What do COVID-19 and spondyloarthritis have in common? One answer is that they both involve the immune system. Whether you develop COVID-19, and how severe that infection is, depend on your body’s immune response. And, of course, spondyloarthritis is a group of diseases in which the immune system attacks the spine and sometimes tendons, other joints, eyes, and intestines. Common treatments for spondyloarthritis include medications like biologics (for example, Enbrel or Humira), NSAIDs (non-steroidal anti-inflammatory drugs like Advil or Aleve), and other choices that usually target inflammation or the immune system. So, patients and medical providers need to know if these medications might be harmful by increasing the risk of contracting COVID-19 or the risk of developing life-threatening COVID-19.
To address these questions, we worked to design a study, and the SAA and ASIF (Axial Spondyloarthritis International Federation) reached out to their members. More than 3,000 people participated in a web-based survey, which is still ongoing. The bottom line: the survey found no evidence that biologics like TNF or IL-17 inhibitors, NSAIDs, or medications like methotrexate increased the risk of contracting COVID-19 or the risk of developing more severe COVID-19. This is of course reassuring information for both patients and for those who provide medical care.
There are some limits to this study. A survey might attract a pool of respondents who are not truly representative. Although we surveyed more than 3,000 people with spondyloarthritis, not very many had confirmed COVID-19. It’s also important to think of the infection as having at least two phases: an early phase when symptoms are often not apparent and, in some, a late phase when the immune system can be overactive and the disease can be life threatening. Several of the medications used to suppress the immune system in treating immune-mediated diseases such as spondyloarthritis are currently being studied as potential treatments for the life-threatening phase of COVID-19. We had only a small number of survey respondents with COVID-19 and an even smaller number who needed hospitalization.
Even with these limits, the survey is important and reassuring. SAA is proud to share this study with our community, and we deeply thank all those who have participated so far, making it possible to obtain these data. This would not have been possible without you!
The full study, “Biologics, spondylitis and COVID-19,” which was published recently in the Annals of the Rheumatic Diseases (generally considered the top rheumatology journal), is available here: https://ard.bmj.com/content/annrheumdis/early/2020/06/09/annrheumdis-2020-217941.full.pdf
My personal thanks to everyone who has contributed to this important research so far! As this is a longitudinal survey, we hope you’ll be kind enough to keep participating in the brief follow-ups. We will keep sharing what we learn with you.
If you haven’t taken part yet, but would like to, you can start here: https://spondylitis.org/research-new/covid-19-and-spondyloarthritis-survey/ Everyone’s experience is important, and we want to hear from you!