NASS have advice and guidance on COVID-19 for people living with axial SpA (AS)
Updated 27 September 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 email@example.com.
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.
More detailed information on the COVID-19 vaccination programme can be found in the Greenbook.
Updates from the JCVI
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 10mg per week either as a tablet or injection – this is the dose recommended by the British Society for Rheumatology)
- certain combination therapies at individual doses lower than above (e.g. 7.5mg prednisolone per day in combination with sulfasalazine)
Rheumatology teams have been asked identify patients within their care who fit the JCVI’s definition as being eligible for a third primary dose and to consider the optimal timing for administering a third dose, based on the JCVI’s advice.
If your rheumatology department is based in a hospital operating as a hospital vaccine hub then it’s been recommended that you should be offered the vaccine at the hospital. If that’s not possible then your consultant should write to your GP and you should then receive your vaccine through a designated GP practice within your Primary Care Network.
You should not be directed to the NHS vaccine booking website as the timing of the booster dose is different to the timing for the third dose.
Read the updated JCVI guidance in full.
On 15 September 2021 it was announced that single vaccines will be additionally be offered to children aged 12-15 and booster jabs to over-50s and health workers and the most vulnerable. This applies to England, Scotland, Wales and Northern Ireland.
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:
- 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:
- 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.
- 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.
- 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.
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.
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.