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Effect of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort
  1. Denis Poddubnyy1,
  2. Martin Rudwaleit2,
  3. Hildrun Haibel1,
  4. Joachim Listing3,
  5. Elisabeth Märker-Hermann4,
  6. Henning Zeidler5,
  7. Jürgen Braun6,
  8. Joachim Sieper1
  1. 1Med. Department I, Rheumatology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
  2. 2Endokrinologikum, Berlin, Germany
  3. 3Department of Epidemiology, German Rheumatism Research Centre, Berlin, Germany
  4. 4Department of Rheumatology, Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
  5. 5Department of Rheumatology, Medizinische Hochschule, Hannover, Germany
  6. 6Rheumazentrum Ruhrgebiet, Herne, Germany
  1. Correspondence to Joachim Sieper, Med. Department I, Rheumatology, Charité – Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; joachim.sieper{at}


Objective To investigate the influence of non-steroidal anti-inflammatory drugs (NSAIDs) intake on radiographic spinal progression over 2 years in patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (SpA).

Methods 164 patients with axial SpA (88 with AS and 76 with non-radiographic axial SpA) were selected for this analysis based on availability of spinal radiographs at baseline and after 2 years of follow-up and the data on NSAIDs intake. Spinal radiographs were scored by two trained readers in a concealed randomly selected order according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) system. An index of the NSAID intake counting both dose and duration of drug intake was calculated.

Results High NSAIDs intake (NSAID index≥50) in AS was associated with lower likelihood of significant radiographic progression defined as an mSASSS worsening by ≥2 units: OR=0.15, 95% CI 0.02 to 0.96, p=0.045 (adjusted for baseline structural damage, elevated C reactive protein (CRP) and smoking status) in comparison with patients with low NSAIDs intake (NSAID index<50). This effect was most pronounced in patients with baseline syndesmophytes plus elevated CRP: mean mSASSS progression was 4.36±4.53 in patients with low NSAIDs intake versus 0.14±1.80 with high intake, p=0.02. In non-radiographic axial SpA, no significant differences regarding radiographic progression between patients with high and low NSAIDs intake were found.

Conclusion A high NSAIDs intake over 2 years is associated with retarded radiographic spinal progression in AS. In non-radiographic axial SpA this effect is less evident, probably due to a low grade of new bone formation in the spine at this stage.

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  • Funding As part of the German competence network in rheumatology (Kompetenznetz Rheuma), GESPIC has been financially supported by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung – BMBF), grant number: FKZ 01G19946. As funding by BMBF was reduced according to schedule in 2005 and stopped in 2007, complementary financial support has been obtained also from Abbott, Amgen, Centocor, Schering-Plough and Wyeth. Since 2010, additional support has being obtained also from ANCYLOSS and ArthroMark projects funded by the German Federal Ministry of Education and Research.

  • Competing interests None.

  • Ethics approval Approval provided by the Central Ethics Committee (Berlin) und local committees of the involved centres.

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

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