Background Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton. It associated loss of vertebral and hips bone mineral density (BMD) due to inflammation. Both changes in biomechanical properties of the spine as decreased BMD condition increased bone fragility. The prevalence of vertebral fractures in clinical literature varies between 10-17%. Nonsteroidal antiinflammatory drugs (NSAIDs) are drugs with analgesic and anti-inflammatory effect considered the mainstay of treatment in AS. In Spain, data from the Registry of Spondyloarthopaties of the Spanish Society of Rheumatology (REGISPONSER) 2006 showed that 95% were taking NSAIDs and 61% consumed them daily. The administration of NSAIDs could be prevented continuously radiographic progression in AS as well as the risk of fractures according to the literature.
Objectives We analyzed longitudinally the impact of taking NSAIDs in BMD and the presence of fractures in a sample of 69 patients with AS.
Methods Patients with AS were included according to modified New York criteria. In such patients epidemiological characteristics (age, gender), year of diagnosis, treatment with NSAIDs (daily vs only if pain is present), toxic habits, body mass index (BMI), ESR, CRP, disease activity (BASDAI), physical measurements, function (BASFI), bone density and the presence of fractures (according to Genant semiquantitative method) were collected. We exclude patients treated with biological therapies and those treated with modifying BMD drugs or with some associated metabolic bone disease.
Results 69 patients (47 men and 22 women) were analyzed. The mean age was 49 years (23-87), with a time of disease duration of 13.4 years. The use of NSAIDs was only if the patient had pain in 66.7% of cases. Regarding BMD, 45% of patients had a decrease in BMD at the spine and 40.6% at the hip, but we didn't found statistically significant differences in the way of taking NSAIDs (p=0.61 and p=0.42 respectively). They had vertebral fractures 11 to 69 patients, with no statistically significant differences among those taking NSAIDs continuously or on demand (p=0.998). These differences were still not significant after adjustment for confounders.
Conclusions In our patients, the use of NSAIDs is mainly only if there's pain, which contrasts with the revised literature. We observed a decrease in BMD of our patients, considering that it is young population, although no differences were found in patients as the dose of NSAIDs. The incidence of fractures in our patients is 16%, with no difference between groups as taking NSAIDs. Thus we can conclude that in our AS patients taking NSAIDs daily or only if they've pain does not affect BMD or the presence of fractures.
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Vosse D, Landewé R, van der Heijde D et al. Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum Dis 2009;68:1839-42.
Disclosure of Interest None declared
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