Clinical Phenotypes of Pediatric Rheumatic and Systemic Inflammatory Manifestations Temporally Associated With SARS-CoV-2: A Retrospective Descriptive Cohort
DOI:
https://doi.org/10.52340/GBMN.2026.01.01.195Keywords:
Arthritis, COVID-19, Juvenile Idiopathic Arthritis, Multisystem Inflammatory Syndrome in Children (MIS-C), Pediatric Rheumatology, SARS-CoV-2, VasculitisAbstract
Background: Rheumatic and systemic inflammatory manifestations temporally associated with SARS-CoV-2 infection or exposure in children range from isolated vascular or articular disease to multisystem inflammation and persistent rheumatic illness, but their phenotypic diversity remains insufficiently characterized.
Objectives: To characterize clinical phenotypes, inflammatory findings, treatment, complications, and short-term outcomes in children in Georgia presenting with rheumatic or systemic inflammatory manifestations temporally associated with SARS-CoV-2 infection or exposure.
Methods: This retrospective single-center descriptive cohort study, conducted from March 2022 to March 2025, included 68 children younger than 18 years with new-onset rheumatic or systemic inflammatory manifestations temporally associated with preceding SARS-CoV-2 infection or epidemiological exposure.
Results: The cohort included 41 females (60.3%) and 27 males (39.7%); the mean age was 6.12±4.71 years. We could interpret the infection/exposure-to-symptom interval for 53/68 children, with a median of 8 weeks (IQR, 5–12). The vascular phenotype occurred in 32 children (47.1%), articular in 20 (29.4%), systemic inflammatory in 9 (13.2%), and mixed in 7 (10.3%). Cutaneous manifestations were documented in 35 children (51.5%), predominantly consisting of vasculitis or vasculopathy (33/35, 94.3%) and arthritis in 23 (33.8%). We administered corticosteroids to 51 children (75.0%), NSAIDs to 26 (38.2%), antibiotics to 22 (32.4%), and IVIG to 4 (5.9%). Complications were documented in 9/68 children (13.2%; 95% CI, 7.1–23.3). Among 41 children with available longitudinal follow-up, 16 (39.0%) had persistent or recurrent inflammatory manifestations, including 9 (22.0% of followed children) who subsequently fulfilled ILAR criteria for JIA.
Conclusions: Children with rheumatic or systemic inflammatory manifestations temporally associated with SARS-CoV-2 infection or exposure showed heterogeneous vascular, articular, systemic inflammatory, and overlapping presentations. The descriptive phenotype framework summarizes predominant clinical presentations but should not be interpreted as a validated disease classification. Longitudinal assessment is particularly important in children with persistent arthritis, recurrent inflammation, or cardiovascular involvement.
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