Background Co treatment of NSAIDs with TnFα inhibitors (TnFi) in patients with early active Axial SpA was associated with increased levels of remission (INFAST trial)
Objectives To investigate any effects of the addition of NSAIDs in patients with Axial SpA in remission with TnFi.
Methods 40 patients with AxSpA (28 with Ankylosing Spondylarthritis (AS), 9 with Psoriatic Axial SpA (PsAS) and 3 with Inflammatory Bowel Disease Axial SpA (IBDAS) 32 men, 8 women with mean age 40,8±13,29, with mean disease duration 12,46 years ±11,8 all under anti TnFa Inhibitor treatment (Adalimumab n=9, Etanercept n=7, Golimumab n=10, Infliximab n=14) in clinical remission, with BASDAI <4 and ASDASTKE < 2,1 before NSAIDs administration. We decided to add etoricoxib 90mg n=23 or Indomethacin 150 mg n=17 in a non randomized trial for a period of 1 month when we reassessed all clinical and laboratory indices ESR, CRP, BASDAI and ASDASESR.
Results All patients were tolerated NSAIDs well, with no serious adverse events. Most of them had developed significant improvement in the clinical parameters of BASDAI and ASDASESR indices. Mean BASDAI at the beginning was 2,33 and ASDAS 1,99. After the addition of NSAIDs the mean values decreased to 0,93 and 1,46 respectively, differences statistically significant p<0,0001. The most significant improvement was noticed in the second question of the BASDAI index and was associated with neck pain, where many patients, especially those with advanced disease, don't respond adequately to TnFi. There were no differences in the levels of inflammation indices.
Conclusions The addition of NSAIDs in patients with AxSpA in clinical remission with TnFi treatment, promoted significant improvement in parameters such as pain and stiffness. In our opinion bigger trials (number of patient and duration) with co-estimation of imaging findings will be useful to determine the position of NSAIDs in the treatment of patients with AxSpA.
Sieper J et al. Ann Rheum Dis. 2014 Jan;73(1):101-7
Disclosure of Interest None declared