2486B - Non-Steroidal Anti-Inflammatory Drugs Reduce Radiographic Spinal Progression in Patients with Ankylosing Spondylitis but Not in Non-Radiographic Axial Spondyloarthritis

Tuesday, November 8, 2011: 2:45 PM
W475a (McCormick Place West)
Denis Poddubnyy1, Hildrun Haibel2, Joachim Listing3, Elisabeth Märker-Hermann4, Henning Zeidler5, Jürgen Braun6, Martin Rudwaleit7 and Joachim Sieper2, 1Charité Medical University, Campus Benjamin Franklin, Berlin, Germany, 2Charité – Campus Benjamin Franklin, Berlin, Germany, 3German Rheumatism Research Centre, Berlin, Germany, 4Dr. Horst Schmidt Kliniken, Wiesbaden, Germany, 5Medizinische Hochschule, Hannover, Germany, 6Rheumazentrum Ruhrgebiet, Herne, Germany, 7Ev. Krankenhaus Hagen-Haspe, Hagen, Germany
Presentation Number: 2486B

Background/Purpose: Non-steroidal anti-inflammatory drugs (NSAIDs) are clinically effective and considered as a first line therapy in patients with axial spondyloarthritis (SpA) including ankylosing spondylitis (AS). At the same time NSAIDs might work not only as symptom-modifying drugs, but might also have disease-modifying activities retarding radiographic spinal progression and syndesmophyte growth in AS [1]. However, this earlier report [1] has not been confirmed until now. Furthermore, the influence of NSAIDs on radiographic progression has not been investigated so far in non-radiographic axial SpA (nrSpA). The objective of the study was to investigate the effect of NSAIDs intake on the radiographic spinal progression in patients with AS and nrSpA.

Method: 164 patients with axial SpA (88 with AS and duration of symptoms <10 years; 76 with nrSpA and duration of symptoms <5 years) from the German Spondyloarthritis Inception Cohort (GESPIC) [2] have been selected for this analysis based on availability of spinal radiographs at baseline and after 2 years of follow-up and of the data on NSAIDs intake during this period of time. None of the patients included in this analysis received anti-TNF therapy. Radiographs of the cervical and lumbar spine were centrally collected, digitized, and subsequently scored according to the mSASSS independently by two trained readers, who were blinded for time point and all clinical data. Data on NSAIDs intake were collected at baseline and every 6 months thereafter during 2 years of follow-up. An index of the NSAIDs intake [3], as recommended by ASAS, counting both dose and duration of drug intake (range 0-100) was calculated. High NSAIDs intake was defined as a mean NSAID intake index over 2 years of ≥50, low NSAIDs intake – as a mean NSAID intake index <50.

Result: Patients with AS and high NSAIDs intake (n=24 or  27%), in comparison to patients with low NSAIDs intake (n=64 or 73%), had a significantly lower rate of radiographic spinal progression as assessed by the change of mSASSS score over 2 years (0.02±1.38 vs. 0.96±2.78 mSASSS units, respectively, p=0.039), and numerically lower rates of patients with progression by ≥2 mSASSS units (8.3% vs 21.9%) and with new syndesmophyte formation (4.2% vs 15.6%) over 2 years. After adjustment for other factors potentially associated with radiographic spinal progression in this cohort (baseline syndesmophyte, elevated acute phase reactants and smoking status) the high NSAIDs intake showed significant association with reduced radiographic spinal progression (OR=0.23, 95%CI 0.55-0.98 for the mSASSS progression by ≥2 units, p=0.047). In nrSpA, no significant differences regarding radiographic progression between subgroups with high (n=19 or 25%) and low NSAIDs intake (n= 57 or 75%) was found.


A high NSAIDs intake over 2 years is associated with lower radiographic progression in patients with AS. The lack of influence of NSAIDs intake on radiographic progression in nrSpA might be related to the relatively low baseline structural damage of the spine in this group.


1. Wanders A, et al. Arthritis Rheum 2005;52:1756-65. 2. Rudwaleit M, et al. Arthritis Rheum. 2009;60:717-27. 3. Dougados M, et al. Ann Rheum Dis 2011;70:249-51.

Keywords: ankylosing spondylitis (AS), nonsteroidal antiinflammatory drugs (NSAIDs) and spondylarthropathy

Disclosure: D. Poddubnyy, None; H. Haibel, None; J. Listing, None; E. Märker-Hermann, None; H. Zeidler, None; J. Braun, None; M. Rudwaleit, None; J. Sieper, None.