ArticleBMC rheumatology2025
Use of nonsteroidal anti-inflammatory drugs in patients with axial spondyloarthritis receiving biotherapy and associated factors: a prospective cohort study.
Article in BMC rheumatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe objectives of this study were to evaluate NSAID use over time in patients with axial spondyloarthritis (axSpA) receiving biologic therapy, to determine the prevalence of axSpA remission without NSAIDs, and to identify factors associated with continued NSAID use after one year of follow-up.
methodsThis is a prospective longitudinal study included 85 patients with axSpA who were diagnosed according to the ASAS criteria and treated with biologics. Assessments were performed at baseline and at 3,6, and 12 months, and disease activity was evaluated with the ASDAS-CRP, BASDAI, and CRP. Data on NSAID use and type were collected, and the ASAS-NSAID index was calculated. This prospective longitudinal study included 85 patients with axSpA, diagnosed according to the ASAS criteria and treated with targeted therapies, regardless of the duration of prior exposure. All patients received targeted therapies. Assessments were conducted at baseline and at 3, 6, and 12 months. Disease activity was evaluated using the ASDAS-CRP, BASDAI, and CRP. Data on NSAID use, type, and dosage were collected, and the ASAS-NSAID index was calculated. At baseline, patients were categorized into two groups according to their NSAID use status, and baseline characteristics were compared accordingly.
resultsThe mean age was 37.46 ± 11 years, with a male predominance (69.4%). Axial radiographic involvement was present in 87.1% of patients. The mean disease duration was 12 years [9–19.25], with a median time from diagnosis to biologic initiation of 3 years [1–8.5]. Thirty-four patients (40%) were in remission. At baseline, 42.3% of the participants used NSAIDs, which significantly declined to 11.5% at M12 (p < 0.001). At M12, 36.1% of patients achieved remission, all without NSAIDs. The ASAS-NSAID score significantly decreased over time. Persistent NSAID use at M12 was due primarily to mechanical pain (57.1%) rather than to inflammatory activity (42.9%). Multivariate analysis revealed that mechanical pain was the main factor associated with continued NSAID use.
conclusionBiologic therapy significantly reduces NSAID use and ASAS-NSAID scores in axSpA patients, highlighting the NSAID-sparing effect of bDMARDs. Additionally, NSAID use is not always linked to SpA activity but may be driven by mechanical pain. CLINICAL TRIAL NUMBER: Not applicable.
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