TOPLINE:

In patients with axial spondyloarthritis (axSpA), a higher intake of non-steroidal anti-inflammatory drugs (NSAIDs) was associated with reduced radiographic spinal progression, particularly in those with radiographic disease.

METHODOLOGY:

• Researchers investigated whether the intake of NSAIDs affected the radiographic spinal progression in patients with axSpA, using data from a German cohort.
• They included 252 patients with axSpA (139 with non-radiographic and 113 with radiographic disease; mean age, 35.9 years; 50% men). All patients had at least two consecutive spinal radiographs.
• NSAID intake, stratified by drug type, was assessed over a 10-year follow-up period and scored between 0 and 100, with 0 representing no use and 100 representing full-dose daily use.
• The outcome was an increase in the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) assessed on spinal radiographs over an interval of 2 years.

TAKEAWAY:

• At baseline, 80% of patients were taking NSAIDs, with 18% taking COX-2 inhibitors and 62% taking non-selective NSAIDs. The mean total NSAID intake score was 38.3 points.
• Each 10-point increase in the NSAID intake score was associated with a smaller increase in the mSASSS (adjusted beta coefficient, -0.052; 95% CI, -0.097 to -0.007), consistent across models.
• The effect was evident in patients with radiographic axSpA (adjusted beta coefficient, -0.077; 95% CI, -0.152 to -0.003) but not in those with non-radiographic axSpA.
• Among all patients, a slightly larger reduction in score progression was seen with COX‑2 inhibitors than with non‑selective NSAIDs (adjusted beta coefficient, -0.061 vs -0.045 per 10‑point higher intake), but the difference was not statistically significant.

IN PRACTICE:

"Although NSAIDs are currently recommended as the first-line therapy to manage axSpA symptoms, their potential effect on slowing structural damage may add another dimension to their therapeutic value," the authors of this study wrote.

SOURCE:

This study was led by Murat Torgutalp, MD, MSc, Charité – Universitätsmedizin Berlin in Berlin, Germany. It was published online on November 27, 2025, in Arthritis & Rheumatology.

LIMITATIONS:

This study lacked data on MRI-detected inflammation and key comorbidities that could have influenced the results. Excluding patients without consecutive spinal radiographs may have introduced attrition bias. The use of NSAIDs was self-reported by patients, which may have introduced recall bias.

DISCLOSURES:

This study received initial funding from the German Federal Ministry of Education and Research, with additional support from Abbott/AbbVie, Amgen, Centocor, Schering-Plough, and Wyeth. Since 2010, AbbVie has provided support, along with grants from the ANCYLOSS, ArthroMark, and METARTHROS projects. Several authors reported receiving travel support, grants, and speaker fees and having other financial ties with multiple pharmaceutical and healthcare companies including AbbVie, Janssen, and Novartis.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.