Daily Treatment Slows Ankylosing Spondylitis
Continuous Use of Anti-Inflammatory Drugs May Be Better Than As-Needed Approach
June 2, 2005 -- People with a type of arthritis called may fare better by taking anti-inflammatory drugs on a
steady schedule instead of on an as-needed basis.
So say European researchers in June's issue of Arthritis & Rheumatism.
In their two-year study, X-rays showed that the disease progressed more slowly
in patients taking
continuously, compared with those who took the drugs when needed.
Ongoing use of NSAIDs didn't substantially increase side effects. This
provides a strong indication that regular use of NSAIDs may slow disease
progression, according to Astrid Wanders, MD, of University Hospital in
Ankylosing spondylitis affects the spine, causing pain and stiffness from
the neck to the lower back. The bones of the spine, called vertebrae, may grow
or fuse together, resulting in a rigid spine.
NSAIDs have been shown to provide rapid relief of inflammatory back pain and
stiffness, as well as improving physical function, say the researchers.
"NSAIDs are among the most frequently prescribed drugs for [ankylosing
spondylitis], but toxic effects on the gastrointestinal tract limit their
long-term use," they write.
Since last fall in some patients. This study was
conducted in France years before that (1998-2001). Most participants were in
their late 30s or early 40s and therefore at low risk of heart problems.
Continuous vs. As-Needed Treatment
Wanders and colleagues studied 215 people with ankylosing spondylitis.
Participants were randomly assigned either to take NSAIDs daily for two
years or to take NSAIDs as needed during that time. Doses started with 100
milligrams of Celebrex twice daily; participants could raise that to 200
milligrams twice daily or switch to another NSAID while sticking to the same
The study was funded by Pharmacia. Pfizer, a WebMD sponsor, owns
X-rays, symptoms, and side effects were noted at 10 visits.
Slower Progression With Continuous Treatment
X-rays showed that the disease progressed more slowly in the
continuous-treatment group. Those patients also tended to have more cases of
high blood pressure, abdominal pain, and indigestion, but the differences
weren't significant, say the researchers.
However, symptoms of depression were significantly more common in the
continuous-treatment group (15 people, compared to four in the on-demand
group). The reasons for this are unclear.
Only one serious side effect was considered to be related to the study's
medication. That person, who was in the on-demand group, had severe abdominal
pain requiring hospital admission.
The findings need to be confirmed, say the researchers.
"While awaiting confirmation of these results, we carefully recommend
that if patients need treatment with NSAIDs to reduce the signs and symptoms of
ankylosing spondylitis, they should take NSAIDs continuously instead of as
needed based on symptoms," write the researchers.
They say they can't recommend NSAIDs to ankylosing spondylitis patients who
don't need NSAIDs to manage their symptoms, since they don't have data for such