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.
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.
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.
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.
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.
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.
