Long COVID Management Tips for Patients with Ankylosing Spondylitis

Q: Long COVID Management Tips for Patients with Ankylosing Spondylitis

Hello, thank you for your inquiry. <br>Here are my responses：<br>1. <br>Is the slower recovery from long COVID possibly related to ankylosing spondylitis? How long does it take to fully recover? --> Long COVID can be monitored for three months; after three months, most symptoms s

Considerations for Long COVID Treatment in Patients with Ankylosing Spondylitis

Hello Doctor: My son, who is 20 years old, has a history of ankylosing spondylitis.
He tested positive for COVID-19 in early October 2022, experiencing mild symptoms (low-grade fever for 1-2 days, muscle aches for 1-2 days, and a slight cough for several days).
He tested negative approximately 11 days later, but it has been over six months, and he still has a slight cough (dry, without phlegm) that feels like clearing his throat.
After his COVID-19 diagnosis in early October 2022, he stopped taking his usual medication, Salazopyrin (2 tablets daily) for two weeks.
He resumed taking Salazopyrin (2 tablets daily) from mid-October to mid-December 2022.
From mid-December 2022 to April 2023, he continued with Salazopyrin (2 tablets daily) and added Mesalazine (1 or 2 tablets daily).
I would like to ask the doctor: 1.
Could his ankylosing spondylitis be related to his slower recovery from long COVID? How long might it take for him to fully recover? 2.
In May 2022, the director of the hospital, Dr.
Wei Zheng, tested positive for COVID-19 and mentioned that Mesalazine has anti-inflammatory effects for sore throat.
My son has been taking Mesalazine (1 or 2 tablets) for 3-4 months due to his ankylosing spondylitis, so why does he still have a slight cough (dry, without phlegm)? Is it related to his ankylosing spondylitis? 3.
Given his ankylosing spondylitis, are there any special considerations to keep in mind when visiting a long COVID clinic (e.g., regarding medication)? 4.
Given his ankylosing spondylitis, are there any special considerations to keep in mind when visiting a traditional Chinese medicine clinic (e.g., regarding medication)? Thank you for your assistance, Doctor!

Xiao Zheng, 50~59 year old female. Ask Date: 2023/04/21

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
Here are my responses:
1.
Is the slower recovery from long COVID possibly related to ankylosing spondylitis? How long does it take to fully recover? --> Long COVID can be monitored for three months; after three months, most symptoms should gradually subside.
2.
In May 2022, Dr.
Wei Zheng, the director of the Zhenxing Hospital, was diagnosed with COVID-19 and mentioned that Celecoxib has anti-inflammatory effects for sore throat.
My son has been taking one (or two) Celecoxib capsules for 3-4 months due to ankylosing spondylitis, yet he still has a slight throat-clearing cough (dry cough) symptom.
Is this related to ankylosing spondylitis? --> The throat-clearing symptom is likely unrelated to ankylosing spondylitis and is more associated with residual symptoms following COVID-19.
3.
Given the presence of ankylosing spondylitis, are there any special considerations when visiting a long COVID clinic (such as medication)? --> Celecoxib is very safe, and I believe it can be used in conjunction with long COVID treatment.
4.
Given the presence of ankylosing spondylitis, are there any special considerations when visiting a traditional Chinese medicine clinic (such as medication)? --> Currently, there is no consensus on how to combine Western and traditional Chinese medicine.
It is recommended to space the use of both by more than one hour.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2023/04/21

More Info

Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), can present unique challenges for individuals with pre-existing conditions such as ankylosing spondylitis (AS). Here are some management tips and insights regarding your concerns:
1. Connection Between Ankylosing Spondylitis and Long COVID Recovery: It is possible that having ankylosing spondylitis may influence the recovery timeline from Long COVID. Chronic inflammatory conditions can affect the immune response, potentially leading to prolonged symptoms. However, the exact relationship between AS and Long COVID is still being researched. Recovery times can vary significantly from person to person, and while some individuals may recover within weeks, others may experience lingering symptoms for months. It is essential to maintain regular follow-ups with your healthcare provider to monitor progress and adjust treatment as necessary.

2. Persistent Cough and Its Relation to Ankylosing Spondylitis: The persistent cough you mentioned, which is dry and without phlegm, may not directly be related to ankylosing spondylitis. It could be a residual effect of the COVID-19 infection, as some individuals experience prolonged respiratory symptoms even after the acute phase of the illness has resolved. The use of medications like Celebrex (celecoxib) may help manage inflammation associated with AS but may not directly alleviate respiratory symptoms. If the cough persists, it may be beneficial to consult a pulmonologist to rule out other causes, such as post-viral bronchial hyperreactivity or other respiratory conditions.

3. Considerations for Long COVID Clinics: When visiting a Long COVID clinic, it is crucial to inform the healthcare providers about your son's ankylosing spondylitis and the medications he is taking. This information will help them tailor their approach to his treatment. They may consider the potential interactions between his AS medications and any new treatments they might recommend for Long COVID symptoms. It is also essential to discuss any new symptoms that arise, as they may require a different management strategy.

4. Consulting Traditional Chinese Medicine (TCM): If considering TCM for managing symptoms related to both ankylosing spondylitis and Long COVID, it is important to communicate with the practitioner about all medications currently being taken. Some herbal remedies may interact with conventional medications, so it is vital to ensure that any TCM treatments are safe and appropriate. Additionally, practitioners may have specific recommendations based on the individual's overall health status and symptoms.

In summary, managing Long COVID in the context of ankylosing spondylitis requires a comprehensive approach that considers both conditions. Regular communication with healthcare providers, whether they are conventional or alternative practitioners, is essential for optimizing treatment and addressing any new or persistent symptoms. Encourage your son to maintain a healthy lifestyle, including a balanced diet, regular physical activity (as tolerated), and adequate rest, which can support overall recovery and well-being.

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