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COVID19 / Coronavirus

NASS have advice and guidance on COVID-19 for people living with axial SpA (AS)

Updated 17 December 2021

Since the start of the COVID19 pandemic NASS has carefully monitored the situation for people living with axial SpA (AS). This page includes the answers to your most frequently asked questions. If you have a question which we haven’t covered below please contact the NASS Helpline on 0208 741 1515 between 10:00 and 16:00 Monday to Friday. You can also email

COVID19 Vaccine

For more general information on the COVID vaccine please download our detailed information on the COVID-19 vaccines which have been approved for use in the UK. This article was written by Dr Antoni Chan, Consultant Rheumatologist at the Royal Berkshire NHS Foundation Trust and published in the NASS members magazine, AS News. 

COVID19 Vaccine information

More detailed information on the COVID-19 vaccination programme can be found in the Greenbook.

The 3rd primary vaccine

On 1 September 2021 The Joint Committee on Vaccination and Immunisation (JCVI) advised that a third dose should be offered to people aged 12 years and over with severe immunosuppression. This group will include those taking:

  • biologic therapy (including anti TNF and anti Il-17A)
  • high-dose corticosteroids  (20mg or more of prednisolone per day) for more than 10 days in the previous month
  • long-term moderate dose corticosteroids (10mg of prednisolone per day for more than 4 weeks) in the previous 3 months
  • methotrexate (more than 20 mg per week either as a tablet or injection is the dose recommended by the JCVI but the British Society for Rheumatology recommend it for anyone on more than 10mg per week)
  • certain combination therapies at individual doses lower than above (e.g. 7.5mg prednisolone per day in combination with sulfasalazine)

If you are in England you can now book your third vaccine on the NHS booking site.

Read the information sent to health professionals

Read the updated JCVI guidance in full.

JCVI guidance on the third dose

The booster vaccine

The booster vaccine can now be given 3 months after the primary course of vaccines.

New treatments for COVID19

Vaccines remain the primary defence against COVID19, but on 8 December 2021 the UK Government announced that it has made available other new treatment options for COVID-19 for eligible groups of patients.

These new treatments are used in the earliest stages of infection and often taken at home. These treatments should be administered as soon as possible after a confirmed COVID19 positive PCR test has been received. In England it has been announced that if you are eligible for a COVID-19 treatment, you should be sent a PCR test kit to keep at home. This means you can tested tested quickly if you have any of the COVID symptoms. Call 119 if you think you may be eligible for treatment but have not received your test kit by 10 January 2022.

These new treatments are oral antivirals. They are being offered through a new national study called PANORAMIC. This study will  gather the data on how antivirals work in a predominantly vaccinated population. You may be eligible for PANORAMIC if:

  • You have received a PCR positive test for COVID-19
  • You feel unwell with symptoms of COVID-19 that started in the last 5 days
  • You are aged 50+, or 18-49 years old with an underlying medical condition that can increase the chance of having severe COVID-19

The eligible underlying medical conditions include axial SpA but if you are 18-49 you would also need to be:

  • Taking Rituximab or other B cell depleting therapy in the last 12 months
  • Taking corticosteroids, cyclophosphamide, tacrolimus, cyclosporin or mycophenolate.
  • Having active/unstable disease on biologics (e.g. anti TNF or anti IL17A)

Read more about the The PANORAMIC study.

Watch a video explaining more about the anti-viral treatments, monoclonal antibody treatments and the panoramic study.

The OCTAVE study

The OCTAVE study is a multi-centre, UK-wide trial. It is evaluating the immune responses following COVID-19 vaccination in clinically at-risk immunocompromised patients. For people with axial SpA that includes those on biologic therapies such as anti TNF and anti IL 17A.

The study is being led by the University of Glasgow and the University of Birmingham’s Cancer Research UK Clinical Trials Unit. OCTAVE is funded by UK Research and Innovation (UKRI).

The study used a range of tests performed on blood samples taken before and/or after COVID-19 vaccination in around 600 people across the UK including those with:

  • cancer
  • inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis and axial SpA)
  • severe vasculitis (inflammation of blood vessels)
  • diseases of the kidney or liver
  • and who are having a stem cell transplant.

OCTAVE’s early data has been published. These initial results include 149 patients in the rheumatology group, with 119 with inflammatory arthritis taking TNF inhibitors and/or methotrexate but does not include people with axial SpA.

The results show that:

  • 98% of the patients with inflammatory arthritis had a detectable antibody response in their blood following two doses of COVID vaccine.
  • Antibody responses were lower than those seen in healthy people with 53% of people with inflammatory arthritis showing low responses.

It’s important to be aware that:

  1. The inflammatory arthritis group included included those rheumatoid arthritis and psoriatic arthritis on anti TNF and/or methotrexate but not people with a diagnosis of axial SpA. The larger OCTAVE group includes patients with axial SpA on anti TNF or IL-17A drugs, with results expected in the next few weeks.
  2. The significance of these findings in providing protection from exposure to COVID-19 is not currently known. There is no current agreed clinical cut off to measure COVID-19 vaccination response.
  3. Despite lower antibody responses (which are made by B cells) to the spike protein, all groups had good T cell responses to the spike protein, similar to those seen in healthy people.

The follow-on OCTAVE-DUO study has already started to determine whether a third booster vaccination will improve the immune response against COVID-19 for patients who have a low immune response after two doses.

If you’d like to read about how the study was run you can download a summary
OCTAVE-DUO Lay Trial summary v 1.0_10-Sep-2021

If you’d like to read the findings in more detail, we’ve included a link to The Lancet.

An end to shielding

At the start of the COVID-19 pandemic, shielding was introduced as one of the few ways to support those who, at the time, were considered clinically extremely vulnerable. People have not been  advised people to shield since Spring 2021, and since the summer, people previously identified as clinically extremely vulnerable have been advised to follow the same guidance as the rest of the population.

The advice is now that people should consider their own risk, supported by their GP and specialist where necessary. You can read more in this Department of Health information.

End of Shielding FAQs – FINAL


Do consider the risks of close contact with others, particularly if you are clinically extremely vulnerable or not yet fully vaccinated, as the risk of catching or passing on COVID-19 is generally higher:

  • in crowded spaces, where there are more people who might be infectious
  • in enclosed indoor spaces where there is limited fresh air
  • when COVID-19 disease levels are high in the general community

Extra precautions you might wish to consider if they are not mandatory in your area, include:

  • meeting outside if possible
  • make sure the space is well ventilated if you meet inside
  • consider continuing to practice social distancing if that feels right for you and your friends
  • asking friends and family to take a lateral flow test before visiting you
  • wear face coverings in crowded areas, such as public transport
  • go shopping at quieter times of day


When social distancing measures are ended in the workplace and people no longer have to work from home, employers will still have a legal responsibility to protect their employees and others from risks to their health and safety.

The Health and Safety Executive (HSE) has published guidance on protecting vulnerable workers, including advice for employers and employees on how to talk about reducing risks in the workplace.

If you need support to work at home or in the workplace you can apply for Access to Work. Access to Work may provide support for the disability-related extra costs of working that are beyond standard reasonable adjustments an employer must provide. Access to Work will prioritise Access to Work applications from disabled people who are in the clinically extremely vulnerable Group.

If you have access to occupational health and employee assistance programmes in the workplace, these services can also provide you with a range of health support and advice for your physical and mental health needs.

The Coronavirus Job Retention Scheme (furlough) is available until 30 September. You may be eligible throughout this period, even when shielding is paused, providing your employer agrees. The Self-Employment Income Support Scheme (SEISS) is also available until 30 September.

You may be eligible for Statutory Sick Pay (SSP) or Employment and Support Allowance (ESA) if you are sick or incapable of work, either due to coronavirus or other health reasons, subject to meeting the eligibility conditions.

If you have concerns about your health and safety at work then you can raise them with your workplace union, HSE or your local authority. Where employers are not managing the risk of COVID-19, HSE and local authorities will take action which can range from the provision of specific advice, issuing enforcement notices, stopping certain work practices until they are made safe and, where businesses fail to comply with enforcement notices, this could lead to prosecution.

Citizens Advice also has information about your rights at work and how to solve problems in the workplace. If you have concerns you can also get advice on your specific situation and your employment rights by visiting the Acas website or calling the Acas helpline on 0300 123 1100.

Will I see my rheumatologist and physiotherapist as usual?

There may be delays to planned appointments as staff in rheumatology departments were redeployed during COVID19. To keep everyone safe, a lot of appointments are being carried out over the phone or online. NASS has produced a short video to help you make the most of remote appointments.

What research is being carried out into COVID19 and axial SpA (AS)?

In order to understand how COVID19 might impact on people living with rheumatological conditions like axial SpA (AS) a Global Rheumatology Alliance was established. Its aim is to increase our knowledge and understanding of how COVID19 both affects people with rheumatic conditions and if the medications people commonly take changes their risk. It is a database and clinicians from around the world are registering details of patients with rheumatic conditions who have contracted COVID19.

Research papers are already being produced based on the results. One paper based on over 600 patients from 40 different countries indicated only those taking more than 10mg of oral steroids were at greater risk of being hospitalised for COVID19. No other drugs increased the risk of hospitalisation and anti TNF appeared to decrease the risk.

Can I help by taking part in any research?

We’ve put together a list of studies taking part around the world and here in the UK looking at the impact of COVID19. You can find out more here.