Ankylosing spondylitis (AS) is an inflammatory condition that impacts the spine and other areas of the body. Chronic back pain and stiffness are two of the most common symptoms of AS.

If you have a chronic condition such as AS, it’s important to take steps to protect your health. This includes staying up to date on your vaccinations, including the COVID-19 vaccine.

In this article, we’ll discuss the COVID-19 vaccine recommendations for people with AS. We’ll also cover questions about vaccine safety and whether vaccination can affect your treatment plan.

The Centers for Disease Control and Prevention (CDC) recommends that:

  • all people ages 6 months and older receive a primary vaccine series
  • everyone ages 5 years and older receive booster doses when eligible

According to the American College of Rheumatology (ACR) guidelines, COVID-19 vaccination should be prioritized in people with inflammatory rheumatic diseases, which includes AS. The ACR notes that, aside from known allergies to vaccine ingredients, there are no other contraindications to vaccination in this group.

COVID-19 vaccines are effective for people with AS. A 2022 study determined vaccine effectiveness in 63,145 people with immune-mediated inflammatory diseases between March and November 2021. It included 7,863 people with AS.

For those with AS, the effectiveness of two vaccine doses was found to be 89%. Adding a third vaccine dose led to a similar level of effectiveness. Vaccination was also very effective (97%) at preventing serious COVID-19 in people with AS.

Some people with AS take medications that suppress the immune system as a part of their treatment plan. Because of this, they may be considered moderately-to-severely immunocompromised.

The COVID-19 vaccine schedule for immunocompromised adults is a little different to the recommended schedule for non-immunocompromised adults. Here’s what’s recommended if you have AS:

Pfizer-BioNTech

  • Primary series: three doses
    • second dose 3 weeks after first dose
    • third dose at least 4 weeks after second dose
  • First booster: at least 3 months after primary series (mRNA preferred)
  • Second booster: at least 4 months after the first booster (mRNA only)
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Moderna

  • Primary series: three doses
    • second dose 4 weeks after first dose
    • third dose at least 4 weeks after second dose
  • First booster: at least 3 months after primary series (mRNA preferred)
  • Second booster: at least 4 months after the first booster (mRNA only)
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J&J

  • Primary series: two doses
    • second dose at least 4 weeks after first dose (mRNA only)
  • First booster: at least 2 months after primary series (mRNA preferred)
  • Second booster: at least 4 months after the first booster (mRNA only)
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Novavax

  • Primary series: two doses
    • second dose 3 weeks after first dose
  • Boosters: not recommended at this time
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Unsure of which vaccine schedule to follow? A doctor or healthcare professional can let you know which one is recommended based on your AS treatment plan and your overall health.

AS can be treated with a variety of medications, some of which may suppress the immune system, including TNF-alpha inhibitors such as adalimumab (Humira) and infliximab (Remicade). Sometimes oral or injected corticosteroids are also used.

While it’s unlikely that the COVID-19 vaccine will impact your AS treatment, it’s possible that your AS treatment may impact vaccine effectiveness.

A 2021 study looked into the effect of immunosuppressive therapy on the effectiveness of mRNA vaccines in people with chronic inflammatory conditions such as AS. Researchers made the following findings:

  • Most people (88.7%) with chronic inflammatory conditions made antibodies in response to the vaccine.
  • Although there was a numeric difference in vaccine response for those taking TNF-alpha inhibitors and those who weren’t, this difference wasn’t significant.
  • Those taking corticosteroids as a part of their treatment had lower levels of antibodies compared with those who didn’t use corticosteroids.

According to the ACR guidelines, there’s no evidence that the timing of medications affects the vaccine’s safety or effectiveness. However, they do note that a doctor may choose to change the timing of medications to optimize your response to the vaccine.

According to the CDC, the most common side effects of the COVID-19 vaccine include:

  • redness, swelling, or pain at the injection site
  • fatigue
  • fever
  • chills
  • muscle aches
  • headache
  • nausea

A 2022 study looked into the side effects of the COVID-19 vaccine in people with rheumatic diseases, including AS. It found that some of the most common side effects in this group were similar to those listed above and included:

  • pain or swelling at the injection side
  • fatigue
  • fever
  • headache

The researchers also noted that no individual type of drug therapy for rheumatic disease was associated with an increased risk of side effects.

Mild side effects from the vaccine are normal and a sign that your immune system is building a response. These side effects typically go away after a few days and can be eased with at-home care such as:

  • applying a cold compress to the injection site to help with pain and swelling
  • staying hydrated
  • taking over-the-counter (OTC) medications, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), to ease pain and fever

Who shouldn’t get the COVID-19 vaccine?

You shouldn’t get the COVID-19 vaccine if you’ve:

  • had a severe allergic reaction (anaphylaxis) to a previous dose of the COVID-19 vaccine or to an ingredient in the COVID-19 vaccine
  • a known, diagnosed allergy to an ingredient in the COVID-19 vaccine
  • experienced a clotting condition called thrombosis with thrombocytopenia syndrome after a previous dose of the J&J vaccine (this is a contraindication for the J&J vaccine only)

A 2021 study found that having axial spondyloarthritis (SpA) may protect against severe COVID-19. The study included 9,766 people with SpA, including 924 with AS. Compared with those without axial SpA, people with AS had a lower risk of:

Another 2022 study of people with SpA looked into the impact of different types of SpA treatment. It found that no class of medication used to treat SpA affected the risk of contracting COVID-19 or becoming seriously ill because of COVID-19.

If you get COVID-19

Despite these findings, you may still be wondering what steps you should take if you become ill with COVID-19. Generally speaking, mild-to-moderate COVID-19 can be treated at home by:

  • getting plenty of rest
  • staying hydrated
  • using OTC medications to help relieve symptoms

Additionally, the antiviral medications nirmatrelvir/ritonavir (Paxlovid) are available for individuals who are at a high risk of serious COVID-19 illness. It’s taken by mouth and is most effective when started as soon as possible after symptoms begin.

The Spondylitis Association of America says that Paxlovid is safe for people with AS, but they note that it may interact with some medications. As such, it’s important to discuss your medications with a doctor or pharmacist before taking it.

If you have COVID-19 and develop any of the following symptoms, call 911 or local emergency services or go to the emergency room:

Vaccination can help protect against serious illness because of COVID-19. As such, it’s important that all eligible individuals, including those with AS, receive their primary COVID-19 vaccine series as well as any recommended boosters.

The COVID-19 vaccine is both safe and effective for people with AS. Because some AS medications can suppress the immune system, talk with a doctor about your AS treatment plan and which vaccine schedule you should follow.