New Guideline: NSAIDs Effective in Treating Ankylosing Spondylitis & Non-radiographic Axial Spondyloarthritis

In February, new recommendations were released for the treatment of ankylosing spondylitis and…|By Richard Quinn

Phenylbutazone was discovered in 1946 and promptly exhibited efficacy in various rheumatic diseases in the early 1950s. Its efficacy on pain and general well-being was especially present in ankylosing spondylitis (AS), which was then known as ‘rheumatoid spondylitis’.1 ,2 However, even in the early…

The question behind this question is really whether NSAIDs have a disease-modifying function (in preventing AS structural progression towards ankylosis), or is it merely a symptom-relieving anti-inflammatory, in which case it can be stopped once pain is gone or inflammation is controlled by "stronger" medicines like the anti-TNFs.

Non-steroidal anti-inflammatory drugs (NSAIDs), including Coxibs, are recommended as first-line drug treatment for patients with ankylosing spondylitis (AS) with inflammatory back pain and stiffness. Continuous treatment with NSAIDs is preferred for patients with persistently active, symptomatic dis...

This paper provides a straightforward answer to the previous question (which is, "maybe, but we can't be sure"), and a commonsensical approach to the management of AS that is both cost-effective yet personalised ("full-dose NSAID is first-line"). Read it.

 Dr. Lianne S. Gensler

Is NSAID to AS like MTX is to RA? The data is not robust enough to recommend that AS patients needing an anti-TNF for adequate disease control should stay on an NSAID as well to forestall structural progression; but the trend is suggestive.

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