Does Ankylosing Spondylitis Increase Severe COVID-19 Risk?

Do patients with ankylosing spondylitis have a higher risk of developing severe COVID-19?

Hello doctor, may I ask if patients with ankylosing spondylitis are more likely to develop moderate to severe symptoms after contracting COVID-19? Thank you, doctor.

Ting, 20~29 year old female. Ask Date: 2022/04/18

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Whether patients with rheumatic diseases develop severe illness after infection is related to their overall health status at the time of infection.
Factors such as whether the rheumatic disease is well-controlled, the current condition of the disease (for example, whether ankylosing spondylitis has caused spinal fusion leading to thoracic deformity or kyphosis), the presence of other comorbidities (such as hypertension, diabetes, heart disease, etc.), medication status, and the type of virus involved are all relevant.
Patients with unstable conditions and comorbidities are at higher risk.
However, if the condition is well-controlled, with regular exercise and minimal or no joint fusion, the risk is similar to that of the general population, and there is no need for excessive concern.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, cares about your health.

Reply Date: 2022/04/18

More Info

Ankylosing Spondylitis (AS) is a type of inflammatory arthritis that primarily affects the spine and can lead to severe, chronic pain and discomfort. Patients with AS often take immunosuppressive medications, which can impact their immune response. When it comes to COVID-19, there are several factors to consider regarding the risk of severe illness in individuals with AS.

Firstly, individuals with Ankylosing Spondylitis may have a higher risk of severe COVID-19 due to the nature of their condition and the treatments they receive. Immunosuppressive medications, such as those used to manage AS, can weaken the immune system's ability to fight off infections, including viral infections like COVID-19. This means that if a person with AS contracts COVID-19, their body may not respond as effectively as someone with a fully functioning immune system, potentially leading to more severe symptoms or complications.

Moreover, the underlying inflammation associated with AS can also play a role. Chronic inflammation can affect various body systems, including the respiratory system, which is particularly relevant given that COVID-19 primarily affects the lungs. Patients with AS may already have compromised lung function due to their condition, which could exacerbate the effects of COVID-19.

However, it is essential to note that not all individuals with AS will experience severe COVID-19. The severity of the disease can vary widely among individuals, influenced by factors such as age, overall health, comorbidities, and the specific medications being taken. For instance, some studies suggest that certain biologic therapies used to treat AS may not significantly increase the risk of severe COVID-19, while others might.

Vaccination is a critical tool in mitigating the risk of severe illness from COVID-19. The American College of Rheumatology (ACR) recommends that patients with rheumatic diseases, including those with AS, receive COVID-19 vaccinations. Vaccination can help bolster the immune response and reduce the likelihood of severe illness, even in individuals who are on immunosuppressive therapy.

In summary, while individuals with Ankylosing Spondylitis may have an increased risk of severe COVID-19 due to their condition and treatment, this risk can be managed through vaccination and careful monitoring of health. It is crucial for patients with AS to discuss their individual risk factors with their healthcare provider, who can provide personalized advice on managing their condition and protecting themselves against COVID-19. Regular follow-ups and adherence to treatment plans are also essential in maintaining overall health and reducing the risk of complications from infections.

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