Background/Purpose: The Covid-19 pandemic has been especially challenging for patients with inflammatory diseases including spondyloarthritis (SpA). Patients with rheumatic and musculoskeletal diseases (RMDs) remain at an increased risk of morbidity and mortality from vaccine preventable infections, often as a result of disease activity, comorbidities, and immunosuppressive medication.^[1] Susceptibility and severity of Covid-19 was addressed with an online survey of patients with a diagnosis of SpA established by a physician.

Methods: We conducted a web-based survey of SpA distributed to approximately 40,000 individuals (mostly in North America) who had registered with the Spondylitis Association of America. Additional surveys were distributed based on lists provided by the Axial Spondyloarthritis International Federation (ASIF). The survey was translated into 15 additional languages to accommodate ASIF members.

Results: Responses from 4723 subjects with SpA and 450 household contacts of these subjects. Most from the US (64.9%), Canada (8%), and the rest from 72 other countries. 63% of the were female. Median age was male 54 and females 49. Several forms of SpA were identified, with 83.5% as ankylosing spondylitis. Respondents reported being exposed to Covid-19 (19.6%) with 384 (8.2%) reported being infected. Of those infected 295 had a confirmatory positive test. Table 1 indicates that none of the treatments appeared to affect the likelihood to develop Covid-19 or the subjective rating of the severity of Covid-19. Some classes of medications such as anti-malarials and JAK inhibitors were not commonly used by the respondents so the statistical meaning of the results could be confounded by the limited size of the database. Patients with SpA were not statistically significantly different from household controls.

Conclusion: Based on survey results, SpA does not affect susceptibility or severity of Covid-19. Medications commonly used to treat spondyloarthritis do not affect susceptibility or severity of Covid-19.

We cannot exclude confounding because patients taking certain medications such as a biologic might exercise greater care to socially distance and minimize exposure.

Analysis of medication usage and the susceptibility and severity of Covid_19 * Wald test; ** t-test against No Med. Rate ratio is calculated relative to patients taking no medication. Mean severity is the subjective severity of Covid_19 infection using a one (most mild) to ten (most severe) scale. Abbreviations: C19=Covid_19; SD=standard deviation; MTX=methotrexate; HCQ=hydroxychloroquine; TNF=tumor necrosis factor; NSAID=nonsteroidal anti-inflammatory drug; JAK=janus kinase; No Med=no medication for spondyloarthritis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/interplay-between-covid-19-and-spondyloarthritis-or-its-treatment/