Is Ankylosing Spondylitis a Severe Risk Factor for COVID-19?

Q: Is Ankylosing Spondylitis a Severe Risk Factor for COVID-19?

Hello, thank you for your question. <br>Here are my responses：<br>1) There are many risk factors for severe COVID-19, one of which is "diseases affecting immune function (HIV infection, congenital immunodeficiency, solid organ or hematopoietic stem cell transplantation, use of st

Is ankylosing spondylitis a risk factor for severe disease?

Hello Doctor, my son is 19 years old and has ankylosing spondylitis.
I have some questions to ask you.

1) There are many risk factors for severe COVID-19, one of which is "diseases affecting immune function (such as HIV infection, congenital immunodeficiency, solid organ or hematopoietic stem cell transplantation, and the use of steroids or other immunosuppressants)." I noticed that autoimmune diseases like rheumatoid arthritis or ankylosing spondylitis are not mentioned in the parentheses.
Could you please clarify whether rheumatoid arthritis and ankylosing spondylitis are considered "diseases affecting immune function" in terms of severe risk factors?
2) If ankylosing spondylitis is not a severe risk factor, I am a bit worried because this morning my son was diagnosed with COVID-19 at an ENT clinic.
The doctor said that according to regulations, he needs to be prescribed the antiviral medication Paxlovid.
I was concerned that if he took the antiviral medication, he would not be able to receive Traditional Chinese Medicine treatment with Qingguan No.
1, so I told the doctor I would consider it and might return for a follow-up tomorrow.
I would like to ask if it is really necessary for a patient with ankylosing spondylitis to take antiviral medication?
3) If he takes the antiviral medication Paxlovid, does he need to stop taking Salazopyrin, which he is currently taking daily? If so, for how long should he stop?
4) If he does not take antiviral medication, what other treatment recommendations do you have to prevent moderate to severe illness for a patient with ankylosing spondylitis who has tested positive for COVID-19, aside from taking general medications similar to those for a cold? Note: My son has received two doses of the BNT vaccine, currently takes two Salazopyrin daily for maintenance, with CRP levels below 0.4 mg/dL, and ESR occasionally reaching 40-50.
His ankylosing symptoms are currently very mild.
Thank you, Doctor.

Hao, 50~59 year old female. Ask Date: 2022/10/04

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1) There are many risk factors for severe COVID-19, one of which is "diseases affecting immune function (HIV infection, congenital immunodeficiency, solid organ or hematopoietic stem cell transplantation, use of steroids or other immunosuppressants)." I noticed that autoimmune diseases like rheumatoid arthritis or ankylosing spondylitis were not mentioned in the parentheses.
I would like to ask the doctor if rheumatoid arthritis and ankylosing spondylitis are considered "diseases affecting immune function" in the context of severe risk factors? --> Since Salazopyrin is an immunosuppressant, ankylosing spondylitis can indeed be classified as a "disease affecting immune function."
2) If ankylosing spondylitis is not a severe risk factor, I am a bit worried because this morning my son was diagnosed with COVID-19 by an ENT clinic, and the doctor said that according to regulations, antiviral medication Paxlovid must be prescribed.
I was concerned that if I started the antiviral medication, I wouldn't be able to ask my traditional Chinese medicine doctor for Qingguan No.
1, so I told the physician that I would consider it and might return for a follow-up tomorrow.
I would like to ask the doctor if it is really necessary to prescribe antiviral medication for someone with ankylosing spondylitis? (I am worried that young people who are initially diagnosed with mild cases might experience adverse effects from taking such strong medication.) --> In terms of effectiveness in clearing the virus, I personally believe that Paxlovid may be more effective.
For individuals with immune system diseases, antiviral medication is recommended.
The side effects of Paxlovid are actually quite rare, so there should be no need for concern.
3) If I take the antiviral medication Paxlovid, should I stop taking Salazopyrin, which I normally take daily? How long should I stop? --> You can stop taking it during the period you are on Paxlovid.
4) If I do not take antiviral medication, what other treatment recommendations does the doctor have to avoid moderate to severe illness for a patient with ankylosing spondylitis who has been diagnosed with COVID-19, aside from taking general cold-like medications? --> Currently, there are no other specific recommendations.
However, the virus can usually be cleared by the body's immune system on its own.
It is advised to drink plenty of water to support immune function, get ample rest, avoid rushing into exercise, and refrain from staying up late binge-watching shows; typically, this can lead to a quick improvement.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/10/04

More Info

Ankylosing Spondylitis (AS) is a type of inflammatory arthritis that primarily affects the spine, leading to severe, chronic pain and discomfort. It is classified as a type of autoimmune disease, which means that the immune system mistakenly attacks the body's own tissues. Given the context of COVID-19, it is important to understand how AS may influence the risk of severe outcomes from the virus.

1. Is Ankylosing Spondylitis a Severe Risk Factor for COVID-19?
Individuals with autoimmune diseases, including Ankylosing Spondylitis, may be at an increased risk for severe COVID-19 outcomes. This is primarily due to the immunosuppressive treatments often used to manage these conditions, such as corticosteroids and other immunomodulatory drugs. While AS itself does not inherently compromise the immune system like HIV or congenital immunodeficiencies, the medications used to treat it can lead to a weakened immune response. Therefore, patients with AS who are on immunosuppressive therapy may be categorized under the broader umbrella of individuals with "immune-compromising conditions," which is a recognized risk factor for severe COVID-19.

2. Treatment Considerations for COVID-19 in AS Patients:
If your son has been diagnosed with COVID-19, the recommendation for antiviral treatment, such as Paxlovid, is generally based on the presence of risk factors for severe disease. Given that he has Ankylosing Spondylitis and is on Salazine (an immunomodulatory medication), it would be prudent to follow the advice of healthcare professionals regarding antiviral treatment. Paxlovid is effective in reducing the viral load and the risk of progression to severe disease, especially in patients with underlying conditions. Concerns about side effects are valid, but the benefits of reducing the risk of severe COVID-19 typically outweigh the potential risks of the medication.

3. Interaction with Salazine:
If your son is prescribed Paxlovid, it is generally recommended to pause the use of Salazine during the course of the antiviral treatment. This is to avoid any potential interactions and to ensure that the antiviral medication can work effectively. The duration for which Salazine should be paused can vary, but it is typically safe to resume it after completing the course of Paxlovid. It is crucial to discuss this with the prescribing physician to get tailored advice.

4. Alternative Management Strategies:
If your son opts not to take antiviral medication, it is essential to monitor his symptoms closely. While many individuals with mild COVID-19 recover without specific antiviral treatment, those with underlying conditions should take extra precautions. Recommendations include staying well-hydrated, getting plenty of rest, and managing symptoms with over-the-counter medications as needed. It is also advisable to maintain regular communication with healthcare providers to monitor any changes in symptoms and to seek medical attention if his condition worsens.

In conclusion, while Ankylosing Spondylitis itself may not be explicitly listed as a severe risk factor for COVID-19, the treatments associated with it can place patients at higher risk. It is essential to follow medical advice regarding antiviral treatment and to monitor health closely during COVID-19 infection. The interplay between autoimmune conditions and viral infections is complex, and individualized care is crucial for optimal outcomes.

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