People with a type of arthritis called ankylosing spondylitis 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 nonsteroidal anti-inflammatory drugs (NSAIDs) 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 Maastricht, Netherlands.
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.
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Why NSAIDs?
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, NSAIDs have also been at the center of controversy over possible higher heart risks 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.
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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 dose plan.
The study was funded by Pharmacia. Pfizer, a WebMD sponsor, owns Pharmacia.
X-rays, symptoms, and side effects were noted at 10 visits.
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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.
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'Careful Recommendation'
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 people.
Click here to read WebMD's "Special Report: Painkillers Under Fire"
By Miranda Hitti, reviewed by Michael W. Smith, MD
SOURCES: Wanders, A. Arthritis & Rheumatism, June 2005; vol 52: pp 1756-1765. WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Ankylosing Spondylitis." News release, John Wiley & Sons, Inc.
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