Ankylosing spondylitis (AS) is a form of autoimmune arthritis. Some people with the condition take medications that suppress their immune system to reduce symptoms. However, this increases their risk of developing infectious illnesses, such as COVID-19.

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For this reason, it is important that individuals who take immunosuppressant medications get the COVID-19 vaccine as soon as possible and stay up to date with booster doses. Some may also be eligible for medications, such as Evusheld, that reduce the chance of developing COVID-19.

Read on to learn more about AS and the COVID-19 vaccine, including how and when a person should get the vaccine, whether it affects AS symptoms, and the potential risks.

A person wearing nitrile gloves preparing a COVID-19 vaccine for someone with ankylosing spondylitis.Share on Pinterest

Yes, most individuals with AS can have the COVID-19 vaccine.

This vaccine is safe for most people, including those with various chronic conditions. However, some may wish to consult a doctor before having it. Healthcare professionals may suggest adjusting doses or timing of the doses according to the person’s condition and medical history.

A small number of people should not get the COVID-19 vaccine. The Centers for Disease Control and Prevention (CDC) state that a person should not receive it if they have had an allergic reaction to any ingredient in previous doses.

Additionally, if someone has ever had an immediate allergic reaction to a previous vaccine or injection, they should ask their doctor if it is safe to get the COVID-19 vaccine. This applies even if the allergic reaction was not severe.

If a person cannot get one type of COVID-19 vaccine because they are allergic to any of its ingredients, they can ask their doctor about getting a different type.

It is important for anyone with a chronic condition, particularly autoimmune conditions, to get the COVID-19 vaccine.

Some people with AS take medications that suppress their immune system. This can increase their risk of contracting SARS-CoV-2, the virus that causes COVID-19. It is especially important for individuals in this group to get the vaccine to prevent severe illness.

AS medications that can suppress a person’s immune system include:

  • Disease-modifying antirheumatic drugs (DMARDs): DMARDs are a type of medication that people use to treat several types of inflammatory arthritis, including AS. Individuals with AS symptoms in various joints around the body may take the DMARD sulfasalazine. However, if a person has AS that only affects the spine, they will most likely not need standard DMARDs.
  • Biologics: Biologics are a type of DMARD. A person may self-inject these medications or receive them via infusion at the doctor’s office. The most effective biologics for AS are tumor necrosis factor inhibitors and interleukin inhibitors.
  • Corticosteroids:These are powerful anti-inflammatory drugs that can provide quick pain relief. Doctors typically only use corticosteroids as a short-term treatment for those with AS, as long-term use can cause serious side effects.

Few studies have examined whether people with AS who do not take immunosuppressant medications are also at an increased risk of severe COVID-19 compared with the rest of the population. Scientists do not know for sure if this group is also vulnerable.

However, even if a person who has AS does not take these medications, it is still beneficial for them to get the vaccine. This is especially true if they have other risk factors that make severe COVID-19 more likely, such as:

  • older age
  • smoking
  • obesity
  • diabetes
  • high blood pressure
  • lung conditions, such as asthma
  • chronic kidney or liver disease
  • heart conditions
  • substance misuse

People with AS who are taking immunosuppressant medication may have a weaker response to the vaccine than those who do not.

The COVID-19 vaccine works by teaching cells in the body to make a specific protein. This protein then triggers a response from the immune system, allowing it to effectively fight a SARS-CoV-2 infection. But if a person’s immune system is not as active as it would usually be, this may not work as well as it would otherwise.

A 2021 study tested this by administering the COVID-19 vaccine to 133 participants with chronic inflammatory diseases (CID) and 53 controls with no chronic disease. Almost all participants developed antibodies in response to the vaccine.

However, the study showed that people with CID who were taking immunosuppressive medications had a lower antibody response than the control group. This study also does not account for the new SARS-CoV-2 variants that have evolved since 2021 and may evade vaccine protection more effectively.

Despite this, it is still important to get the vaccine. As the study showed, the vaccine still encourages the body to create antibodies that can help fight SARS-CoV-2. Without it, people taking immunosuppressive medication may have a higher chance of developing severe illness.

If a person has AS and is not taking immunosuppressive medications, they can follow the standard vaccination schedule. For most people, this involves getting two initial doses and then a booster.

However, if an individual is taking immunosuppressive medications, the CDC considers them to be immunocompromised. This means that, if they are 12 years old or over, they can get a total of five COVID-19 vaccine doses.

Below are the CDC’s recommended vaccine schedules for immunocompromised people, according to the type of vaccine they receive.

Pfizer-BioNTech vaccine schedule

The first series of this vaccine consists of three doses:

  1. the first dose, which a person can get at any time
  2. the second dose, which must be 3 weeks after the first dose
  3. the third dose, which must be at least 4 weeks after the second dose

The individual then requires two booster doses. The first booster is at least 3 months after the third dose, while the second booster follows after at least 4 months.

Moderna vaccine schedule

The first series of this vaccine also consists of three doses:

  1. the first dose, which a person can get at any time
  2. the second dose, which is 4 weeks after the first dose
  3. the third dose, which is at least 4 weeks after the second dose

The individual then requires two booster doses. The first booster must be at least 3 months after the third dose, while the second booster is 4 months after that.

Johnson & Johnson/Janssen vaccine schedule

If a person receives a Johnson & Johnson/Janssen vaccine, they may only require two doses and then two boosters following this. The first dose will be of this vaccine type, and the second will either be Pfizer-BioNTech or Moderna.

The first series consists of two doses at least 4 weeks apart. The first booster comes at least 2 months after the second dose. The final booster then follows 4 months after that.

Some people with AS may experience a flare-up of symptoms after getting the COVID-19 vaccine, but current evidence suggests this is unlikely.

A 2021 study involving 1,519 people with arthritis and other musculoskeletal conditions found that only 5% of the participants experienced a flare-up of symptoms after receiving the vaccine. Only 1.2% of participants experienced a severe flare-up.

The authors conclude that the vaccine is safe and that people with arthritis generally tolerate it well.

In addition to the low risk of temporarily worsened AS symptoms, there are other potential side effects of getting the COVID-19 vaccine. However, most are mild and go away on their own in a few days.

Common side effects of the COVID-19 vaccine include:

  • pain and swelling at the site of the injection
  • tiredness
  • headache
  • muscle pain
  • chills
  • fever
  • nausea

To reduce pain and swelling at the injection site, a person can apply a clean, cool, wet washcloth over the area and use or exercise their arm.

Severe allergic reactions to the COVID-19 vaccine are rare. If a person thinks they are having an allergic reaction to the vaccine after they have left the vaccination center, they should seek immediate medical attention by calling 911.

Anaphylaxis: Symptoms and what to do

Anaphylaxis is a severe allergic reaction that can be life threatening. The symptoms develop suddenly and include:

  • hives
  • swelling of the face or mouth
  • wheezing
  • fast, shallow breathing
  • a fast heart rate
  • clammy skin
  • anxiety or confusion
  • dizziness
  • vomiting
  • blue or white lips
  • fainting or loss of consciousness

If someone has these symptoms:

  1. Check whether they are carrying an epinephrine pen. If they are, follow the instructions on the side of the pen to use it.
  2. Dial 911 or the number of the nearest emergency department.
  3. Lay the person down from a standing position. If they have vomited, turn them onto their side.
  4. Stay with them until the emergency services arrive.

Some people may need more than one epinephrine injection. If the symptoms do not improve in 5–15 minutes, or they come back, use a second pen if the person has one.

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People who have AS often take medication that suppresses their immune system. These medications can increase their risk of getting infections. The COVID-19 vaccine can reduce the risk of getting severely ill from this infectious disease, so the CDC recommends people taking immunosuppressants get the vaccines as soon as possible.

Immunosuppressant medications for AS may make the COVID-19 vaccination less effective. However, they still offer benefits. Studies have shown that most people will still develop an immune system response from getting the vaccine.

Individuals with concerns about the vaccine’s side effects, the risk of allergic reactions, or the potential effect on their AS symptoms can speak with a doctor for advice.