Can arthritis medications, such as biologics (e.g., etanercept, adalimumab) and corticosteroids (e.g., prednisone), suppress the immune response and affect the accuracy of COVID-19 or influenza tests?

Can Arthritis Medications Suppress COVID-19 or Flu Test Results?

Arthritis medications, including corticosteroids and biologics, do not directly suppress COVID-19 or influenza test results, but corticosteroids may increase your risk of COVID-19 infection while TNF-α inhibitors might actually have protective effects against COVID-19. 1, 2, 3

Effects of Different Arthritis Medications on COVID-19 Testing

Corticosteroids (e.g., prednisone)

• Corticosteroids, even at low doses, may increase the risk of COVID-19 infection 2
• They can potentially delay viral clearance and suppress immune responses 4
• May mask symptoms of infection but do not affect the accuracy of PCR or antigen tests 1
• The American College of Rheumatology (ACR) recommends continuing glucocorticoids at the lowest effective dose during the pandemic to control underlying disease and avoid adrenal insufficiency 1

TNF-α Inhibitors (e.g., etanercept, adalimumab, infliximab)

• May actually have protective effects against COVID-19 infection 3
• According to a case-control study, TNF-α blockers decreased the risk of developing COVID-19 by up to:
  • 96.8% with adalimumab
  • 95% with infliximab
  • 80.3% with etanercept 3
• The ACR guidance suggests that TNF inhibitors may be continued if necessary to control underlying disease in patients with asymptomatic COVID-19 1

Other Biologics and DMARDs

• The ACR recommends temporarily withholding or stopping non-IL-6 biologics, immunosuppressants, and JAK inhibitors in the context of documented or presumptive COVID-19 1
• IL-6 receptor inhibitors might be continued in select circumstances during SARS-CoV-2 infection 1

Impact on Testing Accuracy

None of the arthritis medications have been shown to directly interfere with the laboratory detection of COVID-19 or influenza viruses. The tests detect:

• COVID-19 tests: viral RNA or antigens from SARS-CoV-2
• Influenza tests: viral RNA or antigens from influenza viruses

These detection methods are not affected by the presence of arthritis medications in the body. However, the medications may affect the clinical course of the infection:

1. Corticosteroids may:

   • Delay viral clearance 4
   • Mask inflammatory symptoms (fever, pain) 5
   • Increase susceptibility to infection 5

2. Biologics may:

   • Alter the immune response to infection
   • In the case of TNF-α inhibitors, potentially provide some protection against COVID-19 3

Clinical Implications

If you're on arthritis medications and need COVID-19 or flu testing:

• Continue your medications as prescribed unless directed otherwise by your physician
• Be aware that corticosteroids might increase your risk of infection 2
• Understand that while medications don't affect test accuracy, they might affect symptom presentation
• If you're on high-dose corticosteroids (≥20 mg/day prednisone equivalent), you may have a potentially blunted vaccine response 1

Vaccination Considerations

For patients on arthritis medications who need COVID-19 or flu vaccination:

• Most DMARDs can be continued without modification during vaccination 1
• For methotrexate: Consider withholding for 1 week after each vaccine dose 1
• For JAK inhibitors: Consider withholding for 1 week after each vaccine dose 1
• For abatacept: Special timing considerations apply 1
• For rituximab: Consider delaying vaccination until 2-4 weeks after treatment 1

In conclusion, arthritis medications do not directly suppress or interfere with COVID-19 or influenza testing, but they may affect your susceptibility to infection or the clinical presentation of symptoms.