Can Immune Modulators Like Salazopyrin Reduce Severe COVID-19 Risk?

Q: Can Immune Modulators Like Salazopyrin Reduce Severe COVID-19 Risk?

Hello, thank you for your inquiry. <br>Here are my responses： <br>1) From a theoretical standpoint, could it be that because I am taking Salazopyrin, I am less likely to develop moderate to severe symptoms after contracting COVID-19 compared to others of the same age and conditio

Does the immunomodulatory function of Salvia miltiorrhiza reduce the likelihood of developing moderate to severe symptoms after contracting COVID-19?

Hello Doctor, I have ankylosing spondylitis and I am currently 20 years old.
I am taking two Salazopyrin (500 mg each) and one Methotrexate daily as part of my stable treatment.
Recently, I have seen news reports mentioning that immunomodulators are used to treat moderate to severe COVID-19 patients, and since Salazopyrin is also an immunomodulator, I have a few questions:
1) From a theoretical standpoint, does taking Salazopyrin mean that I am less likely to develop moderate to severe COVID-19 compared to others my age who are not taking it?
2) My ankylosing spondylitis is currently stable (ASAS score of 1.6, CRP of 0.5 mg/dl, average sacroiliac joint pain of 1.5 months with mild pain for 2-3 days; I only experience pain in the sacroiliac joint, with no pain in other joints, no iritis, and no morning stiffness).
However, my ESR levels fluctuate between 13 and 36 mm/hr.
Given that everything else is well-controlled, should I be concerned about the ESR reaching as high as 36?
3) The ASAS assessment includes CRP values but does not include ESR values.
Does this mean that monitoring ankylosing spondylitis primarily relies on CRP, while ESR is relatively less important?
4) Given that I am on long-term medication, is there a risk of kidney or liver damage? Should I consider taking any dietary supplements? Thank you, Doctor.

En, 20~29 year old female. Ask Date: 2022/05/15

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
Here are my responses:
1) From a theoretical standpoint, could it be that because I am taking Salazopyrin, I am less likely to develop moderate to severe symptoms after contracting COVID-19 compared to others of the same age and condition who are not taking Salazopyrin? --> Currently, the evidence is insufficient, so there is no definitive answer.
It is advisable to remain cautious in daily life.
2) My ankylosing spondylitis is currently under stable treatment (ASAS score of 1.6, CRP 0.5 mg/dL, average sacroiliac joint pain of 1.5 months with mild pain for 2-3 days [I only experience pain in the sacroiliac joint, with no pain in other joints, no iritis, and no morning stiffness]), and three months ago, the X-ray indicated that my sacroiliitis is between stages 1 and 2.
However, my ESR is relatively unstable, fluctuating between 13 and 36 mm/hr.
I would like to ask the doctor, since everything else is well-controlled, should I be concerned about the ESR occasionally reaching 36? --> There are multiple factors that can affect ESR, and it is an indirect indicator of inflammation.
Therefore, if the ESR is elevated only in a single test and there are no worsening clinical symptoms, I might suggest monitoring it and reassessing with the next results.
3) The ASAS assessment includes the value of CRP but does not include the value of ESR.
Does this mean that the follow-up of ankylosing spondylitis is primarily based on CRP, while ESR is relatively less important? --> Not necessarily.
Both have their reference values.
The ASAS assessment simply includes CRP.
4) Given that I have been on long-term medication, is there a risk of kidney or liver damage, and should I take any dietary supplements? --> A normal diet is sufficient.
The Department of Allergy, Immunology, and Rheumatology at Changhua Hospital, Ministry of Health and Welfare, is concerned about your health.

Reply Date: 2022/05/15

More Info

When considering the use of immune modulators like Salazopyrin (sulfasalazine) in the context of COVID-19, it is essential to understand both the therapeutic effects of these medications and their potential implications for viral infections.
1. Impact of Salazopyrin on COVID-19 Severity: Salazopyrin is primarily used to treat inflammatory conditions such as ankylosing spondylitis (AS) by modulating the immune response and reducing inflammation. While some studies suggest that certain immune modulators may have a role in managing severe COVID-19 cases, the evidence is not definitive regarding whether taking Salazopyrin would reduce the risk of developing severe COVID-19 in patients with AS. In fact, individuals with autoimmune conditions who are on immunosuppressive therapies may have a higher risk of severe outcomes from COVID-19 due to their underlying disease and the effects of the medication on the immune system. Therefore, while Salazopyrin may help manage your AS, it does not guarantee protection against severe COVID-19.

2. Monitoring ESR Levels: Your ESR (erythrocyte sedimentation rate) levels fluctuating between 13 to 36 mm/hr can be indicative of underlying inflammation. In ankylosing spondylitis, it is common for ESR levels to vary, and while a higher ESR may suggest active inflammation, it is essential to interpret these results in conjunction with clinical symptoms and other laboratory findings. If your AS is stable and you are not experiencing significant symptoms, occasional elevations in ESR may not require immediate intervention. However, it is advisable to discuss these fluctuations with your healthcare provider to determine if any adjustments to your treatment plan are necessary.

3. CRP vs. ESR in AS Monitoring: The ASAS (Ankylosing Spondylitis Assessment Score) primarily incorporates CRP (C-reactive protein) as a marker of inflammation because it is more sensitive to changes in disease activity compared to ESR. While both markers can indicate inflammation, CRP tends to respond more quickly to changes in disease status. Therefore, in the context of monitoring ankylosing spondylitis, CRP is often prioritized over ESR.

4. Long-term Use of Salazopyrin and Organ Health: Long-term use of Salazopyrin can have implications for kidney and liver health, although it is generally considered safe when monitored appropriately. Regular blood tests to assess liver function and kidney health are recommended for patients on this medication. As for dietary supplements, it is crucial to consult with your healthcare provider before starting any new supplements, as some may interact with your medications or affect your health condition. Maintaining a balanced diet, staying hydrated, and possibly incorporating omega-3 fatty acids or antioxidants may support overall health, but these should be personalized based on your specific health needs and in consultation with your doctor.

In summary, while Salazopyrin is an effective treatment for managing ankylosing spondylitis, its role in influencing COVID-19 severity is not clear-cut. Regular monitoring of inflammatory markers like CRP and ESR, along with routine assessments of liver and kidney function, is essential for managing your health effectively. Always discuss any concerns or changes in your treatment plan with your healthcare provider to ensure the best outcomes for your condition.

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