NSAIDs work as well as advanced therapies in controlling AS: Study
Disease activity low with anti-inflammatories and treatments like TNF inhibitors
Both nonsteroidal anti-inflammatory drugs (NSAIDs) and more advanced medications appear to keep disease activity and structural damage under control in people with axial spondyloarthritis, including ankylosing spondylitis (AS), a real-world study found.
The study, “Clinical and structural damage outcomes in axial spondyloarthritis patients receiving NSAIDs or advanced therapies: a description of a real-life cohort,” was published in Frontiers in Medicine.
Axial spondyloarthritis causes joints in the spine to become inflamed. It mainly affects the sacroiliac joints, which join the spine to the pelvis. Inflammation damages the joints, leading to pain and stiffness. In people with AS, damage to the spine can be seen on an X-ray.
While there is no cure for axial spondyloarthritis and it currently is not possible to reverse the damage caused to the joints, disease treatments are available to ease symptoms and slow progression.
NSAIDS are a first-line therapy for pain and stiffness in AS patients
Researchers in Spain looked at the clinical features, disease activity, and structural damage in patients with axial spondyloarthritis who were being treated long-term with either NSAIDs or more advanced medications. The goal was to understand how these treatments affect patient outcomes in a real-world clinical setting.
Their study included 193 adults, with a mean age 51, who had been living with axial spondyloarthritis for an average of 21.4 years. Most (83%) had ankylosing spondylitis. Disease activity was low, with a mean Bath AS Disease Activity Index (BASDAI) of 3.1 and a mean AS Disease Activity Score C-reactive protein (ASDAS-CRP) of 1.8.
“NSAIDs are recommended as the first-line therapy for patients experiencing pain and stiffness, up to the maximum dose,” the researchers wrote, noting that of the 193 patients, 85 (44%) were taking NSAIDs alone. Most patients on NSAIDs used them as needed (64.7%).
The remaining 108 patients (56%) were on advanced medications, mainly TNF inhibitors (86.1%). Compared to patients on NSAIDs, those on advanced medications were more likely to be male (69.4% vs. 51.8%) and younger (average age of 49 vs. 53.6 years).
Although patients on advanced medications had significantly lower ASDAS-CRP scores, indicating less severe disease symptoms, there were no differences in levels of CRP — a marker of inflammation — or BASDAI scores between the two groups. The type of medication used did not affect disease activity or structural damage.
“Our results suggest that good clinical and radiological outcomes can be achieved with both NSAID and advanced therapies in [axial spondyloarthritis] patients in a real-world setting,” the researchers wrote.
“Patients for whom clinicians decided to continue NSAID therapy have achieved general treatment goals,” they added, noting that most patients “exclusively used on-demand treatment during clinical flares,” which could ease concerns about side effects with long-term use.
