Effect of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort
Effect of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort
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DOI：
10.1136/annrheumdis-2011-201252
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发表时间：
2012-10-01
影响因子：
27.4
通讯作者：
Sieper, Joachim
中科院分区：
文献类型：
--
作者：
Poddubnyy, Denis;Rudwaleit, Martin;Sieper, Joachim
目的探讨服用非甾体类抗炎药（NSAIDs）2年以上对强直性脊柱炎（AS）合并无放射学表现中轴型脊柱关节炎（SpA）患者放射学脊柱进展的影响。（88例AS和76例非放射学轴向SpA）根据基线时和2年随访后脊柱X线片的可用性以及NSAID摄入量的数据，选择进行该分析。根据改良的斯托克强直性脊柱炎脊柱评分（mSASSS）系统，由两名经过培训的阅片员以隐藏的随机选择顺序对脊柱X线片进行评分。计算出NSAID摄入量的指数，包括药物摄入的剂量和持续时间（NSAID指数>= 50）与显著放射学进展（定义为mSASSS恶化>= 2个单位）的可能性较低相关：与NSAID摄入量低的患者（NSAID指数< 50）相比，OR = 0.15，95%CI 0.02 - 0.96，p = 0.045（校正基线结构损伤、C反应蛋白（CRP）升高和吸烟状况）。这种效应在基线联合韧带赘生物伴CRP升高的患者中最为明显：低NSAID摄入患者的平均mSASSS进展为4.36 +/- 4.53，而高NSAID摄入患者为0.14 +/- 1.80，p = 0.02。在非放射学轴向SpA，高和低NSAIDs摄入量的患者之间的放射学进展没有显着差异被发现。结论高NSAIDs摄入量超过2年与延迟放射学脊柱进展AS。在非放射学轴向SpA中，这种影响不太明显，可能是由于该阶段脊柱中的新骨形成等级较低。
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..