Background Current guidelines for the treatment of spondyloarthritis with predominantly axial lesion (axSpA) consider non-steroid anti-inflammatory drugs (NSAIDs) as a first-line medication. There are limited data that NSAIDs can reduce active sacroiliitis in patients with axSpA . However, it is unclear whether the ability of NSAIDs to reduce bone marrow oedema is property dependent on the dose and mode of drug intake.
Objectives The aim of the present study is to evaluate the effectiveness of different modes of etoricoxib (ET) administration in active sacroiliitis reduction in patients with axSpA.
Methods 40 patients with axSpA fulfilling ASAS criteria (10 non-radiographic axSpA/30 ankylosing spondylitis patients fulfilled the modified New York criteria) with the Bath Ankylosing Spondylitis Index (BASDAI) ≥4 and active sacroiliitis as defined by ASAS  were randomized into 2 groups: 20 patients received 90 mg of ET per os daily (group 1), 20 patients received 90 mg of ET per os 3 times per week (group 2). Magnetic Resonance Imaging (MRI) of sacroiliac joints (SIJ) at least in STIR sequence was performed at baseline and week 12. MRI images were anonymized and scored by reader, blinded from the clinical data. Scoring of SIJ osteitis was performed per quandrant: 0 points - no osteitis; 1 - osteitis less than 33% of the area of the quadrant; 2 - 33% - 66%; 3 - 66% or more; “99” – results cannot be estimated. Afterwards scores were summed - 0-12 points for each SIJ, 0-24 for patient. The primary study endpoint was the percentage of patients who achieved the decrease of total score of osteitis (TSO) at week 12. Statistics was performed in SPSS17.
Results Groups 1 and 2 were matched in age, sex, disease activity. At week 12 TSO decreased in 33 (82.5%) patients totally. Primary endpoint was achieved in 19 patients in group 1 and in 14 – in group 2. Active sacroiliitis completely resolved in 15 (37.5%) patients: in 11 (55%) patients constantly taking ET and in 4 (20%) patients with rare ET intake, p=0.08.
The TSO at week 12 totally reduced from 6.5 [4. 9] to 2 [0. 5], n=40, p<0.0001 for the difference with baseline. In group 1 TSO decreased from 6.5 [4; 8.5] to 0 [0, 3], n=20, p<0.0001. In this group, 19 patients had improvement (95%), one - unchanged. TSO in group 2 decreased from 6.5 [4, 10] to 4.0 [1, 8], n=20, p=0.49. 14 patients of group 2 had an improvement in TSO, 4 (20%) – worsening of TSO and 2 (10%) patients had no changes. There was no difference between mean TSO achieved in the both groups at week 12, p=0,056.
Conclusions 12 weeks of 90 mg etoricoxib administration lead to the decrease of active sacroiliitis in patients with axSpA. Daily intake of etoricoxib leads to greater reduction of total osteitis score in more patients than etoricoxib administration 3 times or less per week.
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Disclosure of Interest None declared