NSAID Use and Functional Impairment in Ankylosing Spondylitis

Mark Hwang¹, Seth Eisen¹, MinJae Lee², Michael Ward³, Lianne S. Gensler⁴, Prabha Ranganathan⁵, Johnathan Jia⁶, Amirali Tahanan², Matthew A. Brown⁷, Mohammad H. Rahbar², Michael Weisman⁸ and John D. Reveille⁹, ¹Internal Medicine-Rheumatology, Washington University in Saint Louis, School of Medicine, Saint Louis, MO, ²Biostatistics/Epidemiology/Research Design (BERD) Core | Center for Clinical and Translational Sciences, University of Texas-McGovern Medical School, Houston, TX, ³NIH/NIAMS, Bethesda, MD, ⁴Medicine/Rheumatology, UCSF, San Francisco, CA, ⁵Washington University in Saint Louis, School of Medicine, Saint Louis, MO, ⁶University of Texas-McGovern Medical School, Houston, TX, ⁷The University of Queensland Diamantina Institute, Brisbane, Australia, ⁸Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, ⁹Rheumatology, University of Texas-McGovern Medical School, Houston, TX

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Ankylosing spondylitis (AS), Clinical research, functional status and treatment

Session Information

Date: Sunday, November 13, 2016

Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment - Poster I: Axial and Peripheral Spondyloarthritis – Clinical Aspects, Imaging and Treatment

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Ankylosing spondylitis (AS) is a chronic inflammatory disease with significant burden to patients and society. NSAIDs are the first line pharmacologic therapy in AS with proven efficacy. This efficacy is class-wide and we hypothesize a higher effect with more use of medication. An important aspect of treatment efficacy is its effect on functionality. This study aims to identify the effect of NSAID use in AS as defined by the percent of the full inflammatory dose taken over time (the NSAID Index) on functional impairment

Methods: A prospective cohort of 823 AS patients who met the modified New York criteria were followed for at least 2 outpatient visits from multiple sites. Patients underwent a comprehensive clinical evaluation including assessment of functional impairment by the Bath AS Functional Index (BASFI) in addition to demographic, social, and psychological variables collected. Medications taken concurrently, inflammatory markers and radiographs were taken at each visit. NSAID use was captured by self-report of numbers of pills taken in the last week, month, and 6 month interval. Longitudinal multivariable analyses using mixed effect negative binomial regression models that account for the correlation of repeated measures over time were conducted to assess associations between NSAID use (NSAID index of 0%, >0 & ≤50%, and >50%) and BASFI while controlling for other variables.

Results: . Of the 5456 visits included in this analysis, 40%, 28% and 25% had an NSAID index of 0%, >0 & ≤50%, and >50% respectively. No significant differences were found analyzing the data over a one month and six month interval. Table 1 shows the longitudinal associations between NSAID use and other covariables over a 6 month period on BASFI scores. We found that NSAID use was significantly associated with higher BASFI (overall p=0.002); patients who had high NSAID index (>50%) and low NSAID index (>0 and ≤50%) were more likely to have higher BASFI compared to patients with no NSAID use (ARR=1.13; p=0.0019 and ARR=1.08; p=0.0172, respectively). There was no association of NSAID use with BASFI when we compared patients with high NSAID index to those with low NSAID index (ARR= 1.05; p=0.1948).. C-reactive protein (CRP), Disease duration, baseline radiographic disease, depression (defined by Center for Epidemiologic Studies Depression Scale (CESD) score>16), comorbidty and opioid use were positively associated with BASFI.

Conclusion: We found an association between any NSAID use and higher functional impairment, while high vs. low NSAID use was not associated. This may be due to AS patients with higher functional impairment taking more NSAIDs. Our findings also hint at a modest treatment effect of NSAIDs in AS as high vs. low use was not associated with change in functional impairment. Table 1. NSAID Use and Covariables Associated with Longitudinal Functional Impairment in Multivariable Regression Modeling

Variable	Adjusted Rate Ratio (95% CI)	p-value
NSAID (last 6 months) use: High (>50) Low= ( >0 &≤50) and no use (0)
Low vs. No use	1.08 (1.02, 1.16)	0.0125
High vs. No use	1.13 (1.04, 1.22)	0.0021
High vs, Low use	1.04 (0.97, 1.11)	0.2560
TNFi use vs, No use	0.88 (0.82, 0.96)	0.0022
Male vs. Female	0.91 (0.80, 1.05)	0.1958
Education ≥ college vs. <college	0.72 (0.61, 0.86)	0.0003
White Race vs. other	0.80 (0.69, 0.94)	0.0057
Disease duration ≥10 vs. <10 years	1.27 (1.10, 1.47)	0.0011
CRP abnormal vs. normal	1.14 (1.09, 1.20)	<.0001
baseline mSASSS ≥ 4^a	1.65 (1.44, 1.90)	<.0001
CESD total >16 vs. <16^b	1.25 (1.17, 1.34)	<.0001
# comorbidity≥1 vs, 0	1.25 (1.08, 1.44)	0.0022
History of Smoking vs. No Smoking	1.06 (0.93, 1.20)	0.3653
Opioid Use vs. No use	1.19 (1.09, 1.30)	0.0001

a. modified Stoke Ankylosing Spondylitis Spinal Scores (mSASSS).

b. Center for Epidemiologic Studies Depression Scale (CESD)

Disclosure: M. Hwang, None; S. Eisen, None; M. Lee, None; M. Ward, None; L. S. Gensler, AbbVie, Amgen, Janssen, Novartis, UCB, 5; P. Ranganathan, None; J. Jia, None; A. Tahanan, None; M. A. Brown, None; M. H. Rahbar, None; M. Weisman, None; J. D. Reveille, None.

To cite this abstract in AMA style:

Hwang M, Eisen S, Lee M, Ward M, Gensler LS, Ranganathan P, Jia J, Tahanan A, Brown MA, Rahbar MH, Weisman M, Reveille JD. NSAID Use and Functional Impairment in Ankylosing Spondylitis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/nsaid-use-and-functional-impairment-in-ankylosing-spondylitis/. Accessed .

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