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 a coronavirus 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 suppress 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.

While preliminary research suggests no significant difference in COVID-19 risk and severity of symptoms between the general population and patients with rheumatic conditions like ankylosing spondylitis being treated with biologics, further research is needed to determine if a relationship exists.

Some researchers 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.

Complications of Ankylosing Spondylitis and COVID-19

While evidence is still preliminary and more research is needed, current evidence suggests that patients with ankylosing spondylitis treated with immunosuppressive medication are not at any increased risk of complications from COVID-19 compared to the general population.

Research supports that patients with ankylosing spondylitis are not at increased risk of hospitalization compared to the general population, and that use of biologic medication is not associated with worsening of symptoms from COVID-19.

Ankylosing Spondylitis Treatments and COVID-19

While research is still underway, current evidence suggests that treatment for COVID-19 is the same for people with or without ankylosing spondylitis.

In one study, people with ankylosing spondylitis with a confirmed case of COVID-19 received antibiotic treatment, while one was hospitalized and received antiviral medication and hydroxychloroquine. All patients temporarily discontinued their medication for ankylosing spondylitis under the guidance of their healthcare providers. None of the patients with ankylosing spondylitis who were infected with COVID-19 developed severe respiratory complications or required ventilation.

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. mRNA vaccines teach 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.

How to Stay Safe

To minimize your risk of COVID-19, the Centers for Disease Control and Prevention (CDC) advises those who may be at increased risk to:

  • Stay home as much as possible.
  • Avoid crowds and limit close contact with other people in public (maintain a social distance of six feet).
  • Avoid touching your eyes, nose, or mouth in public.
  • Disinfect or avoid touching frequently used surfaces—such as doorknobs, elevator buttons, and shopping carts—in public places.
  • Wash your hands with soap and water for 20 seconds or use an alcohol-based hand sanitizer to clean your hands.

Symptoms of COVID-19 may appear between two and 14 days after exposure, and can include:

  • Cough
  • Shortness of breath
  • Fever
  • Chills
  • Loss of taste or smell
  • Sore throat
  • Headache
  • Muscle or body aches
  • Diarrhea
  • Nausea or vomiting
  • Congestion
  • Fatigue

If you have any of these symptoms, it is best to get a COVID-19 test to determine if you have been infected. You can visit the website of your local or state health department to find a testing location near you. COVID-19 tests are typically covered by your health insurance or free if you are uninsured.

A Word From Verywell

While patients with ankylosing spondylitis taking biologic medications may 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.

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

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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.