Benefits and risks of ankylosing spondylitis treatment with nonsteroidal antiinflammatory drugs

Ankylosing spondylitis (AS) is a chronic inflammatory disease with a prevalence of 0.1–1.2%, and it normally starts in the third decade of life. In contrast to other inflammatory rheumatic diseases, such as rheumatoid arthritis (RA), the therapeutic options are limited and confined to nonsteroidal antiinflammatory drugs (NSAIDs) and, if this treatment fails, to tumor necrosis factor (TNF) blockers. Disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids have only a limited role for peripheral arthritis but are not effective for the axial manifestations. Consequently, recently reported recommendations for the management of AS suggested NSAIDs as a first-line drug treatment for patients with symptomatic disease (1). Furthermore, a failure of previous treatment with NSAIDs should be documented before treatment with TNF blockers can be started in patients with active disease. Thus, NSAIDs play a crucial role in the management of AS and related spondylarthritides.