Effect of NSAIDs on Ankylosing Spondylitis

[Mike Bartolatz]

EFFECT OF NSAIDs ON RADIOGRAPHIC PROGRESSION IN AS

In the first Plenary Session of the meeting, Désirée van der Heijde from the University Hospital Maastricht, Maastricht, The Netherlands, reported the results of the first prospective study of the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on radiographic progression in ankylosing spondylitis (AS). The investigators studied 215 AS patients fulfilling the modified New York criteria, who had previously participated in a 6-week randomized clinical trial comparing celecoxib, ketoprofen, and placebo (Dougados M, et al. Arthritis Rheum. 2001;44:180-185.).

Patients were randomly allocated to either continuous treatment (celecoxib 100 mg twice daily) (n=111) or discontinuous treatment (celecoxib on demand) (n=104) for 2 years. The dosage was increased to 200 mg celecoxib twice daily in case of severe pain. The patient could switch to another NSAID, but had to be maintained on the same treatment strategy. Lateral radiographs of the lumbar and cervical spine were performed at inclusion and at 2 years to evaluate radiographic progression. These radiographs were scored according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) by one reader, with concealed time order. Complete sets of X-rays were available for 76 patients in the continuous group and for 74 in the discontinuous group. The study found that a treatment strategy of every-day, fixed-dose, NSAID therapy is significantly more efficacious in slowing radiographic progression compared to a strategy of taking NSAIDs on demand. This is the first trial in AS that proves a slowing of radiographic progression by treatment