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

Is ankylosing spondylitis a risk factor for severe illness? Additional question?

Hello Doctor, I apologize for the follow-up question regarding the issue I asked yesterday (#187270).
I would like to ask you: My child has been taking 2 tablets of Salbutamol daily for the past six months.
Since he takes Salbutamol every day, does this mean he falls under the COVID-19 severe risk factor of "conditions affecting immune function (such as HIV infection, congenital immunodeficiency, solid organ or hematopoietic stem cell transplantation, or the use of steroids or other immunosuppressants)"? Thank you, Doctor.

Hao, 50~59 year old female. Ask Date: 2022/10/05

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Broadly speaking, I believe it is.
In a narrower sense, having a smaller quantity of two can also be considered as not being so.
I tend to lean towards the broader definition.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, cares about you.

Reply Date: 2022/10/05

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. It is classified as a type of autoimmune disease, which means that the immune system mistakenly attacks the body's own tissues. In the context of COVID-19, individuals with autoimmune diseases, including AS, may be considered at higher risk for severe outcomes due to the potential impact on their immune system.

1. Risk Factor for Severe COVID-19: While Ankylosing Spondylitis itself is not explicitly listed as a severe risk factor for COVID-19, the medications used to manage AS can influence this classification. For instance, Salazopyrine (Salsalate), which your child is taking, is an immunomodulatory drug. Immunosuppressive medications can weaken the immune response, making individuals more susceptible to infections, including COVID-19. Therefore, patients with AS who are on such medications may fall under the category of individuals with "immunocompromising conditions," which is a recognized risk factor for severe COVID-19.

2. Treatment Considerations: If your child has tested positive for COVID-19, the recommendation to initiate antiviral treatment, such as Paxlovid, is generally based on the presence of risk factors that could lead to severe disease. Given that your child is on Salazopyrine, it is advisable to follow the healthcare provider's recommendations regarding antiviral treatment. Paxlovid has been shown to reduce the risk of hospitalization and severe outcomes in high-risk patients. The potential benefits of taking Paxlovid in this context likely outweigh the risks, especially since the drug is generally well-tolerated.

3. Concurrent Medications: When it comes to taking Paxlovid alongside Salazopyrine, it is essential to consult with the prescribing physician. Generally, Paxlovid can be taken while on Salazopyrine, but the healthcare provider may recommend temporarily discontinuing Salazopyrine during the course of Paxlovid treatment to minimize any potential drug interactions. The duration of discontinuation should be determined by the healthcare provider based on your child's specific health needs.

4. Alternative Treatments: If your child chooses not to take antiviral medication, it is crucial to monitor symptoms closely. For patients with AS who contract COVID-19, supportive care is vital. This includes staying hydrated, resting, and managing symptoms with over-the-counter medications as needed. It is also important to maintain communication with healthcare providers to ensure that any worsening symptoms are addressed promptly.

5. Vaccination and Immune Response: Vaccination remains a critical tool in reducing the risk of severe COVID-19. While there may be concerns about the impact of vaccines on autoimmune conditions, the benefits of vaccination in preventing severe illness generally outweigh the risks. It is advisable for individuals with AS to discuss vaccination options with their rheumatologist, especially if they have experienced exacerbations of their condition post-vaccination.

In summary, while Ankylosing Spondylitis itself may not be explicitly listed as a severe risk factor for COVID-19, the immunosuppressive nature of the medications used to treat it can place individuals at higher risk. It is essential to follow medical advice regarding antiviral treatments and to maintain open communication with healthcare providers to ensure the best possible outcomes for your child's health.

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