Background Although nonsteroidal anti-inflammatory drug (NSAIDs) is effective in relieving joint pain in rheumatoid arthritis (RA) patients, long-term use of NSAIDs can cause adverse effects on gastrointestinal or cardiovascular organs. When patients discontinue daily use of NSAIDs, there is often a dichotomous clinical response in patient-reported outcomes (PRO).
Objectives We aimed to examine the clinical outcome especially joint pain, and its associated factors in RA patients with low disease activity (LDA) after discontinuing NSAIDs.
Methods This study was a 16-week, multi-center prospective open-label trial conducted at eight rheumatology clinics in Korea. RA patients who achieved LDA (DAS28 <3.2) who were on NSAIDs for more than 2 consecutive months, discontinued the NSAID. Acetaminophen (AAP) was used as the rescue medication. During the study period, changes of DAS28 and PRO including pain visual analogue scale (VAS) and Routine Assessment of Patient Index Data 3 (RAPID-3) score were assessed. NSAIDs were restarted when patient's 1) pain was uncontrolled with AAP and 2) PRO were aggravated. The endpoint was to analyze the group of patients who continued to withdraw NSAIDs within the study period. Patients were further classified to have “sustained effectiveness” who met the following: 1) 16-week pain VAS ≤30 mm or increase less than 20% from baseline and 2) 16-week RAPID-3 score ≤6 or increase less than 20% from baseline.
Results A total of 121 RA patients with LDA were enrolled in the study. Four patients were lost to follow-up. At the end of the study, 18 (15.3%) patients had restarted NSAIDs owing to uncontrolled pain. In general, there was a difference in pain VAS between baseline (median 15 mm (IQR 5–20)) and 16 weeks (median 17 mm (IQR 5–40)) (p=0.022). Changes of DAS28 and RAPID-3 were insignificant in patients taking on-demand AAP (n=99) (0 versus 16 weeks; DAS28, p=0.111; RAPID-3; p=0.339). Moreover, 60% of the total patients (73/117) ended up to show sustained effectiveness without restarting NSAIDs. By using a multivariate logistic regression model, we found out that joint swelling was the detrimental factor compromising sustained effectiveness (OR 0.312, 95% C.I. 0.125–0.777, p=0.012).
Conclusions Discontinuation of NSAIDs can be attempted in RA patients with LDA, especially in those without swollen joints at the time point of its cessation.
Disclosure of Interest None declared