks in the setting of the COVID-19 pandemic. These children are often immunosuppressed due to their underlying disease or the medications used to treat them. It is unknown whether children with rheumatic diseases are at increased risk of SARS CoV-2 infection or of developing serious disease complications should they become infected. We report on the pediatric data from the COVID-19 Global Rheumatology Alliance (C19-GRA) Patient Experience Survey.

Methods: The C19-GRA launched an international Patient Experience Survey for adults and parents of children with rheumatic disease, with or without COVID-19 infection. The survey was distributed online through patient support organizations and on social media. Parents completed the data on behalf of their children, including their child's rheumatic disease diagnosis, medications, disease activity (as measured by a visual analog scale from 0-10, where 0=very good and 10=very poor), whether or not they developed COVID-19, and COVID-19 disease outcomes. Parents also completed the PROMIS Parent Proxy Scale v1.0 - Global Health 7. We report on data for children less than 18 years of age from April 3-May 8, 2020.

Results: A total of 427 children are included in the analyses. Their demographics and clinical characteristics are shown in Table 1. Most respondents resided in the Americas (64.9%) and were white (73.3%), female (63.0%), and between the ages of 5-14 (64.9%). The majority of patients had juvenile idiopathic arthritis, and most were taking conventional synthetic DMARDs (csDMARDs) and/or biologic DMARDs (bDMARDs). The median disease activity score was 3 (IQR 1-6). The median T-score of the PROMIS Global Health measure was 43.9. Within this group, only 5 children (1.2%) were diagnosed with COVID-19, and none required hospitalization. Their COVID-19 disease experience is shown in Table 2.

Conclusions: In this international survey of children with rheumatic diseases, only a handful of children developed COVID-19, all of whom had benign outcomes. Similar to otherwise healthy children, those with rheumatic disease do not seem to be at greater risk of developing COVID-19 or of COVID-19-related complications, even while taking immunosuppressive medications. Limitations of this study include a convenience sample of parents engaged in social media, which may not be representative of the pediatric rheumatology population. Data were self-reported and could not be verified. Future studies should assess the long-term effect of COVID-19 infection in patients with rheumatic disease, as well as assess the rates of complications such as Multisystem Inflammatory Syndrome in Children (MIS-C).

Disclaimer: The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance and do not necessarily represent the views of the American College of Rheumatology, the European League Against Rheumatism (EULAR), or any other organization.

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