Ankylosing Spondylitis and the COVID Vaccine: Is It Safe?

People with ankylosing spondylitis (AS), an inflammatory arthritic disorder affecting the spine, usually have compromised or weakened immune systems due to the medications that treat it. Though these medications help reduce or control symptoms, they can also increase your risk of becoming infected with or seriously ill from certain viruses or bacteria, such as COVID-19.

This article investigates the risk and dangers of contracting COVID-19 with ankylosing spondylitis and how the vaccine can help.

COVID-19 vaccines.

Andriy Onufriyenko / Getty Images

Is the COVID Vaccine Safe and Effective for People With Ankylosing Spondylitis?

The National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) strongly recommend that anyone with a moderately or severely weakened immune system stay up to date on COVID-19 vaccines and boosters.

Though there is limited long-term data for the safety and effectiveness of COVID vaccines—especially in immunocompromised people—early studies show that initial vaccination and regular booster doses have been effective in reducing cases of moderate and severe COVID-19 disease as well as hospitalizations and deaths.

Current COVID-19 Vaccines Approved in the United States

Each COVID vaccine developed and approved for use in the U.S. has passed rigorous development and testing procedures to ensure their safety before authorization. The COVID vaccines currently approved for use in the U.S. include:

  • Pfizer-BioNTech (mRNA vaccine)
  • Moderna (mRNA vaccine)
  • Novavax (protein subunit vaccine)
  • Johnson & Johnson Janssen (viral vector vaccine)

Which Type Should People With Ankylosing Spondylitis Get?

There is no specific recommendation for which COVID vaccine people with ankylosing spondylitis should get. Instead, the American College of Rheumatology emphasizes that people with inflammatory rheumatic conditions like AS should prioritize getting vaccinated and staying up to date with boosters.

In one study, people with AS who received at least two doses of the Pfizer or Moderna vaccines were well-protected against COVID-19, with only about 6% testing positive during the study period.

Discuss the best time to get the vaccines and boosters with your healthcare provider because your current medication schedule may influence optimal timing.

Are There Any Side Effects of Taking the COVID-19 Vaccine?

The potential side effects from the COVID vaccine are similar for people with or without AS. However, if your immune system is moderately or severely weakened, you may have a weaker immune response to the vaccine than people with stronger immune systems. This could result in fewer or less severe side effects.

Side effects of the COVID-19 vaccination may include:

  • Fever
  • Chills
  • Fatigue
  • Muscle or body aches
  • Headache

Additionally, there is a risk of developing a rare allergic reaction to any formula of the COVID vaccine or a rare but increased risk of blood clots after administration of the Johnson & Johnson/Janssen vaccine.

Risks of COVID-19 for People With Ankylosing Spondylitis

People with rheumatic diseases, like AS, are known to be at a greater risk of becoming infected with and more severely ill from SARS-CoV-2 (the virus that causes the COVID-19 infection).

One study found that people with rheumatic diseases were between 25% and 64% more likely to become sick with COVID-19 than those without rheumatic diseases. However, the most severe cases of COVID-19 observed in that study were found in people with additional risk factors, including obesity, kidney disease, and treatments with high doses of steroids.

What Should People Avoid Before Taking the COVID-19 Vaccine?

You should not change, delay, or stop any medications prescribed to treat your AS without talking to your healthcare provider. You should speak to them about the optimal timing to receive a COVID-19 vaccine because AS medications suppress the immune system.

The NIH recommends timing your COVID vaccination around your immunotherapy medications if possible. This means completing your vaccination series at least two weeks before starting or resuming medications or therapies that can suppress the immune system.

Where Does the COVID-19 Vaccine Come From?

Several types of COVID vaccines have been approved in the U.S.:

Live virus vaccines: These traditional vaccines use bits of material from the infectious virus to elicit an immune response and produce antibodies that can fight future infections.

mRNA vaccines: These vaccines don't contain any actual virus particles. Instead, they carry instructions to your immune system that allow it to produce proteins that can detect and fight off the SARS-CoV-2 virus. These vaccines are fairly new but have been investigated for use against other infections like influenza, rabies, and even cancer. Pfizer-BioNTech and Moderna are both mRNA vaccines.

Protein subunit vaccine: This contains proteins from the virus and an adjuvant (added) compound that helps your immune system develop protection against the virus. It can also protect against hepatitis B and whooping cough. Novavax manufactures this COVID vaccine in the U.S.

Viral vector vaccine: This vaccine uses an altered version of the virus to deliver immunity information to cells. It has been around for decades and can treat viruses like Ebola. The COVID viral vector vaccine is made by Johnson & Johnson/Janssen.

Outside of the U.S., there are many other COVID vaccines. According to the World Health Organization (WHO), 153 different COVID vaccines have been approved for clinical trials, and another 196 are in preclinical trials. Most of the vaccines developed or in the research stages are protein subunit vaccines (34%) and RNA vaccines (18%).

Where Can You Get the COVID Vaccine?

Many places offer COVID vaccines, including:

  • Your primary care provider
  • Drug stores or pharmacies
  • Medical centers
  • Retail locations
  • Vaccination clinics
  • Your local health department

The CDC offers an online tool to help you find a vaccination center near you.

When Should You Take the COVID Vaccine?

When you receive the COVID vaccine may depend on the timing of your regular AS treatments, but it can also depend on which type of COVID vaccine you get. Different intervals and timing of doses are recommended for each vaccine.

For people with moderately or severely compromised immune systems, the following timing is recommended for each vaccine.

Pfizer-BioNTech

  • First dose: anytime
  • Second dose: three weeks after the first dose
  • Third dose: at least four weeks after the second dose
  • Fourth dose: at least two months after the third dose or most recent booster

Moderna

  • First dose: anytime
  • Second dose: four weeks after the first dose
  • Third dose: at least four weeks after the second dose
  • Fourth dose: at least two months after the third dose or most recent booster

Novavax

  • First dose: anytime
  • Second dose: three weeks after the first dose
  • Third dose: at least two months after the third dose or most recent booster

Johnson & Johnson/Janssen

  • First dose: Anytime
  • Second dose: four weeks after the first dose
  • Third dose: at least two months after the third dose or most recent booster

Talk to your healthcare provider about the best timing for your individual condition and needs.

Summary

People who take medications that suppress the immune system are at an increased risk of developing a severe COVID-19 infection. Getting vaccinated can help prevent serious infections and other complications. People with conditions like ankylosing spondylitis are at a heightened risk of getting infected with COVID-19 and should receive priority vaccinations.

Talk to your healthcare provider about the best time to vaccinate against COVID, especially if you take immunosuppressant medications to treat AS symptoms.

A Word From Verywell

If you have an inflammatory rheumatic disease like AS and take medications that suppress your immune system, your risk of becoming severely ill with COVID-19 is higher. Luckily, the COVID-19 vaccine is safe and effective. Speak with your healthcare provider about when to schedule your COVID vaccines and boosters.

Frequently Asked Questions

  • Do COVID vaccines work in people who take immunosuppressants?

    Yes, immunosuppressed people can still be vaccinated against COVID and other viruses. Studies show that current COVID vaccines in the U.S. provide strong protection for up to three months.

  • Are people with inflammatory diseases more likely to get COVID-19?

    Yes, inflammatory diseases like ankylosing spondylitis put you at a greater risk of developing severe COVID-19 infection that may result in hospitalization or even death.

  • Should I stop my immunosuppressant treatments to get the COVID vaccine?

    Never stop taking your regular medications without talking to the healthcare provider first. You may want to time your COVID vaccine around your next medication dose, but you should not alter your AS treatment plan to receive the vaccine or make any changes until you speak with your healthcare provider.

10 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. Centers for Disease Control and Prevention. Special considerations in people who are immunocompromised.

  3. American College of Rheumatology. COVID-19 vaccine clinical guidance summary for patients with rheumatic and musculoskeletal diseases.

  4. Centers for Disease Control and Prevention. COVID-19: overview of COVID-19 vaccines.

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  6. Vandergraesen T, Mekkaoui L, Dahma H, et al. Immunogenicity of COVID-19 vaccination in patients with ankylosing spondylitis: a monocentric prospective belgian cohort studyJour Rheum. 2022. doi:10.3899/jrheum.211313

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

  8. Centers for Disease Control and Prevention. COVID-19: understanding how COVID-19 vaccines work.

  9. Li M, Wang H, Tian L, et al. COVID-19 vaccine development: milestones, lessons and prospects. Signal Transduct Target Ther. 2022 3;7(1):146. doi:10.1038/s41392-022-00996-y

  10. Centers for Disease Control and Prevention. Vaccines for people who are moderately or severely immunocompromised.

By Rachael Zimlich, BSN, RN
 Rachael is a freelance healthcare writer and critical care nurse based near Cleveland, Ohio.