#2-73E. NSAIDs and Spinal Progression in AxSpA: 10-Year Cohort Insights (ACRJs, 2024)

Does prolonged non-steroidal anti-inflammatory drug (NSAID) use truly offer disease-modifying benefits beyond symptom control in patients with axial spondyloarthritis (axSpA)? This 10-year longitudinal study utilized the German Spondyloarthritis Inception Cohort (GESPIC) data to investigate the association between NSAID intake score—differentiating between COX-2 inhibitors (COX2i) and non-selective NSAIDs (ns-NSAIDs)—and radiographic spinal progression, measured by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), across both radiographic (r-axSpA) and non-radiographic (nr-axSpA) subsets. The critical finding indicates that higher NSAID intake is consistently associated with a statistically significant retardation of radiographic progression, particularly pronounced in patients with r-axSpA (β: -0.077, 95% CI: -0.152, -0.003). Furthermore, COX2i showed a numerically stronger effect compared to ns-NSAIDs across the whole axSpA spectrum. However, clinicians must consider the limitation that NSAID usage data relied on patient self-report, introducing the potential for recall bias. This research is pivotal for rheumatologists, as it supports optimizing NSAID use as a potential strategy to slow irreversible structural damage in r-axSpA patients, providing robust evidence for long-term therapeutic tailoring, provided cardiovascular and gastrointestinal risks are managed appropriately.

Citation: Murat Torgutalp, Valeria Rios Rodriguez, Fabian Proft, Mikhail Protopopov, Judith Rademacher, Hildrun Haibel, Joachim Sieper, Martin Rudwaleit, Denis Poddubnyy. The impact of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: 10-year results from an inception cohort. ACR journals. 2024. DOI: 10.1002/art.43447

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