Sözeri Betül, Demir Ferhat, Kalın Sevinç, Hasbal Akkuş Canan, Salı Enes, Çakır Deniz
Department of Child Health and Diseases, Pediatric Rheumatology, Ümraniye Training and Research Hospital, Istanbul, Turkey.
Department of Radiology, Pediatric Radiology, Ümraniye Training and Research Hospital, Istanbul, Turkey.
Arch Rheumatol. 2021 Feb 9;36(3):381-388. doi: 10.46497/ArchRheumatol.2021.8603. eCollection 2021 Sep.
In this study, we present our clinical severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) experience in patients with childhood rheumatic disease during novel coronavirus-2019 (COVID-19) pandemic.
A total of 87 patients (50 males, 37 females; median age: 12 years; range, 6.6 to 16 years) suspected of having COVID-19 at our pediatric rheumatology clinic between March 11th and October 15th 2020 were retrospectively analyzed. Demographic and clinical features, treatments, laboratory results, imaging findings, and clinical outcomes of the patients diagnosed with COVID-19 and/or multisystem inflammatory syndrome in children (MIS-C) were retrieved from the medical records. The diagnosis of SARS-CoV-2 infection was made based on the reverse transcriptase-polymerase chain reaction test.
The most common rheumatic diseases were juvenile idiopathic arthritis and familial Mediterranean fever (35.6% and 34.5%, respectively). Twenty-six of these patients were treated with biological disease-modifying anti-rheumatic drugs. SARS-CoV-2 infection was tested as positive in 84 (96.5%) patients. Also, 51 (58.6%) patients had an epidemiological contact to a person with COVID-19. Eighteen patients met the clinical criteria and diagnosed with MIS-C. The COVID-19 outbreak also caused exacerbation of systemic disease in 56 children due to medication cessation, postponed drug switch, or recurrent viral infection.
Children with rheumatic disease do not appear to present a higher risk of severe COVID-19. The immunosuppressive treatments can be adjusted in case of infection; otherwise, it is not recommended to interrupt the treatments. Physicians should be cautious about the hyperinflammatory syndrome associated with COVID-19 in rheumatic children, which may be severe in this group of patients and may be confused with primary diseases.
在本研究中，我们介绍了在2019年新型冠状病毒（COVID-19）大流行期间，我们在儿童风湿性疾病患者中治疗严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的临床经验。
对2020年3月11日至10月15日期间在我们儿科风湿病诊所疑似患有COVID-19的87例患者（50例男性，37例女性；中位年龄：12岁；范围6.6至16岁）进行回顾性分析。从病历中获取确诊为COVID-19和/或儿童多系统炎症综合征（MIS-C）患者的人口统计学和临床特征、治疗方法、实验室检查结果、影像学检查结果及临床结局。SARS-CoV-2感染的诊断基于逆转录聚合酶链反应检测。
最常见的风湿性疾病是幼年特发性关节炎和家族性地中海热（分别占35.6%和34.5%）。其中26例患者接受了生物性改善病情抗风湿药物治疗。84例（96.5%）患者的SARS-CoV-2感染检测呈阳性。此外，51例（58.6%）患者与COVID-19患者有流行病学接触史。18例患者符合临床标准并被诊断为MIS-C。COVID-19疫情还导致56例儿童因停药、推迟换药或反复病毒感染而出现全身性疾病加重。
风湿性疾病患儿似乎并未出现更高的严重COVID-19风险。感染时可调整免疫抑制治疗；否则，不建议中断治疗。医生应警惕风湿性疾病患儿中与COVID-19相关的高炎症综合征，该综合征在这组患者中可能较为严重，且可能与原发性疾病相混淆。
