Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Continuance of Non-Steroidal Anti-Inflammatory Drugs May Reduce Radiographic Progression in Ankylosing Spondylitis Patients on Biological Therapy.

Haroon1,  Nigil, Shen2,  Hua, Carty3,  Adele, Anton3,  Ammepa, Cook2,  Richard J., Inman1,  Robert D.

Toronto Western Research Institute, University Health Network and University of Toronto, Toronto, ON
University of Waterloo, Waterloo, ON
Toronto Western Hospital, Toronto, ON


Anti-TNF therapy has brought significant improvement in symptoms and quality of life of patients with ankylosing spondylitis (AS). However a reduction in the rate of progression of radiographic damage has not been clearly demonstrated. The only therapy that has been shown to affect radiographic damage is the continuous use of non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs are commonly discontinued once symptoms are well controlled with biologics. We aimed to study the effect of continuous NSAID therapy in patients with AS who are already on biologics.


In this study 20 patients with AS (modified New York criteria) on anti-TNF therapy who continued their NSAIDS (B+N), were followed with X-rays at 2 years and clinical evaluation annually. For comparison, 20 AS patients on biological therapy (B) in whom NSAIDs had been discontinued were assessed. All patients were assessed on a regular basis on a longitudinal protocol. Disease activity was assessed by BASDAI, CRP and ESR. BASFI, BASG and BASMI were recorded. X-rays were obtained at baseline and follow up and scored using the mSASSS method. Absolute change in mSASSS and rate of change (change per year) were calculated and used as dependant variables. Mann-Whitney test and Fisher's exact test were used where appropriate.


The mean (SD) age of onset of AS for B was 21 (9.1) years and for B+N 18.9 (8.5) years. There was no significant difference in the age of onset or diagnosis of AS between the two groups. There were three females in both groups. HLA B27 was positive in 12 and 15 patients respectively in the B and B+N groups. The baseline mSASSS scores were comparable (B: 12.35 ± 16.9; B+N:13.4 ± 18.5). The baseline BASMI, CRP and ESR were comparable in the two groups. The baseline BASDAI was higher in the B+N group (3.93 ± 2.1 vs 2.6 ± 2.2; p=0.05). There was a trend at baseline towards higher BASFI (3.5 ± 2.7 vs 2.1 ± 2.1) and BASG (4.1 ± 2.5 vs 2.6 ±2.3) in the B+N group. The mean change in mSASSS over 2 yr was 3.05 ± 6.2 in group B compared to only 0.2 ± 3.4 units in group B+N (p=0.08). The rate of change in mSASSS also was similarly different with 2.508 ± 5.9 units change per year seen in group B compared to much lower progression at 0.05 ± 2.1 units per year in group B+T (p=0.09). There was no difference in the prevalence of extra-articular manifestations in the two groups.


The results point towards a trend reflecting less radiographic progression when NSAIDs are continued after the institution of biologic therapy in AS. Larger studies are needed to confirm this observation.

To cite this abstract, please use the following information:
Haroon, Nigil, Shen, Hua, Carty, Adele, Anton, Ammepa, Cook, Richard J., Inman, Robert D.; Continuance of Non-Steroidal Anti-Inflammatory Drugs May Reduce Radiographic Progression in Ankylosing Spondylitis Patients on Biological Therapy. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1303

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