The Interplay Between COVID-19 and Spondyloarthritis or Its Treatment

The coronavirus disease 2019 (COVID-19) pandemic has created multiple uncertainties regarding rheumatic diseases or their treatment, with regard to the susceptibility to or severity of the viral disease. We aimed to address these questions as they relate to spondyloarthritis (SpA).

We created a longitudinal survey from April 10, 2020, to April 26, 2021. There were 4723 subjects with SpA and 450 household contacts who participated worldwide. Of these, 3064 respondents were from the US and 70.4% of them provided longitudinal data. To control for the duration of potential risk of COVID-19, the rate of contracting the disease was normalized for person-months of exposure.

In an analysis of US subjects who provided longitudinal data, the incident rate ratio for the 159 (out of 2157) subjects who tested positive for COVID-19 was 1.16 compared to the US population as adjusted for age and sex (range 0.997-1.361, P = 0.06). A paired evaluation using patients and household members did not show a statistically significant effect to indicate a predisposition for developing COVID-19 as a result of SpA or its treatment. Our data failed to show that any class of medication commonly used to treat SpA significantly affected the risk of developing COVID-19 or increasing the severity of COVID-19.

These data do not exclude a small increased risk of developing COVID-19 as a result of SpA, but the risk, if it exists, is low and not consistently demonstrated. The data should provide reassurance to patients and to rheumatologists about the risk that COVID-19 poses to patients with SpA.