Efficiency of treatment with non-steroidal anti-inflammatory drugs according to current recommendations in patients with radiographic and non-radiographic axial spondyloarthritis.

Abstract

OBJECTIVE:

NSAIDs are first-line therapy in axial SpA (axSpA). The proportion of patients responding to NSAIDs and differences between AS and non-radiographic axSpA (nr-axSpA) in this regard have not been studied in detail to date. The aim of this study was to examine the proportion of patients with AS and nr-axSpA responding to NSAIDs according to current treatment recommendations.

METHODS:

Consecutive anti-TNF-naïve patients with nr-axSpA and AS (n = 50 each) were included if their BASDAI score was ⩾4 without having received maximal NSAID doses. In case of a BASDAI score ⩾4 1 week later, another NSAID was prescribed. For the next 3 weeks, continuous intake of maximal doses was recommended but patients could reduce doses in case of intolerance or improvement. MRI of the SI joints was performed at baseline and week 4.

RESULTS:

All outcomes except for CRP and MRI scores improved significantly after 4 weeks of NSAIDs, with no difference between axSpA subgroups. An Assessment of SpondyloArthritis international Society 40% (ASAS40) response and partial remission rates were 35 and 16% at week 4, respectively. At the same time point, a BASDAI score ⩾4 was still present in 44% of patients, 30% of which had reduced NSAID doses, partly due to intolerance (38%). Only 13% of all patients had continuously taken NSAIDs at the maximal dosage, but there was no difference in the efficacy outcome compared with those who had taken reduced doses.

CONCLUSION:

AS and nr-axSpA patients had similar response rates to NSAIDs while objective signs of inflammation did not change over 4 weeks. Only a minority of patients was willing to take maximal doses of NSAIDs, and ⩾40% patients remained candidates for TNF blockers. These results may influence future trial designs.

• Authors: Xenofon Baraliakos, Uta Kiltz, Soeren Peters, Heiner Appel, Friedrich Dybowski, Manfred Igelmann, Ludwig Kalthoff, Dietmar Krause, Hans-Juergen Menne, Ertan Saracbasi-Zender, Elmar Schmitz-Bortz, Mathura Vigneswaran, Juergen Braun
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 56 Issue 1 Pg. 95-102 (01 2017) ISSN: 1462-0332 [Electronic] England
• PMID: 27997346 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected].

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Cyclooxygenase 2 Inhibitors
• C-Reactive Protein

Topics

• Adult
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• C-Reactive Protein (immunology)
• Cyclooxygenase 2 Inhibitors (therapeutic use)
• Female
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Practice Guidelines as Topic
• Prospective Studies
• Radiography
• Sacroiliac Joint (diagnostic imaging)
• Spondylarthritis (diagnostic imaging, drug therapy, immunology)
• Spondylitis, Ankylosing (diagnostic imaging, drug therapy, immunology)
• Treatment Outcome