What is it about?

Children and young people appear to be less affected, compared with adults, by severe COVID-19, with most experiencing mild symptoms, or even no symptoms at all. However, some adults with rheumatic diseases, such as rheumatoid arthritis or lupus, especially those whose disease is very active, or those receiving certain medications, are at a higher risk of more severe COVID-19 (i.e. death) compared with adults without arthritis. Is it unknown whether children and young people with rheumatic diseases, such as juvenile idiopathic arthritis (JIA), are likely to have more severe COVID-19. What was discovered? This study, investigating 607 children and young people with rheumatic diseases including JIA and lupus, found that very few (around one-in-twenty; 7%) were hospitalised due to COVID-19. Those that were hospitalised experienced mild symptoms, with four-in-five of those hospitalised not needing any additional oxygen treatment. Children and young people were more likely to be hospitalised if they had a diagnosis of lupus or vasculitis (a rare rheumatic disease which causes inflammation of blood vessels) compared with those who had JIA. In addition, those who were obese (BMI ≥30) were more likely to be hospitalised, although only a small number of patients in this study were obese (6%). Those children and young people treated with biologic therapies, such as TNF inhibitors, did not experience more severe COVID-19. The small number of patients who died were from countries with limited healthcare resources.

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Why is it important?

Whilst it remains important to follow national COVID-19 guidance to minimising risk of infection, parents and families can be reassured that these data show that children and young people with rheumatic diseases who acquire COVID-19 are not at high risk of severe COVID-19. The data showed for the first time that obesity is an important factor in children with rheumatic diseases, supporting that protection measures in those children should be strictly followed.


Previous research has shown that most children and young people do not experience severe COVID-19, many being asymptomatic or with only mild symptoms. So we felt it was important to find out if the same was true for those with RMDs, and the good news is that most do appear to do well and experience mild COVID-19 disease. We of course agree that protective measures are important to follow to minimise the risk of acquiring SARS-CoV-2 infection. However these findings will reassure parents and families that the probability of severe COVID-19 in the majority of children and young people with underlying RMDs is low. The data are very reassuring but do show again the important association between obesity and more severe COVID-19 outcomes, supporting the view that protection measures in those children should be strictly followed. The collective experience is that children, especially younger children, seem less susceptible to symptomatic severe COVID-19 and reports of death are rare. But until now, little was known about the impact of comorbidity and immunosuppression on the risk of severe COVID-19 in the paediatric population with RMDs. This paper offers an important addition to the literature and should be reassuring for young people living with RMDs and their parents.

Dr. Lianne Kearsley-Fleet
University of Manchester

Read the Original

This page is a summary of: Outcomes of SARS-CoV-2 infection among children and young people with pre-existing rheumatic and musculoskeletal diseases, Annals of the Rheumatic Diseases, March 2022, BMJ, DOI: 10.1136/annrheumdis-2022-222241.
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