What to Know About Ankylosing Spondylitis and COVID-19

Ankylosing spondylitis is a type of arthritis that causes inflammation primarily in the spine but can also affect other joints.

People with ankylosing spondylitis are often prescribed immunosuppressive medications to manage their symptoms and reduce inflammation. Because this type of medication weakens the immune system response, people with ankylosing spondylitis who are taking these medications may be at an increased risk of acquiring infections, possibly including COVID-19, or experiencing a more severe infection.

woman getting COVID-19 vaccine

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Ankylosing Spondylitis and COVID-19 Risk

People with ankylosing spondylitis are often prescribed immunosuppressive medications that reduce their immune system response to reduce inflammation and slow disease progression. 

Tumor necrosis factor (TNF) is a specific cytokine, a cell-signaling protein produced by the immune system, that causes inflammation throughout the body. Because TNF is elevated in patients with ankylosing spondylitis, TNF inhibitors such as Humira (adalimumab), Remicade (infliximab), Enbrel (etanercept), Cimzia (certolizumab pegol), and Simponi (golimumab) are commonly prescribed to treat this condition.

Interleukins, specifically interleukin-17 (IL-17) and interleukin-12/23 (IL-12/23), are inflammatory cytokine proteins that are often elevated in ankylosing spondylitis. Biologics like IL-17 and IL-12/23 inhibitors are also used to treat the condition.

Biologics like TNF inhibitors, however, may increase the risk of infections and lower the body’s ability to fight infections, including COVID-19. The Centers for Disease Control and Prevention (CDC) says that people taking immunosuppressive medications may have a higher risk of severe COVID infection.

It's still unclear whether ankylosing spondylitis itself is a risk factor for COVID-19. Some research has shown that rheumatologic conditions like ankylosing spondylitis may increase the risk of COVID-19 infection and more severe disease, but evidence is mixed and unclear.

A 2022 review concluded that people with rheumatologic conditions might have a small increased risk of COVID-19 infection. However, another 2022 study that looked at spondyloarthritis specifically didn't find an increased risk of COVID-19 or increased severity due to the condition or the medications used to treat it.

Some researchers have hypothesized that biologics may increase the risk of only certain types of infections like hepatitis B, varicella zoster, or salmonella, without any specific link to the SARS-CoV-2 virus that causes COVID-19. Research is still ongoing.

If you have ankylosing spondylitis, it is recommended that you continue your medication to prevent worsening of symptoms and progression of your condition. Always consult your healthcare provider before stopping or changing the dosage of your medications.

Ankylosing Spondylitis Treatments and COVID-19

While research is still underway, and people should never change or stop taking their medications without their healthcare provider's okay, it's generally recommended that people with ankylosing spondylitis continue their treatment plan despite any possible increased risk of COVID-19 infection.

However, if a person with rheumatologic disease develops mild COVID-19 symptoms or tests positive, it may be appropriate to pause immunosuppressive medications for a short time. The CDC recommends that people on immunosuppressive medications be considered for treatment with the antiviral Paxlovid to reduce the chances of a severe infection.

A Word From Verywell

While people with ankylosing spondylitis taking biologic medications might be at an increased risk of infections, there is no evidence at this time that suggests that patients with ankylosing spondylitis are at an increased risk of acquiring COVID-19 or having more severe symptoms if they do get sick. It is recommended that patients with ankylosing spondylitis continue their medication and get a COVID-19 vaccine.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.

Frequently Asked Questions

  • Should I get a COVID-19 vaccine if I have ankylosing spondylitis?

    Live virus vaccines can be potentially problematic for patients with weakened immune systems, including those with ankylosing spondylitis. The most widely administered COVID-19 vaccines in the United States use mRNA technology instead. This type of vaccine teaches our cells how to make a protein that triggers an immune response inside our bodies to fight coronavirus.

    There is no evidence at this time that suggests the vaccines increase the risks of getting COVID-19 or side effects among patients with ankylosing spondylitis.

  • Is the COVID-19 vaccine effective for patients with ankylosing spondylitis?

    Medical experts from the Spondylitis Association of America say that patients with ankylosing spondylitis taking biologics like TNF inhibitors can be safely vaccinated, although they may experience a decreased response to the vaccine. People taking biologic medications have suppressed immune systems, so they do not have the same physiological response to vaccines as the general population.

    As a result, the vaccine may provide less protection against COVID-19 for those with ankylosing spondylitis. However, because of this dampened immune response, people with ankylosing spondylitis who receive the COVID-19 vaccine may also experience fewer side effects of the vaccine, like headache, fatigue, and injection site soreness.

    It is possible that those taking biologics may need a higher dose or an extra booster dose of the vaccine, although more research is needed.

  • Should I stop taking my medication before getting the COVID-19 vaccine?

    Taking a temporary break from biologic medications before and after receiving the COVID-19 vaccine may be beneficial in increasing the effectiveness of the vaccine, but you should always talk with your healthcare provider before stopping treatment.

    Depending on the severity of your condition, delaying medication dosages may not be possible. For those who cannot pause their biologic medication treatment, it is still recommended to get the COVID-19 vaccine to give you an elevated level of protection against the virus.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Annapureddy N, Nalleballe K, Onteddu SR, et al. Biologics in systemic autoimmune diseases during COVID-19 pandemic. Clin Rheumatol. 2020;39(12):3529-3531. doi: 10.1007/s10067-020-05439-z

  3. Rosenbaum JT, Hamilton H, Choi D, Weisman MH, Reveille JD, Winthrop KL. Biologics, spondylitis and COVID-19. Ann Rheum Dis. 2020;79(12):1663-1665. doi:10.1136/annrheumdis-2020-217941

  4. Centers for Disease Control and Prevention (CDC). Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals.

  5. Grainger R, Kim AHJ, Conway R, Yazdany J, Robinson PC. COVID-19 in people with rheumatic diseases: risks, outcomes, treatment considerationsNat Rev Rheumatol. 2022;18(4):191-204. doi:10.1038/s41584-022-00755-x

  6. Rosenbaum JT, Weisman MH, Hamilton H, et al. The interplay between COVID-19 and spondyloarthritis or its treatmentJ Rheumatol. 2022;49(2):225-229. doi:10.3899/jrheum.210742

  7. Brito CA, Paiva JG, Pimentel FN, Guimarães RS, Moreira MR. COVID-19 in patients with rheumatological diseases treated with anti-TNF. Ann Rheum Dis. 2020 Jun 16:annrheumdis-2020-218171. doi:10.1136/annrheumdis-2020-218171

  8. Spondylitis Association of America. COVID-19 vaccines and spondyloarthritis: what you should know.

By Kristen Gasnick, PT, DPT
Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.