Association between SARS-CoV-2 seropositivity and disease activity in children with systemic lupus erythematosus

Background: Systemic lupus erythematosus (SLE) is a long-lasting autoimmune disease with its involvement in several organs and varying levels of severity. Pediatric SLE is an uncommon condition, accounting for 10-20% of all SLE cases. Individuals with systemic autoimmune illness have a higher prevalence of severe forms of COVID-19. However, the underlying cause for the heightened severity of COVID-19 in these patients is unclear. Objectives: The aim of the current study was to evaluate SARS-CoV-2 antibodies in children with SLE and the association between SARS-CoV-2 seropositivity and SLE disease activity. Methods: A cross sectional study was enrolled42 children with SLE diagnosed and followed-up with seropositive IgG for COVID-19 infection. Detection of antibodies was done by ELISA. Results: forty two children with SLE diagnosed and followed-up with seropositive IgG for COVID-19 infection and our study focused on 40 children with seropositive IgG. Regarding assessment of COVID-19 symptoms, 14 cases (35%) were symptomatic and 26 cases (65%) were asymptomatic. There is significant difference between symptomatic and asymptomatic cases according socio-demographic, laboratory investigation e.g. CRP, albumin level, Anti-dsDNA, Antinuclear antibody, C3, C4 and also score of the Physician Global Assessment (PGA) before COVID-19 infection and SLE Disease Activity Index (SLEDAI) before and after COVID-19 infection. Furthermore IgG level of COVID-19 was significantly associated with increased scores of either SELDAI or PGA when compared before and after infection. Conclusion: SARS-CoV-2 infection may predispose to SLE exacerbation and worsen disease activity that was found through increase of score of PGA and SELDAI after COVID-19 infection.