Newswise — CHICAGO – Anti-inflammatory pain relievers can slow the progression of ankylosing spondylitis, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Chicago.
Spondyloarthritis is the overall name for a family of inflammatory rheumatic diseases that can affect the spine, joints, ligaments and tendons. These diseases can cause pain and stiffness in the back and neck as well as pain and swelling of the joints and inflammation of the eyes, skin, lungs, and heart valves. While there is no way to prevent these diseases, early treatment by a rheumatologist can reduce pain, stiffness and loss of functionality.
Within the spondyloarthritis family is axial spondyloarthritis – a disease that affects the axial skeleton, the spine and/or sacroiliac joints (joints between the pelvis and the spine). In its more severe form, known as ankylosing spondylitis, radiographic changes may be identified in the spine and sacroiliac joints. Less severe, or earlier, axial spondyloarthritis may present with symptoms but no radiographic damage (non-radiographic axial spondyloarthritis).
Non-steroidal anti-inflammatory drugs (more commonly called NSAIDs) are a class of medications that work to decrease inflammation, pain and fever. Traditional NSAIDs include aspirin, ibuprofen (e.g., Advil®, Motrin®), naproxen (e.g., Aleve®) and many other generic and brand name drugs.
NSAIDS are effective in reduction of pain and stiffness and are considered a first option of treatment in people with ankylosing spondylitis. In addition to relieving pain and reducing inflammation, researchers suspect NSAIDS might actually slow the progression of the disease (including new bone formations in the spine – called syndesmophytes), and researchers recently studied the effect of NSAIDs on the progression of ankylosing spondylitis and non-radiographic axial spondyloarthritis.
Led by Denis Poddubnyy, MD, PhD; Martin Rudwaleit, MD, PhD; and Joachim Sieper, MD, PhD; researchers obtained cervical and lumbar spine X-rays of 164 patients (88 with ankylosing spondylitis and 76 with non-radiographic axial spondyloarthritis) at the beginning of the study and again after two years of follow up. The X-rays were reviewed and scored for structural changes such as erosions, sclerosis, vertebral squaring (caused by formation of new bone at the corners of spinal vertebrae) and syndesmophytes by two people without knowledge of when they were taken or the health history of the patients.
In addition to obtaining X-rays, the researchers noted each patient’s use of NSAIDS at the beginning of the study and again every six months for the following two years. They noted dosage and duration of each patient’s NSAID intake (high intake was defined as an average intake of 50 percent or more of the maximal dose over two years; low intake was an average of less than 50 percent of the maximal dose).
When reviewing the X-rays and comparing the disease progression to the intake of NSAIDS, the researchers noted that patients with ankylosing spondylitis who had a high NSAID intake (which was about 27 percent of the participants), in comparison to those with low intake (73 percent), had significantly lower rate of disease progression in the spine. However, no differences were found in the group of patients with non-radiographic axial spondyloarthritis. These findings remained significant –even when other factors that could affect the progression of ankylosing spondylitis and non-radiographic axial spondyloarthritis — such as the presence syndesmophytes at the beginning of the study, an elevation of proteins in blood that reflect inflammation, and smoking status — were taken into account.
“These data provide further support for the idea that NSAIDs might nave not only a symptomatic efficacy by reducing pain and stiffness, but could be able to modify the course of the disease by slowing radiographic progression of the structural changes in the spine in patients with ankylosing spondylitis,” comments Dr. Poddubnyy. “The data indicate also that those patients who are at high risk for radiographic progression [e.g., patients with ankylosing spondylitis who already have syndesmophytes] might especially benefit from the continuous use of NSAIDs. Nonetheless, such a treatment should currently be justified by an increased level of pain and stiffness, and individual risk/benefit assessments must be performed in every patient.”
The American College of Rheumatology is an international professional medical society that represents more than 8,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology. The ACR/ARHP Annual Scientific Meeting is the premier meeting in rheumatology. For more information about the meeting, visit www.rheumatology.org/education. Follow the meeting on Twitter by using the official hashtag: #ACR2011.
Editor’s Notes: Joachim Sieper, MD, PhD, will present this research during the ACR Annual Scientific Meeting at the McCormick Place Convention Center at 2:45 PM on Tuesday, November 8 in Room W475a. Dr. Poddubnyy will be available for media questions and briefing at 1:30 PM on Tuesday, November 8 in the on-site press conference room, W 175C.
Learn more about living well with rheumatic disease as well as rheumatologists and the role they play in health care. Also, discover the ACR’s Simple Tasks campaign, which highlights the severity of rheumatic diseases and the importance of early and appropriate referral to a rheumatologist.
Presentation Number: 2486B
Non-Steroidal Anti-Inflammatory Drugs Reduce Radiographic Spinal Progression in Patients with Ankylosing Spondylitis but Not in Non-Radiographic Axial Spondyloarthritis
Denis Poddubnyy (Charité Medical University, Campus Benjamin Franklin, Berlin, Germany)Hildrun Haibel (Charité – Campus Benjamin Franklin, Berlin, Germany)Joachim Listing (German Rheumatism Research Centre, Berlin, Germany)Elisabeth Märker-Hermann (Dr. Horst Schmidt Kliniken, Wiesbaden, Germany) Henning Zeidler (Medizinische Hochschule, Hannover, Germany)Jürgen Braun (Rheumazentrum Ruhrgebiet, Herne, Germany)Martin Rudwaleit (Ev. Krankenhaus Hagen-Haspe, Hagen, Germany)Joachim Sieper (Charité – Campus Benjamin Franklin, Berlin, Germany)
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.
Conclusion: 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.
References: 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.
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.
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