Spondylitis Association of America Forums General Discussion General Message Board for Ankylosing Spondylitis and Related Diseases Novel Coronavirus

Anyone else getting nervous about the potential of a global pandemic of this virus and the potential impact of taking TNF blockers if that occurs?

The news today is that several Italian towns have been shut down amid a cluster of infections of unknown origins (The original patient had not been to China nor had apparent contact with anyone who was ill).

Yes. I have travel, within the US, planned for early April. I am considering canceling that. Fortunately I can easily limit my contact with the public. I'm retired and can order groceries delivered. I have tests scheduled for Friday at a local hospital medical complex, I might wear a mask. But mostly, I wash my hands a lot or use hand sanitizer and try not to touch my face.

I would be potentially curious to understand in general what would my predisposition to fight any virus including influenza in a condition of mild AS. Am I more or less susceptible and is my immune system more prompt to act/defend? Because as it stands everyone around me getting seasonal colds flus and I am untouchable.

Are you HLA-B27+? There's research indicating that HLA-B27+ people are less likely to die from influenza. There's a paper out there somewhere explaining why it is believed so many people in Inuit populations are HLA-B27+. The theory is that at some point all the Inuits who weren't HLA-B27+ were killed by flu and so HLA-B27 was passed on in every subsequent generation. Many people who are HLA-B27+ are also "longterm non-progessors" when infected with HIV, which means that they can live with HIV for a very long time before developing symptoms of AIDs. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3240147/. I'm not sure that these virus-fighting superpowers extend to all viruses, however.

I am actually HLA-B27 negative. I am fairly prone to influenza, having had it about 5 times in the last 25 years or so.

Prior to being on biologics I had significant disease activity but also had not had so much as a cold in years; I think my immune system was just permanently on high. The last time a "new" upper respiratory virus was going around here that was making news for getting lots of people sick, I was very sick indeed, missing about 3 weeks of work, running low grade fevers and rapidly losing weight despite not having any gut symptoms at all.

I guess all we can do is watch the news and hope but if it arrives here in a significant way I may ask my rheumatologist about the wisdom of temporarily stopping my biologic.

Sorry Mary Beth, I was actually replying to achala's question posted immediately above mine. I don't think anyone has published anything re how coronaviruses impact people on TNF-a inhibitors. I looked for papers published after SARS (because the new coronavirus is a relative of SARS) but couldn't find anything.

I found this from the UK.

https://www.crohnsandcolitis.org.uk/news/updated-wuhan-novel-coronavirus-advice

"• Immunosuppressive medicine for Crohn’s and Colitis includes azathioprine, mercaptopurine, methotrexate, cyclosporin, infliximab, adalimumab, golimumab, ustekinumab, prednisolone, and budesonide. See our treatments pages for information about these medicines and how they may affect you.
• People taking immunosuppressants for their Crohn’s Disease or Ulcerative Colitis are not at increased risk of catching Wuhan novel coronavirus, however they may be at extra risk of complications from the virus if they are infected.
• In the majority of cases, you will be advised to continue with your current treatment as there is the potential for a flare of your IBD and subsequent need for drugs such as steroids if maintenance treatment is stopped.
• People on immunosuppressants should seek advice by telephone if they develop symptoms of either seasonal Influenza or Wuhan novel coronavirus. "

I found this teaser to a possibly relevant article (which, interestingly, suggests that TNF-a inhibitors might be useful in treating SARS coronavirus infection) but haven't been able to get access to the full article: https://www.researchgate.net/public...modulation_of_SARS_coronavirus_infection .

If anyone can find the full article or a summary of its findings, please post a link here.

I have not found a publicly available summary. But the thought behind it is interesting.

If the lung damage caused by the novel coronavirus is due to an immune overreaction, then TNF inhibitors might actually help reduce the risk of serious complications. If the lung damage, though, is due strictly to the virus itself, then a reduced immune response would put people at higher risk.

Unfortunately I don’t think we have any evidence either way.

There also seems to be a significant age-related risk to this. Thankfully (but strangely) the very young seem to be protected.

https://www.worldometers.info/coron...whiz_CxtN-1CvmMY3qS7CtKfJ8iX8x5WBoN-gHMg

"All patients should talk to their rheumatologist or rheumatology professional prior to discontinuing any of their medications. While there are no data on the influence of these medications on COVID-19, providers should follow their current practice for interrupting therapy during episodes of infection."

that's from the American College of Rheumatology. with other useful tips.

https://www.rheumatology.org/Announcements

Hope that helps.

Rich