ABSTRACT
Introduction: Children appear less susceptible to SARS-CoV2 infection comparing to adults;however, the burden of the disease remains unclear particularly among specific groups, including immunocompromised children. Objectives: To assess the impact of COVID-19 in children with chronic rheumatic/autoinflammatory diseases (AIRD) being treated with disease-modifying antirheumatic drugs (DMARDs). Methods: We conducted a telephone survey between May 2020 and May 2021 interviewing the parents of all children with AIRD that attend the Immunology and 2Rheumatology Unit of our center. A hospital physician inquired about AIRD characteristics, current DMAR Ds use and duration, COVID-19 main symptoms, if any, source of transmission and duration. Results: Of all 453 patients with AIRD who were currently on DMARDs, 20 children (4.4%) had tested positive for SARS-CoV2 by polymerase chain reaction of nasopharyngeal specimen, during the study period. Male/Female ratio of patients was 0.8 and the median age was 13 years old (interquartile range 5.3- 15 years). The underlying AIRD was polyarticular juvenile idiopathic arthritis (35%), followed by oligoarticular idiopathic arthritis (25%). In all cases, primary AIRD was in remission at the time of SARS-CoV2 acquisition. Comorbidities were recorded in three patients (15%), including one adolescent with chronic stable course of asthma, one case of Hashimoto thyroiditis and one child with atopic dermatitis. Six out of all patients (30%) were symptomatic, with a mild course of COVID-19. Predominant symptoms were malaise (67%), cough (67%) and fever (50%);sore throat, muscle aches and abdominal aches were also reported in 33% of cases, respectively. No hospitalizations nor flares of the underlying AIRD were recorded. No in-school transmission was documented. All patients successfully recovered after a median of three days, without experiencing any post-COVID-19 conditions, and were followed until having three serial negative molecular tests. Biologic agents were not administered during COVID-19 course, according to The American College of Rheumatology guidance. Tocilizumab and adalimumab were the most prevalent biologic DMARDs (35%) followed by etanercept (15%). None of the patients were on corticosteroids, while seven (35%) were receiving conventional DMARDs concomitantly, mainly methotrexate (86%). The six COVID-19 symptomatic children were receiving adalimumab (3/ 6), tocilizumab (1/6), canacimumab (1/6) and belimumab (1/6). Conclusion: In our small cohort of children with AIRD and DMARDs, SARS-CoV2 infection was relatively mild in all symptomatic cases without triggering any relapse of the primary AIRD. Our results may suggest a potential protective role of DMARDs in the evolution of COVID-19 among children with AIRD, particularly when the AIRD is in remission and there are no significant comorbidities.