POS0204 RETROSPECTIVE STUDY OF THE COVID-19 COURSE IN CHILDREN WITH RHEUMATIC DISEASES: SINGLE CENTER EXPERIENCE

Abstract

BackgroundThe study of the features of the course and mutual influence of the new coronavirus disease COVID-19 and various rheumatic diseases (RD) in children can still give us new lessons, warnings and fears.ObjectivesTo update the analysis in a retrospective study the course of covid-19 in children with RD based on the results of two years of the pandemic. To analyze the impact of COVID-19 on the course of RD in children.MethodsRetrospective analysis based on data from single center. The study included patients with RD and confirmed COVID-19 for 2 years (2020-2021).ResultsWere registered 320 cases of COVID-19 in children with RD. 158 (49%) patients were asymptomatically infected, 162 (51%) had clinical symptoms. A detailed description of the groups is presented in Table 1. Clinical symptoms were fever (67%), anosmia (47%), rhinitis (34%), cough (19%), arthralgia/myalgia (16%), dyspepsia (5%), rash (2.5%), pneumonia (3%). In the majority of cases (98%), COVID-19 proceeded in mild to moderate severity. Hospitalization due to COVID-19 was required just in 5 cases. 2 children were admitted to the intensive care unit. First, an 11-year-old girl with sJIA with the history of recurrent episodes of MAS resolved by regular administration of canakinumab. 2nd, a 12-year-old girl with Sjogren’s syndrome, who received Rituximab and 1 month later she developed the COVID-19 with MIS-like clinical picture, pneumonia with 25%CT lessions. Both cases have a favorable outcome.Table 1.Clinical characteristics of children with COVID-19 and RDCovid-19 with symptoms (n= 162)Covid-19 asymptomatic (n=158)Worsening of RD after Covid-19 (n=51/320)Sex (F/M)96/66109/4933/18Age, years (Me[25;75]) *15 [9;17]11 [8;14]13 [10;16]IgG Covid-19 positive9112630IgM Covid-19 positive864PCR Covid-19 positive1064822Diagnosis of RDJIA non-systemic11010430sJIA11109SLE652JDM963Scleroderma8153Sjögren’s syndrome862Overlap syndrome040AIDs (CAPS, FMF, Behçet’s disease)972FOP (Fibrodysplasia ossificans progressive)110Treatment of RDNSAID monotherapy23274DMARDs10712529Systemic glucocorticoids362913bDMARDs737221Etanercept22338Adalimumab15113Golimumab1232Infliximab010Abatacept973Tocilizumab663Sarilumab221Canakinumab331Rituximab330Tofacitinib110Baricitinib020Immunoglobulin human normal (in last 6 month)732Duration of disease, years (Me[25;75])5 [2;8]4 [2;8]5 [2;7]Duration of treatment DMARDs, years (Me[25;75])4 [2;7]4 [2;7]4 [2;5]Duration of treatment bDMARDs, years (Me[25;75])4 [1;5,5]3 [2;6]2 [0,6;5]The activity stage of RD by the start of COVID-19Remission919033Low disease activity604916High disease activity11192Temporary withdrawal of DMARD and bDMARDs during COVID-1958818Worsening/flare of RD42951*- p<0,05The clinical characteristics of the patients are presented in Table 1. COVID-19 didn`t affect the course of RD in the 86% of pts. However, 15% developed a flare of the RD with average of 3 months after COVID-19. In this group for 13 pts (girls mostly F/M-9/4, mean age 15 years [9;16]), COVID-19 triggered the new onset of RD (non-systemic JIA – 4, Uveitis – 1, non-bacterial osteomyelitis – 3, systemic JIA – 2, Scleroderma – 2, Sjögren’s syndrome – 1. 12 from 13 these children had clinical symptoms on COVID-19. Whether this is Long-COVID syndrome or an independent RD is not known.ConclusionOur study suggests that the new coronavirus infection in most cases in children with RD, had mild or asymptomatic course, regardless of therapy with immunosuppressive drugs and bDMARD, except of 1 observation with the previous therapy of Rituximab. Worsening of RD after coronavirus infection developed in 15% of cases, regardless of its clinical manifestations. In 13 patients, the RD were started just after COVID-19. The explosive increasing of the incidence of a new strain of COVID-19 for a past month may change the current results and conclusions.Disclosure of InterestsNone declared