Abstract
OBJECTIVE: This study aims to investigate the impact of nonsteroidal anti-inflammatory drug (NSAID) intake on radiographic spinal progression in axial spondyloarthritis (axSpA), considering different NSAID types (COX-2 inhibitors [COX2i] and nonselective NSAIDs [ns-NSAIDs]) and disease subgroups (radiographic [r-axSpA] and nonradiographic [nr-axSpA]). METHODS: Leveraging data from the German Spondyloarthritis Inception Cohort (GESPIC), we conducted analyses on 252 patients with axSpA (139 with nr-axSpA and 113 with r-axSpA), who had minimum two sets of spinal radiographs. The outcome was progression in modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) in two-year intervals. We fitted sequential conditional mean models by using generalized estimating equations and adjusting for longitudinal repeated measures of exposure and time-dependent confounders. We report β-coefficients with 95% confidence intervals (CIs) for outcomes reflecting the progression in mSASSS per 10-point increase in NSAID intake score. RESULTS: At baseline, 201 (80.0%) patients were under NSAID treatment, with 46 (18%) taking COX2i and 156 (62%) taking ns-NSAIDs, and mean total NSAID intake score was 38.3 ± 35.5. A 10-point increase in NSAID intake score was associated with retardation of radiographic progression (β = -0.052, 95% CI: -0.097 to -0.007), with this effect being most pronounced in patients with r-axSpA (β = -0.077, 95% CI: -0.152 to -0.003). COX2i showed a slightly lower point estimate (although not statistically significant) in progression compared to ns-NSAIDs among all patients with axSpA (β = -0.061 and -0.045, respectively). CONCLUSION: Our findings suggest a beneficial effect of higher NSAID intake, particularly COX2i, on slowing radiographic progression in axSpA. These findings may help inform therapeutic strategies, particularly in r-axSpA, although further research is needed for nr-axSpA.