Obesity Increases Risk of COVID-19 Hospitalization in Juvenile Patients


“Understanding the impact of COVID-19 infection on children and young people with RMDs is important to inform national protection, education (such as school attendance), and vaccination guidance."

Most children and young people (CYP) diagnosed with COVID-19 were less susceptible to severe COVID-19 symptoms and were less likely to be hospitalized. However, severe systemic rheumatic and musculoskeletal diseases (RMDs) and obesity increased this risk, according to a study published in Annals of Rheumatic Diseases.1

“While protective measures, as indicated by local policy, are important to follow with respect to minimizing risk of acquiring SARS-CoV-2 infection, parents and families can be reassured that these data do not support a high probability of severe COVID-19 in the majority of children and young people with underlying RMDs,” investigators stated.

Data on CYP with RMDs who reported a COVID-19 infection was obtained via the European Alliance of Associations for Rheumatology COVID-19 Registry, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, and the CARRA-sponsored COVID-19 Global Paediatric Rheumatology Database. Information on the severity of COVID-19 infection, patient demographics, including age, sex, and country of residence, RMD diagnosis, disease severity, current RMD treatment, and comorbidities was collected, and hospitalization factors were investigated.

A total of 607 CYP with RMDs and COVID-19 infection, aged 19 years or younger, were analyzed (median age 14 years, 66% female). Most patients had a juvenile idiopathic arthritis (JIA; n = 378; 62%) diagnosis and did not report any comorbidities (83%). Of patients included, 7% (n = 43) were hospitalized; 3 of which died.

At the time of COVID-19, most patients (n = 423; 70%) were receiving disease-modifying antirheumatic drugs (DMARDs) and 200 patients were on anti-tumor necrosis factor (anti-TNF) therapy. There were no differences in the proportion of hospitalized and non-hospitalized patients discontinuing DMARD therapy at the time of COVID-19 diagnosis.

Patients that were more likely to be hospitalized were those with systemic lupus erythematosus (SLE), mixed-connective tissue disease (MCTD), vasculitis, or other RMDs (OR 4.3; 95% CI 1.7 to 11) or those with autoinflammatory syndromes (OR 3.0; 95% CI 1.1 to 8.6) when compared with JIA diagnosis, as well as obese patients (OR 4.0; 95% CI 1.3 to 12).

Although this was the largest investigation of COVID-19 in CYP with RMDs globally, the choice to include both presumptive and confirmed cases may have introduced misclassification bias. Data collection issues, including missing RMD disease activity information, differences in race and ethnicity reporting between data sources, and missing data on variant types, hindered the analysis of other factors previously associated with worse outcomes. Additionally, vaccination status was unavailable, although most cases were reported prior to approval of the vaccination for younger people, and investigators were unable to capture long-term or late outcomes known as “long COVID-19”.

“Understanding the impact of COVID-19 infection on children and young people with RMDs is important to inform national protection, education (such as school attendance), and vaccination guidance,” investigators concluded. “The majority of children and young people with RMDs appear to do well and experience mild COVID-19 disease… The data also showed for the first time that obesity is a relevant comorbidity also in children with RMDs, supporting that protection measures in those children should be strictly followed.”


Kearsley-Fleet L, Chang ML, Lawson-Tovey S, et al. Outcomes of SARS-CoV-2 infection among children and young people with pre-existing rheumatic and musculoskeletal diseases. Ann Rheum Dis. 2022;81(7):998-1005. doi:10.1136/annrheumdis-2022-222241

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