Paediatric Rheumatology Unit, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain.
La Paz Research Institute (IdiPaz), Madrid, Spain.
Clin Rheumatol. 2022 Jun;41(6):1779-1784. doi: 10.1007/s10067-022-06186-z. Epub 2022 Apr 30.
SARS-CoV-2 infections in children are frequently asymptomatic or mild and can go unnoticed. This study aimed to describe the seroprevalence and clinical course of SARS-CoV-2 in a cohort of children with rheumatic diseases in a real-life setting and assess possible risk factors. A cross-sectional study was performed in a paediatric rheumatology unit (September 2020 to February 2021). At inclusion, a specific questionnaire was completed and SARS-CoV-2 serology was performed. Demographics, treatment and disease activity of patients with and without laboratory-confirmed SARS-CoV-2 infection were compared. A total of 105 children were included. SARS-CoV-2 infection was demonstrated in 27 patients (25.7%). The mean age was 11.8 years, and most patients were females (72.4%). The most frequent underlying condition was juvenile idiopathic arthritis (70.3%; 19/27). Patients received immunosuppressive treatment in 78% of cases (21/27). Overall, 44.4% (12/27) of infected patients were asymptomatic. A total of 66.7% (18/27) of patients did not require medical assistance. Three patients required hospital admission because of COVID-19. Children with confirmed SARS-CoV-2 infection were less frequently in remission (52% vs 72%; p 0.014). Moderate disease activity and treatment with oral corticosteroids were associated with higher risk for SARS-CoV-2 (OR 5.05; CI 95%: 1.56-16.3 and OR 4.2; CI 95%: 1.26-13.9, respectively). In a cohort of Spanish paediatric patients with rheumatic diseases, clinical course of COVID-19 was mild, with more than one third of asymptomatic cases. Higher disease activity and oral corticosteroids appear to be risk factors for SARS-CoV-2 infection. Key Points • We aimed to investigate the seroprevalence of SARS-CoV-2 infection in a cohort of Spanish paediatric patients with RD, testing both symptomatic and asymptomatic patients. We also compared treatment and disease activity of patients with and without laboratory-confirmed SARS-CoV-2 infection. • In our cohort of 105 paediatric patients with rheumatic diseases, the clinical course of COVID-19 was mild and 44% of cases were asymptomatic. Three cases required hospital admission with no complications. Seroprevalence was 20%. • No association was found between disease activity or treatment with corticosteroids and symptomatic or asymptomatic infection. Higher disease activity and treatment with oral corticosteroids appeared to be risk factors for laboratory-confirmed SARS-CoV-2 infection.
SARS-CoV-2 感染在儿童中常为无症状或轻症，容易被忽视。本研究旨在描述真实环境中儿童风湿性疾病患者队列中 SARS-CoV-2 的血清流行率和临床过程，并评估可能的危险因素。这是一项在儿科风湿科进行的横断面研究（2020 年 9 月至 2021 年 2 月）。纳入时，完成了一份特定的问卷，并进行了 SARS-CoV-2 血清学检查。比较了实验室确诊 SARS-CoV-2 感染患者和未感染患者的人口统计学、治疗和疾病活动情况。共纳入 105 例儿童。在 27 例患者中证实存在 SARS-CoV-2 感染（25.7%）。平均年龄为 11.8 岁，大多数患者为女性（72.4%）。最常见的基础疾病是幼年特发性关节炎（70.3%，19/27）。78%（21/27）的患者接受了免疫抑制治疗。总体而言，44.4%（12/27）的感染患者无症状。66.7%（18/27）的患者无需医疗援助。3 例因 COVID-19 需要住院治疗。确诊 SARS-CoV-2 感染的患儿较少处于缓解状态（52% vs 72%；p=0.014）。疾病活动度中度和口服皮质类固醇治疗与 SARS-CoV-2 感染风险增加相关（OR 5.05；95%CI：1.56-16.3 和 OR 4.2；95%CI：1.26-13.9）。在西班牙一组患有风湿性疾病的儿科患者中，COVID-19 的临床过程较轻，三分之一以上为无症状病例。较高的疾病活动度和口服皮质类固醇似乎是 SARS-CoV-2 感染的危险因素。 关键点 • 我们旨在调查西班牙儿科风湿性疾病患者队列中 SARS-CoV-2 感染的血清流行率，对有症状和无症状患者均进行检测。我们还比较了有和无实验室确诊 SARS-CoV-2 感染患者的治疗和疾病活动情况。 • 在我们的 105 例风湿性疾病儿科患者队列中，COVID-19 的临床过程较轻，44%的病例无症状。3 例因 COVID-19 需要住院治疗，无并发症。血清流行率为 20%。 • 疾病活动度或皮质类固醇治疗与有症状或无症状感染之间未发现关联。较高的疾病活动度和口服皮质类固醇治疗似乎是实验室确诊 SARS-CoV-2 感染的危险因素。
