Abstract
BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are regarded as the cornerstone of conventional treatment for AS. However little is known about concomitant NSAID use during treatment (with TNF-α inhibitors) in daily clinical practice.Methods and findingsConsecutive patients from the GLAS cohort were included. NSAID use and ASAS-NSAID index were evaluated at group level and at individual patient level during 52 weeks of follow-up. Analyses were stratified for treatment regimen. Generalized estimating equations (GEE) was used to evaluate NSAID use in relation to assessments of disease activity over time. In patients starting TNF-α inhibitors (n = 254), 79% used NSAIDs at baseline and this proportion decreased significantly to 38% at 52 weeks. ASAS-NSAID index also decreased significantly from median 65 to 0. In patients on conventional treatment (n = 139), 74% used NSAIDs at baseline with median ASAS-NSAID index of 50 and this remained stable during follow-up. At each follow-up visit, approximately half of the patients changed their type or dose of NSAIDs. GEE analysis over time showed that NSAID use was associated with AS disease activity score (p<0.05). This relation was more pronounced in patients treated with TNF-α inhibitors compared to conventional treatment (B = 0.825 vs. B = 0.250).ConclusionsIn this observational cohort of established AS patients, there was no difference in baseline NSAID use between patients with and without indication for TNF-α inhibitors. NSAID use decreased significantly after starting TNF-α inhibitors. During conventional treatment, NSAID use remained stable at group level. However, NSAID use changed frequently at individual patient level and was significantly associated with disease activity.
Highlights
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that primarily affects the axial skeleton
In this observational cohort of established AS patients, there was no difference in baseline Non-steroidal anti-inflammatory drugs (NSAIDs) use between patients with and without indication for TNF-α inhibitors
The Groningen Leeuwarden Ankylosing Spondylitis (GLAS) cohort was approved by the local ethics committees of the Medical Center Leeuwarden (MCL) and University Medical Center Groningen (UMCG) and all patients provided written informed consent according to the Declaration of Helsinki
Summary
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that primarily affects the axial skeleton. Non-steroidal anti-inflammatory drugs (NSAIDs) are regarded as the cornerstone of conventional treatment for AS.[1] NSAIDs have shown good reduction of symptoms in 60–80% of the patients.[2] A recent network meta-analysis of randomized controlled trials (RCTs), reporting on the efficacy of different NSAIDs in AS, showed that the majority of available NSAIDs reduce total pain score significantly compared to placebo up to 12 weeks.[3] Besides the positive effect on pain, NSAIDs reduce the level of acute-phase reactants in the blood of AS patients.[4] a decrease in signal intensity of bone marrow edema of the sacroiliac (SI) joints on MRI was seen after 6 weeks of full dose NSAIDs in newly diagnosed patients with axial spondyloarthritis (SpA).[5] During treatment, disadvantages of NSAIDs such as possible cardiovascular and gastrointestinal side effects should be taken into account, especially in patients with comorbidity and comedication (e.g. anticoagulants).[6,7]. Non-steroidal anti-inflammatory drugs (NSAIDs) are regarded as the cornerstone of conventional treatment for AS. Little is known about concomitant NSAID use during treatment (with TNF-α inhibitors) in daily clinical practice
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