Background/Purpose: Conventional treatments include NSAID and physiotherapy remain the mainstay of treatment in Ankylosing Spondylitis (AS). After the failure of conventional therapy, DMARD therapies are recommended for better outcomes in patients with AS. The aim of this study was to compare the effectiveness of DMARD therapies on NSAID intake, quality of life, and physical functioning and to investigate the relation between disease status parameters and functional outcomes.

Methods: A total of 68 patients were assessed using tools to measure disease (the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Functional Index [BASFI], and Metrology Index [BASMI]), physical functioning (Health Assessment Questionnaire for the Spondylarthropathies [HAQ-S]), fear of movement (Tampa Scale for Kinesiophobia [TSK]), and quality of life (Ankylosing Spondylitis Quality of Life Scale [ASQoL]) status from the patient’s perspective. To calculate NSAID intake, the type of NSAID, dose, percentage of days with intake were recorded, along with DMARD therapy, age, body mass index (BMI), and disease duration. The NSAID equivalent scoring was calculated according to recommendations from longitudinal clinical studies. The drug therapy groups were compared using the Kruskal-Wallis test and the Chi-square test. Correlation between the scales was evaluated by Spearman’s correlation coefficient.

Results: A total of 68 patients (36 women, 32 men; mean age:44.37±10.06 years; mean disease duration:9.63±8.63 years) treated with 4 different DMARDs (Adalimumab+Golimumab=17; Infliximab =17; Etanercept =14; Sulphasalazine =20) were included. NSAID intake was significantly lower in the Infliximab therapy (INFX) (mean:29.34±86.13) compared to the Adalimumab+Golimumab therapy (ADA+GO) (mean:33.25±76.04;p=0.011); the Etanercept therapy (ETA) (mean:33.47±58.23;p=0.041) and the Sulphasalazine therapy (ST) (mean: 74.54±83.30;p=0.002). ASQoL scores were significantly lower in the INFX (mean:3.65±6.17;p=0.011), the ADA+GO therapy (mean:4.35±6.99;p=0.048) and the ETA therapy (mean:4.00±6.13;p=0.013) compared to the ST (mean:10.00±7.07). HAQ-S scores were significantly lower in the ETA therapy (mean:0.34±0.50; p=0.013) and the ADA therapy (mean:0.35±0.44;p=0.024). BMI (p=0.475), disease duration (p=0.551), TSK (p=0.132), BASDAI (p=0.069), BASFI (p=0.271), and BASMI (p=0.769) were similar between DMARD therapies. Age (r=0.400; p=0.001) and disease duration (r=0.255;p=0.037) were correlated with BASMI. There were significant positive correlations between BMI and HAQ-S (r=0.268; p=0.027), BASFI (r=0.245;p=0.044), and ASQoL (r=0.283;p=0.019). TSK was correlated with ASQoL (r=-0.261;p=0.031).

Conclusion: The results suggest that the ability of specific DMARDs to decrease NSAID intake might be considered clinically relevant. The INFX therapy had superior results on NSAID intake and quality of life while the ETA and the ADA+GO therapy were more effective on physical functioning independent of BMI, disease duration, fear of movement, and disease activity. In addition, patients with AS had fear of movement that affect health-related quality of life in spite of the positive results of drug therapies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-dmard-therapies-on-nsaid-intake-quality-of-life-and-physical-functioning-in-patients-with-ankylosing-spondylitis/