NSAIDs Slow AS Progression

Many people with arthritis take nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen (brand name Aleve), to get a little relief from the inflammation and pain associated with the condition. However, studies recently published in the Annals of Rheumatic Diseases suggest NSAIDs may do much more than that for people with ankylosing spondylitis (AS), and an editorial published with the studies wonders: Could NSAIDs be the disease-modifying antirheumatic drugs (DMARDs) to put the brakes on spinal arthritis?

Ankylosing spondylitis is a form of arthritis that primarily affects the spine. Inflammation between the bones of the spine and between the spine and pelvis can lead to pain and stiffness and ultimately cause these bones to fuse together. However, a pair of studies suggests that taking NSAIDs can slow the progression of this arthritis form.

An observational study from Germany looked at 88 people with ankylosing spondylitis and 76 people with a milder form of spinal arthritis called non-radiographic axial spondyloarthritis over the course of two years. Researchers found that of the people with AS, those with a high intake of NSAIDs had an 85% lower likelihood of significant radiographic progression than people who took less of the drugs. Although they didn’t find the same difference in people with the condition’s milder form, the study’s author’s suggested that that could be because the condition was still in its early stages in those participants and thus would have progressed slowly with or without medicine.

Another study looking at 150 people with ankylosing spondylitis found the progression of the condition was slower in people who took NSAIDs continuously than it was in people who took them “on-demand.”

An editorial published along with the studies cited other research and the affects NSAIDs have on bones as further evidence that NSAIDs could serve as disease-modifying antirheumatic drugs to slow the progression of AS. However, the editorial cautioned that “the effect on an individual patient may be difficult to predict,” and that “treatment of AS must be customised to the individual patient.”

The editorial also offered four questions to help guide physicians in the use of NSAIDs in the treatment of AS. These guiding questions pointed out that people with ankylosing spondylitis have an increased risk of gastrointestinal bleeding, and that the use of NSAIDs could increase that risk.

Cooper B. Wilhelm is an Editorial Assistant at Arthritis Self-Management.

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