The Interplay between Covid-19 and Spondyloarthritis or Its Treatment

Rosenbaum, James T; Weisman, Michael H; Hamilton, Hedley; Shafer, Cassie; Aslanyan, Elin; Howard, Richard A; Ogle, Kimberly; Reveille, John D; Winthrop, Kevin L; Choi, Dongseok

OBJECTIVE: The Covid-19 pandemic has created multiple uncertainties regarding rheumatic diseases or their treatment and susceptibility or severity of the viral disease. METHODS: To address these questions as they relate to spondyloarthritis, we created a longitudinal survey from April 10, 2020 to April 26, 2021. 4723 world-wide subjects with spondyloarthritis and 450 household contacts participated. 3064 of the 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 Covid-19 was normalized for person months of exposure. RESULTS: 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 to 1.361, p=0.059). A paired evaluation using patients and household members did not show a statistically significant effect to indicate a predisposition to develop Covid-19 as a result of spondyloarthritis or its treatment. Our data failed to show that any class of medication commonly used to treat spondyloarthritis significantly affected the risk to develop Covid-19 or the severity of Covid-19. CONCLUSION: These data do not exclude a small increased risk to develop Covid-19 as a result of spondyloarthritis, 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 spondyloarthritis.