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A question has been asked about whether a person with Ankylosing Spondylitis receiving therapy that affect the immune system should stop treatment in the setting of the Coronavirus 19 infection?

In specific, this is a question that should be discussed between a patient and their physician, because individual factors will determine the correct answer. However, a general statement can be made in regard to therapy for rheumatoid arthritis. KEEP TAKING YOUR MEDICINE

As I mentioned in my article about immunocompromised and immunosuppressed patients, we want an immune system that is just right - not underactive or overactive. In general, rheumatic disease patients have an overactive immune system that is using energy to damage their own body parts - the spine in AS and the peripheral joints in the hands and feet in RA. Having an immune system that is not overactive is the goal of disease modifying (methotrexate) and biologic (anti-TNF, anti IL17) agents. Having RA and AS under control is a good situation.

A decision will need to be made if an individual is exposed to the Covid 19 virus. Some individuals will have minimal symptoms while others will have more severe disease. While certain parameters have been suggested to predispose to developing more severe illness like being older and having pulmonary disease, the specifics remain to be determined. If someone develops Covid 19 symptoms, they should contact their physician about whether to continue to take or stop their therapy. For most patients, medicines will be held until the infection is resolved. In the majority of individuals, the infection will be cleared. The individual will be able to resume their therapy at that time.

David G. Borenstein, M.D. Past President of ACR-Editor TheArthritisConnection

Rheumatologic Disorders