Biologics and Vaccination for Ankylosing Spondylitis Patients

Q: Biologics and Vaccination for Ankylosing Spondylitis Patients

Hello, thank you for your questions. <br>Here are my responses：<br>1) Is there a regulation on how long one should wait to receive the COVID-19 vaccine before or after receiving a biologic agent? --> Only certain biologic agents require a pause in administration when receiving th

Biologics

Hello Doctor, I am currently 19 years old and have ankylosing spondylitis.
I received my first dose of the BNT vaccine on September 27, 2021, and I am planning to get the second dose (the delay in receiving the second dose is due to my serious suspicion that the first dose of BNT caused my inflammatory markers to become uncontrolled).
However, I have a follow-up appointment with the rheumatologist in one month, and I may be scheduled for my first self-funded biological agent injection (as my current medication is not effectively controlling my inflammatory markers).
If I do indeed receive the first biological agent injection in one month, I would like to ask the doctor: 1) Are there any regulations regarding how long before receiving a biological agent one should refrain from getting the COVID-19 vaccine, or how long after receiving a biological agent one should wait before getting the COVID-19 vaccine? 2) Previously, my inflammatory markers were controlled at CRP 0.3 and ESR 14, but recently, despite taking the same medication, my markers have risen to CRP 0.9 and ESR 40.
Besides suspecting the COVID-19 vaccine as a cause, could it also be possible that my immune system has strengthened (as I am becoming more of an adult), leading to a more robust autoimmune response and making my inflammatory markers harder to control? 3) Generally speaking, at what age does immune function peak? Is it possible that after reaching that age, my immune function may gradually weaken, leading to a gradual reduction in my ankylosing symptoms? 4) I would like to ask the doctor a conceptual question: ankylosing spondylitis is an autoimmune issue, and it is also said to be caused by an overly strong autoimmune response (I am not sure if this is correct).
I want to ask the doctor, if I focus on maintaining good health (going to bed early, waking up early, eating more fruits and vegetables, etc.) and strengthen my body and immune system, could this actually worsen my ankylosing spondylitis?

Hao, 10~19 year old female. Ask Date: 2022/02/16

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your questions.
Here are my responses:
1) Is there a regulation on how long one should wait to receive the COVID-19 vaccine before or after receiving a biologic agent? --> Only certain biologic agents require a pause in administration when receiving the COVID-19 vaccine.
To my knowledge, the biologic agents used for treating ankylosing spondylitis do not affect the timing of vaccine administration.
2) Previously, my inflammatory markers were controlled at CRP 0.3 and ESR 14, but recently, while on the same medication, my levels have risen to CRP 0.9 and ESR 40.
Besides suspecting the COVID-19 vaccine as a cause, could this be due to my immune system becoming stronger (as I am getting older), leading to a more robust autoimmune response and making my inflammatory markers harder to control? --> Your situation is not related to an increase in immune strength or aging.
3) At what age does immune function peak for the general population? Is it possible that after reaching that age, my immune system gradually weakens, leading to a gradual reduction in ankylosing spondylitis symptoms? --> Immune function matures gradually and typically continues to develop and "learn" until around the age of ten, where it learns to distinguish between normal tissues and foreign pathogens.
Rheumatic diseases, including ankylosing spondylitis, are primarily due to dysregulation of the immune system, where the ability to recognize normal tissues and foreign pathogens is impaired, rather than being directly related to immune function being too strong or too weak.
It is possible that as immune function gradually weakens, the severity of some rheumatic diseases, including ankylosing spondylitis, may lessen.
Therefore, a small number of ankylosing spondylitis patients may experience symptom relief and the possibility of reducing or stopping medication as they age.
4) I would like to ask a conceptual question.
Ankylosing spondylitis is an autoimmune issue, and it is said to be caused by an overly strong autoimmune response (not sure if this is correct).
If I focus on maintaining my health (going to bed early, waking up early, eating more fruits and vegetables, etc.) and strengthen my body and immune system, could this potentially worsen my ankylosing spondylitis? --> Focusing on health can stabilize the immune system and generally helps in better controlling various immune diseases, so it should not worsen ankylosing spondylitis.
In fact, some medications, including traditional Chinese medicine, may enhance immune function, which could exacerbate uncontrolled immune responses and worsen rheumatic symptoms.
Therefore, when using medications, including traditional Chinese medicine, it is crucial to consult with experienced practitioners of both Western and traditional medicine for safety.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/02/16

More Info

Ankylosing Spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness. It is part of a group of diseases known as spondyloarthritis, which can also involve other joints and systems in the body. As a 19-year-old diagnosed with AS, your concerns regarding vaccination and the use of biologics are valid and important for your overall health management.

1. Vaccination and Biologics Timing: Generally, there are no strict regulations regarding the timing of COVID-19 vaccinations and the administration of biologics. However, it is often recommended to wait at least two weeks after receiving a vaccine before starting a biologic treatment. This waiting period allows your immune system to respond to the vaccine effectively without interference from the biologic medication. Conversely, if you are already on a biologic, it is advisable to consult your rheumatologist about the timing of any vaccinations, including COVID-19 vaccines, to ensure optimal immune response and safety.

2. Inflammatory Markers and Immune Response: The fluctuation in your inflammatory markers (CRP and ESR) can be influenced by various factors, including changes in your immune system as you age. It is possible that as you transition into adulthood, your immune response may change, potentially affecting the control of your AS. However, it is crucial to consider that other factors, such as stress, infections, or changes in your treatment regimen, can also contribute to increased inflammation. It is essential to discuss these changes with your healthcare provider to determine the best course of action.

3. Peak Immune Function and AS Symptoms: The immune system typically reaches its peak function in early adulthood, around the age of 20 to 30. After this peak, there is a gradual decline in immune function, which may lead to a reduction in autoimmune disease activity for some individuals. However, this is not universally applicable, as AS is a complex condition influenced by genetic, environmental, and lifestyle factors. Some patients may experience a decrease in symptoms as they age, while others may continue to have significant challenges.

4. Autoimmunity and Lifestyle Factors: AS is indeed characterized by an overactive immune response, where the body mistakenly attacks its own tissues. While maintaining a healthy lifestyle—such as eating a balanced diet rich in fruits and vegetables, exercising regularly, and getting adequate sleep—can support overall health and potentially improve your immune function, it is crucial to recognize that these factors may not directly correlate with the severity of AS. In some cases, an enhanced immune response may exacerbate autoimmune conditions. Therefore, it is essential to strike a balance and work closely with your healthcare provider to manage your AS effectively.

In conclusion, managing Ankylosing Spondylitis requires a comprehensive approach that includes medication, lifestyle modifications, and regular monitoring of your condition. It is vital to communicate openly with your rheumatologist about your concerns regarding vaccinations and biologics, as they can provide personalized recommendations based on your health status and treatment goals. Remember, each patient's experience with AS is unique, and ongoing adjustments to your treatment plan may be necessary to achieve optimal control of your symptoms.

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