Nonsteroidal Anti-Inflammatory Drugs (
NSAIDs) effects in
Ankylosing Spondylitis (AS) are only suspensive but because of their rapid efficacy on inflammatory symptoms they are the first-line treatment in AS. Short term efficacy of
NSAIDs in AS is observed for most patients but the correlation of
NSAID intake with the long term prognosis and its potential influence on the structural progression of the disease is still unknown. Therefore, and due to the gastrointestinal side effects of these drugs, daily practice is mostly in favour of discontinuous intake of
NSAIDs, following the clinical relapses. However, the recent introduction of specific
Cox-2 inhibitors, with a lower risk of severe gastrointestinal adverse events, may modify this attitude. Moreover, some patients are inadequately relieved of
pain and
inflammation by
NSAIDs. The number of
NSAIDs to be tested and for each
NSAID, the optimal dosage that must be used before categorizing a patient as "refractory to
NSAID therapy" have to be clarified. The recent determination of response and remission criteria for
NSAIDs therapy is the first step towards well-defined guidelines for short-term and long-term management of
NSAIDs in AS.