COVID-19 & Autoimmune Conditions: Here's What We Know
One of the most scary aspects of COVID-19 is the many unknowns—and the fears we may have about our own risk factors or the ones of those we love. Many with autoimmune diseases are particularly concerned because we've all heard that "comorbidities" and immunosuppression increase risk of developing COVID-19 or having a more severe case.
The first important thing to know is that some autoimmune conditions are not a result of, nor do they cause, immunosuppression or weakened immunity. The second thing is that not all autoimmune diseases increase one's risk of contracting COVID-19 infection, or its severity. That said, some autoimmune conditions, along with some of the immunosuppressive medications used to treat them, can increase risk.
Because the virus is so new and there's a lot we still don't know, medical experts are recommending that most people with autoimmune conditions consider themselves as high risk and follow extra precautions accordingly. And of course, anyone can become infected or sick—so we all need to follow social distancing, hand-washing, and other common preventive measures.
Let's take a look at the most common AI conditions and what we currently know.
At this time, autoimmune thyroid diseases do not seem to increase risk. However, a related coronavirus that caused an epidemic starting in 2002 called SARS may have been responsible for thyroid damage. Any acute illness can affect thyroid function, so if you do experience COVID-19 infection and have autoimmune thyroid disease, pay attention for any thyroid symptoms that may arise. If you notice increased symptoms, ask your health care provider to order a basic thyroid lab panel and have your medications adjusted if needed.
According to the Arthritis Foundation, rheumatoid arthritis has not been flagged as a high-risk condition raising the risk of COVID-19 infection or severity to date. Certain medications taken to treat or suppress this condition, however, may increase your risk.
Inflammatory Bowel Disease (IBD)
IBD includes Crohn's disease and ulcerative colitis, both of which are treated with immunosuppressive medications that do increase susceptibility to viral infection, particularly steroids and immune modulators like azathioprine, 6-mercaptopurine, or methotrexate. Risk likely depends on the extent and severity of the disease, how active it is, and which immunosuppressive medications you're taking. The Crohn's/Colitis Foundation recommends staying on your medications as IBD-caused inflammation can lead to complications and damage to your intestinal tract. Most importantly, they urge the importance of speaking with your doctor if anything feels wrong.
Celiac Disease Foundation medical advisory board member Alessio Fasano, M.D., stated that people with celiac disease are not considered immunocompromised but may be more susceptible to COVID-19 if they have "active celiac disease." According to Fasano, if celiac disease is well-treated, susceptibility is considered to be the same as for the general population.
People with lupus are at higher risk for a number of types of infections, including colds, flu, and other viruses. For this reason, COVID-19 is not expected to be an exception. It's important to speak with your medical care provider about any special precautions or symptoms you should be aware of and observe a high level of diligence about protecting yourself from exposure.
Type 1 Diabetes
Type 1 diabetes, especially if your blood sugar levels aren't carefully controlled, does increase vulnerability to infections and complications. It's also incredibly important to make sure you have an adequate supply of insulin at home, so talk with your health care provider about having a 60- or 90-day supply on hand at home should you be unable to otherwise obtain it (quarantine, shortages).
Multiple Sclerosis (MS)
MS, as well as some MS medications, may increase your risk of susceptibility to and severity of illness from a COVID-19 infection. Check in with your health care provider to discuss any specific considerations for your situation, and remember to practice a high level of vigilance to prevent exposure. The National MS Society's National Medical Advisory Committee recommends the following:
- People with MS should follow CDC guidelines and additional recommendations for people at risk for serious illnesses from COVID-19.
- People with MS should continue disease-modifying therapies (DMTs) and discuss specific risks with their MS health care provider prior to stopping a DMT.
- Before starting a cell-depleting DMT or a DMT that carries warnings of a potentially severe increase in disability after stopping, people with MS and their MS health care providers should consider specific risks (e.g., age, comorbid health conditions, location) and benefits.
Going forward, I urge everyone to be aware of atypical symptoms. While we're all on the lookout for symptoms that could tell us we have this dreaded infection, those who are immunocompromised may or may not have typical symptoms. Your first clue could be dehydration, shortness of breath, or a more severe complication. This risk is likely compounded in those already at high risk, for example, people age 65 and over, people with underlying health conditions (such as diabetes or heart or respiratory disease), or those with suppressed immune systems as the result of a condition such as HIV or AIDS, or a medicine such as steroids or chemotherapy.
Do immunosuppressive medications increase risk of COVID-19?
Being on immunosuppressive medications can increase your risk of contracting a viral infection, but they're also important for maintaining your health and keeping you symptom-free. Because of this, it's important not to discontinue any medications without talking to your health care provider first. The consequences of going off a medication may outweigh your risk of COVID-19.
Medications that can suppress your immunity include but aren't limited to:
- steroids (prednisone/prednisolone)
- immunomodulators like thiopurines (azathioprine, 6-mercaptopurine, cyclosporine, methotrexate)
- the JAK inhibitor tofacitinib (Xeljanz, Olumiant, and Rinvoq), which can inhibit immune response to viral infections
- biologics/biosimilars, like certolizumab pegol (Cimzia), adalimumab (Humira®), infliximab (Remicade), golimumab (Simponi), infliximab-abda (Renflexis), infliximab-dyyb (Inflectra), infliximab-qbtx (Xifi), ustekinumab (Stelara), and vedolizumab (Entyvio)
These medications are not considered immunosuppressives and at this time are not thought to increase COVID-19 risk: mesalamine (Asacol, Apriso, Canasa, Delzicol, Lialda, Pentasa, Rowasa) or other aminosalicylates.
This is a scary time for everyone, and more so if you're stressed that you have higher risk factors. That's normal and natural. It's important not to panic, however: Just continue to treasure yourself, and allow yourself the space to be extra careful in protecting yourself from exposure. Eat well, sleep well, practice meditation and stress reduction—these are the best practices we have for supporting healthy immunity and staying adaptable in these strange and rapidly shifting times.
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