Clinical manifestations and outcome of SARS-CoV-2 infections in children and adolescents with rheumatic musculoskeletal diseases: data from the National Paediatric Rheumatology Database in Germany

  1. Claudia Sengler
  2. Sascha Eulert
  3. Kirsten Minden
  4. Martina Niewerth
  5. Gerd Horneff
  6. Jasmin Kuemmerle-Deschner
  7. Caroline Siemer
  8. Rainer Berendes
  9. Hermann Girschick
  10. Regina Hühn
  11. Michael Borte
  12. Anton Hospach
  13. Wolfgang Emminger
  14. Jakob Armann
  15. Ariane Klein
  16. Tilmann Kallinich

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Abstract

This study aimed to investigate the clinical manifestations, course and outcome of SARS-CoV-2 infection among children and adolescents with rheumatic and musculoskeletal diseases (RMD). Due to their underlying disease as well due to therapeutic immunosuppression, these patients may be at risk for a severe course of COVID-19 or for a flare of the underlying disease triggered by SARS-CoV-2 infection.

Methods

Demographic, clinical and treatment data from juvenile patients with RMD as well as data about SARS-CoV-2 infection like test date and method, clinical characteristics, disease course, outcome and impact on the disease activity of the RMD were documented on a specific SARS-CoV-2 questionnaire implemented in the National Paediatric Rheumatology Database (NPRD) in Germany. The survey data were analysed descriptively.

Results

From 17 April 2020 to 16 February 2021, data were collected from 76 patients (52% female) with RMD and laboratory-proven SARS-CoV-2 infection with median age of 14 years, diagnosed with juvenile idiopathic arthritis (58%), autoinflammatory (24%) and connective tissue disease (8%). Fifty-eight patients (76%) received disease-modifying antirheumatic drugs (DMARDs), 41% biological DMARDs and 11% systemic glucocorticoids. Fifty-eight (76%) had symptoms of COVID-19. Disease course of SARS-CoV-2 infection (classified as asymptomatic, mild, moderate, severe, life-threatening) was mild and outcome of COVID-19 (classified as recovered, not yet recovered, permanent damage or deceased) was good (recovered) in the majority of patients. Two patients were hospitalised, one of whom required intensive care and died of cardiorespiratory failure. In 84% of SARS-CoV-2-positive patients, no relevant increase in disease activity of the RMD was observed.

Conclusions

In our cohort, SARS-CoV-2 infection in juvenile patients with RMD under various medications was mild with good outcome in the majority of cases and does not appear to have a relevant impact on disease activity of the underlying condition.

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  1. Version published to 10.1136/rmdopen-2021-001687
  2. ScreenIT

    SciScore for 10.1101/2021.03.28.21254496: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The SARS-CoV-2 module of the NPRD was approved by the ethics committee of the Charité - Universitäsmedizin Berlin, as was the data collection of the BiKeR Registry and the DGPI Registry by their respective ethics committees.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    This item was evaluated only in individuals with a date of COVID-19 symptom onset, or – if asymptomatic – with a date of PCR or antigen testing, because these methods allowed to determine the point of time the disease/infection occurred (in contrast to antibody testing) To determine whether the NRS values were reported in chronological order, i.e. the NRS timeline can be clearly separated into before/after SARS-CoV-2 infection, only valid dates were considered.
    antigen testing,
    suggested: None
    Software and Algorithms
    SentencesResources
    Statistics: Statistical analyses were performed using IBM SPSS Statistics 26 and SAS 9.4M5.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    Plots were made with Microsoft Excel 2016.
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Our data collection was based on voluntary reporting of confirmed SARS-CoV-2 infections in juvenile patients with RMD and therefore likely does not include all such patients in Germany. The relatively small number of cases of each disease entity and the variety of therapies do not allow reliable conclusions regarding implications of a specific rheumatic disease or the effects of medication on the clinical expression and outcome of SARS-CoV-2 infection in these patients. Assessment of disease activity before and after SARS-CoV-2 infection was performed as part of routine clinical practice and not after a fixed interval. Therefore, it is possible that flares that occurred in the period after SARS-CoV-2 infection but before outcome assessment were not recorded. Furthermore, we did not have a comparison group of SARS-CoV-2-negative patients with RMD regarding the change in NRS of disease activity over a comparable period of time. Summary: In summary, the clinical characteristics of COVID-19 in this patient group are similar to those of healthy peers; disease course was mild with and without maintaining DMARD therapy and COVID- 19 outcome was good in most of these patients. Furthermore, SARS-CoV-2 infection does not appear to have a major effect on the underlying disease activity, whereas discontinuation of therapy might pose a risk of flare in patients with moderately active disease. To our knowledge, our cohort currently represents the largest collection of data fro...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.03.28.21254496v1 on medRxiv