Does having axial spondyloarthritis or spondylitis make me more susceptible to contracting the novel coronavirus (COVID-19)? Is it safe to keep taking my spondylitis medicines if they suppress my immune system? These are some of the questions members of MySpondylitisTeam have been asking amidst the COVID-19 pandemic.

We reached out to Dr. Siddarth Tambar, a rheumatologist and leader of Chicago Arthritis and Regenerative Medicine, to ask what people with spondylitis need to know in the era of COVID-19.

This article addresses:

• Whether people with spondylitis are at increased risk for COVID-19.
• The importance of keeping spondylitis symptoms under control during this pandemic.
• The impact of spondylitis medications on the risk of contracting COVID-19.
• Tips for managing your spondylitis and your health.

Does Spondylitis Raise My Risk of COVID-19?

In a March 27, 2020 interview with MySpondylitisTeam, Dr. Siddharth Tambar talked about the risks of COVID-19 for people facing spondylitis. Dr. Tambar explained:

1. If you have spondylitis and are treating it with medications, you may be at higher risk for infection generally. This is the case for many people with rheumatological and autoimmune conditions. People with spondylitis should take extra precautions to avoid contact with people who might have COVID-19.
2. The benefits of keeping your spondylitis symptoms under control with medication likely outweigh the potential added risk of infection. If your spondylitis is flaring, it can mean even greater risks to you.

“The nature of any sort of chronic active condition is that it makes you more susceptible to any other kind of infectious issue,” Dr. Tambar said. “From the standpoint of having worse outcomes, however, if a condition is under control, we think that the risk [of contracting COVID-19] is really the same as the general population.”

Do My Spondylitis Medications Put Me at Greater Risk for COVID-19?

People with spondylitis tend to take a few different categories of medications. Common treatments for spondylitis include:

• Corticosteroids, such as Prednisone.
• Traditional disease-modifying antirheumatic drugs (DMARDs), such as Methotrexate.
• Biologic disease-modifying antirheumatic drugs (DMARDs), such as Humira (Adalimubab) or Enbrel (Etanercept).
• Nonsteroidal anti-inflammatory drugs (NSAIDs).

Dr. Tambar advises continuing to take your medications if you can and if your doctor feels that is the right strategy for you. He noted, “While there's a little bit higher risk being on the medication, the benefits are that your immune system is under control.” That is preferable to “having a ragingly active condition, which on its own puts you at higher risk for infections.”

Corticosteroids and COVID-19

Keeping your spondylitis under control with medications may help you avoid having to take corticosteroids. According to Dr. Tambar, corticosteroids may be problematic for people with spondylitis. “Steroids, at a high dose for a prolonged period of time, put you at risk for a dramatically higher risk for infections than just the meds that we're using routinely for these autoimmune conditions,” he said.

The American College of Rheumatology reminds people with spondylitis to talk to their rheumatologist or a rheumatology professional prior to discontinuing any of their medications. Certain drugs, such as steroids, that have been used on a long-term basis, cannot just be stopped. People have to slowly taper off of them, and this process requires their doctor’s medical input. In an article in Creaky Joints, Dr. Nilanjana Bose warned, “Prednisone at higher doses [20 milligrams or more] can be severely immunosuppressive but they cannot be tapered off fast.”

Again, it’s important to speak with your doctor about what, if any, changes you should make.

DMARDs and COVID-19

Disease-modifying antirheumatic drugs (DMARDs) have risks of infection associated with them. However, when evaluating the risk of COVID-19, Dr. Tambar believes that an individual’s overall health matters more than the infection risk of taking a DMARD. He recommends people with spondylitis consider these questions:

• Is your spondylitis under control? (If not, work with your doctor to use medications to bring your symptoms under control.)
• What are your other risk factors?
• Is your doctor able to minimize any steroids you are taking?
• Are you taking the right precautions?
• Are you being monitored safely?

Dr. John Reveille, in an interview with the Spondylitis Association of America, reminded people with spondylitis that biologics have different risks for varying infections. He went on to say that unless you are in a high-risk category because of age or other chronic health condition, you should not stop medication without talking to your doctor.

NSAIDs and COVID-19

NSAIDs are the most common medications doctors use to treat spondylitis. Rumors have circulated that people with COVID-19 should not take Ibuprofen, a nonsteroidal anti-inflammatory drug. Both the World Health Organization and the European Medicines Agency have debunked this myth.

Dr. Tambar cautioned that people with spondylitis should consult their primary care physician or rheumatologist, as always, before making any changes or starting any new medications.

Is It Safe to Go to an Infusion Center?

People with spondylitis may need to consider whether they have to leave home to receive medications. Some treatments, such as Remicade (Infliximab), Inflectra (Infliximab-dyyb), or Simponi-Aria (Golimumab), may be given intravenously at a clinic. If that is the case for you, it is important to check with your doctor to see if there are other options available or if you should adjust the timing of your appointments. Take precautions in advance of any upcoming appointments, including monitoring your own health, considering how you will physically get to your appointment (your own car or public transportation), and practicing social distance by leaving space between yourself and others at a clinic.

Dr. Tambar mentioned some of the best practices in his own clinic, including minimizing routine in-person follow-up appointments, rotating staff so they are not working in the clinic for as long, and staggering appointments so they are not filling the entire infusion room. Consider calling your infusion center in advance of your appointment and asking what practices they are putting in place to minimize risk of exposure to COVID-19.

Tips for Managing Your Health During the COVID-19 Outbreak

The U.S. Centers for Disease Control and Prevention (CDC) recommended individuals in high-risk groups avoid attending public events. The advice from the CDC is changing on a daily basis. You can find the latest updates and guidance from the CDC about COVID-19 here.

In general, if you have a fever or you are unsure if you’re experiencing symptoms of COVID-19 — or if you have any questions about how you are feeling — make sure you reach out via telephone or online portal to your health care provider. Also, Medicare is now covering telehealth services to treat COVID-19 (and "other medically reasonable purposes").

In addition to safety measures to protect one’s health, people with spondylitis may want to develop a contingency plan in case they are unable to leave their home. Steps to consider include:

• Contacting your health care provider or health insurance company about obtaining an extra supply of necessary medications.
• Setting up a mail-order service for medication, if available.
• Stocking up on over-the-counter medications to treat fever, cough, and cold symptoms — as well as necessities such as tissues.
• Ordering groceries or supplies through Amazon or another delivery service to minimize public contact.
• Having enough household items and groceries on hand to be prepared to stay at home for an extended period of time.
• If you have people who come in to help, such as a relative or home health aide, making sure they are washing their hands properly and asking what steps they are taking to avoid contracting COVID-19.
• Making a plan to reach out to friends or loved ones by phone or video chat to minimize feelings of isolation. As always, MySpondylitisTeam offers a support group of nearly 78,000 other people facing the same conditions as you, always available online.

Members of MySpondylitisTeam are talking about COVID-19. Join the conversation:

• I Was Exposed to Coronavirus and Now I Am in Quarantine
• I’m an ICU Nurse and on Humira. Getting COVID-19 Feels Almost Inevitable.
• I Can’t Get Ablations Done Because of COVID-19

How are you getting through this trying time? Do you have questions or recommendations on how to prepare? Post your thoughts or questions below.