Axial AS improved by NSAIDs plus COX-2 inhibitors

Combined NSAID and COX-2 inhibitor therapy can improve the symptoms of axial ankylosing spondylitis, irrespective of the presence of peripheral arthritis, according to new findings. The authors identify that the responses were greater in patients without peripheral manifestations. To evaluate the efficacy of combined selective and non-selective cyclo-oxygenase-2 (COX-2) inhibition on the axial manifestations of ankylosing spondylitis (AS) Dr Gossec's team enrolled 387 patients with active axial AS. The researchers also assessed the efficacy of this approach in the presence or absence of chronic peripheral arthritis.Participants were randomised to receive etoricoxib 90mg or 120mg once a day plus naproxen 500mg twice daily, or placebo.According to the results, combined NSAID/COX-2 inhibitors produced a significant treatment response compared with the placebo group for all efficacy measures, both in patients with and without peripheral arthritis. However, patients without arthritis experienced significantly greater improvements in pain from these drugs than did those with arthritis."The greater effects of treatment in patients without peripheral arthritis suggest that such patients may have different disease processes which are more NSAID-responsive than those in patients with peripheral arthritis," the authors comment.Dr Gossec's team call for further studies into the pathophysiology of these patients and conclude the selective and non-selective COX-2 inhibition effectively reduces spinal pain and improve other outcomes in AS patients with axial manifestations.Reference...