Ann Rheum Dis 71:1623-1629 doi:10.1136/annrheumdis-2012-201370
  • Clinical and epidemiological research
  • Extended report

Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis

Editor's Choice
  1. Désirée van der Heijde1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Rheumatology, AVU Amsterdam, Amsterdam, The Netherlands
  3. 3Department of Rheumatology, Atrium Medical Center Heerlen, Heerlen, The Netherlands
  4. 4Paris-Descartes University, Paris, France
  5. 5Department of Rheumatology, Cochin Hospital, Paris, France
  1. Correspondence to Désirée van der Heijde, Leiden University Medical Center, Rheumatology, PO Box 9600, 2300 RC Leiden, The Netherlands; mail{at}
  1. Contributors All authors participated in the design of the analyses. FK, RBML and DvdH performed the analyses. All authors participated in drafting the paper and finally all authors approved the final manuscript.

  • Accepted 7 March 2012
  • Published Online First 24 April 2012


Objectives The aim was to compare continuous and on-demand NSAID treatment with respect to their ability to suppress radiographic progression in subgroups of patients with high/elevated CRP-levels, ESR, ASDAS-levels or BASDAI-levels in comparison to patients with normal levels.

Methods Post-hoc analyses were performed in a randomized trial comparing continuous and on-demand NSAID treatment. Relevant high/elevated subgroups were created based on time-averaged (ta) CRP (>5mg/L), ta-ESR (>12mm/hr), ta-BASDAI (>4), ta-ASDAS-CRP (>2.1) and ta-ASDAS-ESR (>2.1). Subgroups were further split according to NSAID-use (continuous vs. on-demand). Radiological progression was presented in probability plots. Statistical interactions were tested using multiple and logistic regression analysis. Differences in radiological progression were analysed using the Chi-square and Mann-Whitney U test.

Results 150 participants randomized to either the continuous-treatment group (n=76), or the on-demand group (n=74) had complete radiographs and were included. The effect of slowing radiological progression with continuous NSAID therapy was more pronounced in patients with elevated ta-CRP-levels, elevated ta-ESR, high ta-ASDAS-CRP or high ta-ASDAS-ESR versus patients with low/normal values. No such effect was found for participants with high vs. low BASDAI. Also, in participants with elevated ta-ESR (irrespective of treatment), there appeared to be a higher rate of structural progression than in participants with normal ta-ESR. Regression analyses showed that continuous NSAID treatment neutralizes the negative effect of inflammation (high ta-ESR).

Conclusions Patients with elevated acute phase reactants seem to benefit most from continuous treatment with NSAIDs. Continuous NSAID-therapy in patients with elevated acute phase reactants may lead to an improved benefit-risk-ratio of these drugs.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.