Abstract
Background:About one year ago at the beginning of the new SARS-CoV-2 infection pandemic, it was expected, that rheumatic disease (RD) and immunosuppressive therapy could predispose to a more severe course of the Covid-19 infection. At that time, it was unspeakable how this infection would occur in children with RВ in compare to adults. Now it’s time to draw preliminary conclusions.Objectives:to analyze all features of COVID19 infection in children with RDMethods:The retrospective single center study of all patients with pediatric RD who had the COVID19 infection up to the end of January 2021. It was analyzed all variety of clinical manifestations, changing in therapy at the time of COVID-19 and after it, the dynamics of the RD and consequences of the new viral disease.Results:The study included 66 patients under the age of 18 with various RS, including autoinflammatory disease (AIDs). The diagnostic distribution, sex ratio, age and previous therapy present in the Table 1. There were patients treated with DMARDS (methotrexate -47, hydroxychloroquine -3, mycophenolate mofetil -2, colchicine -1), NSAID monotherapy -6, systemic steroids -10; 29 patients recived Biologics, including combination with methotrexate. None of our patients had a severe course of the COVID-19, none of 66 patients was hospitalized for emergency indications in the intensive care unit or in other specialized departments. The diagnosis of Covid-19 infection was based on different evidences: positive PCR in 15 (23%) cases, high levels of immunoglobulins G and M - in 64 (97%) and 7 (11%) respectively, viral pneumonia was confirmed by CT in 2 (10%) cases. A manifest clinical picture presented just in 21 (32 %) of patients, the others were carried the disease asymptomatically. Among the clinical manifestations of SARS-CoV-2 that were observed in our patients were the following: fever, as the most frequent symptom - 19 (90%), rhinitis - 12 (57%), anosmia - 10 (48%), sore throat - 3 (14%), arthralgia/myalgia in 4 (19%), rash - 1 (5%) case, cough - 4 (19%) cases. it is important to note that until July 2020, only 4 patients were registered, and in the next 6 months – 62. The treatment against Covid-19 in our patients with clinical symptoms included: NSAID monotherapy -4 (19%), Systemic steroids -2 (10%), Hydroxychloroquine -2(10%), Antibiotics-5 (24%).Table 1.Clinical characteristics of children with RD according to presence of symptoms of Covid-19ParameterCovid-19 symptomatic course (n=21)Covid-19 asymptomatic course (n=45)p-valuesSex ratio (F/M)9/1230/15nsDuration of RD (Me. Years)4 (2;6)4 (2;7)nsAge(years)Me<10 yrs>10 yrs15 (13; 17)12011 (8;13.5)1926<0,001<0,05<0,001Covid-19 evidencesIgG Covid-19 +1945nsIgM Covid-19 +34nsPCR Covid-19 +110nsDiagnosis of RDJIA non-systemic1431nssJIA13nsSLE41nsJDM11nsScleroderma6nsAIDs (CAPS, FMF, FOP)13nsPrevious therapyNSAID monotherapy36nsDMARDs1633nsSystemic steroids47nsTNF-inhibitors512nsAbatacept13nsIL6-inhibitors (Tocilizumab, Sarilumab)02nsJAK-kinase inhibitors12nsWorsening/flare of RD after Covid-19 infection50p<0,05Conclusion:Our study suggests that the presence of RD and immunosuppression therapy does not lead to an increased frequency or severe course of Covid-19 infection in children. The final conclusion will be drawn as the data accumulates.Disclosure of Interests:None declared
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