The Impact of Nonsteroidal Anti-Inflammatory Drugs on Radiographic Spinal Progression in Patients With Axial Spondyloarthritis: 10-Year Results From an Inception Cohort.
prospective_cohort · Level II
Where this comes from
- Record sourced from PubMed, PMID 41310944.
- Also identified by DOI 10.1002/art.43447 and PMC identifier 12991912.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
This study aims to investigate the impact of nonsteroidal anti-inflammatory drug (NSAID) intake on radiographic spinal progression in axial spondyloarthritis (axSpA), considering different NSAID types (COX-2 inhibitors [COX2i] and nonselective NSAIDs [ns-NSAIDs]) and disease subgroups (radiographic [r-axSpA] and nonradiographic [nr-axSpA]). Leveraging data from the German Spondyloarthritis Inception Cohort (GESPIC), we conducted analyses on 252 patients with axSpA (139 with nr-axSpA and 113 with r-axSpA), who had minimum two sets of spinal radiographs. The outcome was progression in modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) in two-year intervals. We fitted sequential conditional mean models by using generalized estimating equations and adjusting for longitudinal repeated measures of exposure and time-dependent confounders. We report β-coefficients with 95% confidence intervals (CIs) for outcomes reflecting the progression in mSASSS per 10-point increase in NSAID intake score. At baseline, 201 (80.0%) patients were under NSAID treatment, with 46 (18%) taking COX2i and 156 (62%) taking ns-NSAIDs, and mean total NSAID intake score was 38.3 ± 35.5. A 10-point increase in NSAID intake score was associated with retardation of radiographic progression (β = -0.052, 95% CI: -0.097 to -0.007), with this effect being most pronounced in patients with r-axSpA (β = -0.077, 95% CI: -0.152 to -0.003). COX2i showed a slightly lower point estimate (although not statistically significant) in progression compared to ns-NSAIDs among all patients with axSpA (β = -0.061 and -0.045, respectively). Our findings suggest a beneficial effect of higher NSAID intake, particularly COX2i, on slowing radiographic progression in axSpA. These findings may help inform therapeutic strategies, particularly in r-axSpA, although further research is needed for nr-axSpA.
Medical subject headings
- Anti-Inflammatory Agents, Non-Steroidal
- Cyclooxygenase 2 Inhibitors
- Axial Spondyloarthritis
- Spine