1
|
Clemente D, Udaondo C, de Inocencio J, Nieto JC, Del Río PG, Fernández AG, Palomo JA, Bachiller-Corral J, Lopez Robledillo JC, Millán Longo C, Leon L, Abasolo L, Boteanu A. Clinical characteristics and COVID-19 outcomes in a regional cohort of pediatric patients with rheumatic diseases. Pediatr Rheumatol Online J 2021; 19:162. [PMID: 34838054 PMCID: PMC8626725 DOI: 10.1186/s12969-021-00648-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/14/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND This study aimed to assess the baseline characteristics and clinical outcomes of coronavirus disease 2019 (COVID-19) in pediatric patients with rheumatic and musculoskeletal diseases (RMD) and identify the risk factors associated with symptomatic or severe disease defined as hospital admission, intensive care admission or death. METHODS An observational longitudinal study was conducted during the first year of the SARS-CoV-2 pandemic (March 2020-March 2021). All pediatric patients attended at the rheumatology outpatient clinics of six tertiary referral hospitals in Madrid, Spain, with a diagnosis of RMD and COVID-19 were included. Main outcomes were symptomatic disease and hospital admission. The covariates were sociodemographic and clinical characteristics and treatment regimens. We ran a multivariable logistic regression model to assess associated factors for outcomes. RESULTS The study population included 77 pediatric patients. Mean age was 11.88 (4.04) years Of these, 30 patients (38.96%) were asymptomatic, 41 (53.25%) had a mild-moderate COVID-19 and 6 patients (7.79%) required hospital admission. The median length of hospital admission was 5 (2-20) days, one patient required intensive care and there were no deaths. Previous comorbidities increased the risk for symptomatic disease and hospital admission. Compared with outpatients, the factor independently associated with hospital admission was previous use of glucocorticoids (OR 3.51; p = 0.00). No statistically significant risk factors for symptomatic COVID-19 were found in the final model. CONCLUSION No differences in COVID-19 outcomes according to childhood-onset rheumatic disease types were found. Results suggest that associated comorbidities and treatment with glucocorticoids increase the risk of hospital admission.
Collapse
Affiliation(s)
- Daniel Clemente
- Pediatric Rheumatology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Clara Udaondo
- Pediatric Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Jaime de Inocencio
- Pediatric Rheumatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan Carlos Nieto
- Rheumatology Department, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - Pilar Galán Del Río
- Rheumatology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | - Jaime Arroyo Palomo
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Leticia Leon
- Rheumatology Department and IDISSC, Hospital Universitario Clinico San Carlos, Martin Lagos s/n, 28040, Madrid, Spain.
- Health Sciences Faculty, Universidad Camilo Jose Cela, Madrid, Spain.
| | - Lydia Abasolo
- Rheumatology Department and IDISSC, Hospital Universitario Clinico San Carlos, Martin Lagos s/n, 28040, Madrid, Spain
| | - Alina Boteanu
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| |
Collapse
|
2
|
Sengler C, Eulert S, Minden K, Niewerth M, Horneff G, Kuemmerle-Deschner J, Siemer C, Berendes R, Girschick H, Hühn R, Borte M, Hospach A, Emminger W, Armann J, Klein A, Kallinich T. 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. RMD Open 2021; 7:rmdopen-2021-001687. [PMID: 34312307 PMCID: PMC8316693 DOI: 10.1136/rmdopen-2021-001687] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/16/2021] [Indexed: 12/31/2022] Open
Abstract
Objectives 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.
Collapse
Affiliation(s)
- Claudia Sengler
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Sascha Eulert
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Kirsten Minden
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany.,Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martina Niewerth
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Gerd Horneff
- General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany.,Department of Paediatrics and Adolescent Medicine, University Hospital Cologne, Cologne, Germany
| | | | - Caroline Siemer
- German Center for Paediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Rainer Berendes
- Department of Paediatric Rheumatology, Kinderkrankenhaus Sankt Marien gGmbH, Landshut, Germany
| | - Hermann Girschick
- Department of Paediatrics, Vivantes Clinic in Friedrichshain, Berlin, Germany
| | - Regina Hühn
- Clinic for Paediatrics and Adolescent Medicine, University Hospital Halle (Saale), Halle, Germany
| | - Michael Borte
- ImmunDefektCentrum Leipzig (IDCL), Klinikum St. Georg, Leipzig, Germany
| | - Anton Hospach
- Pädiatrie 2, Olgahospital and Women's Clinic, Stuttgart, Germany
| | - Wolfgang Emminger
- Department of Paediatric Nephrology and Gastroenterology, Universitätskinderklinik Wien, Wien, Austria
| | - Jakob Armann
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ariane Klein
- General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany.,Department of Paediatrics and Adolescent Medicine, University Hospital Cologne, Cologne, Germany
| | - Tilmann Kallinich
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|