title: Nonsteroidal Antiinflammatory Drugs for Axial Spondyloarthritis: A Cochrane Review.
abstract: OBJECTIVE
  To determine the benefits and harms of nonsteroidal antiinflammatory drugs (NSAID) in axial spondyloarthritis (axSpA).
  
  
  METHODS
  Systematic review using Cochrane Collaboration methodology.
  
  
  METHODS
  randomized controlled trials (RCT) and quasi-RCT (to June 2014), investigating NSAID versus any control for axSpA, and observational studies of longterm effects (≥ 6 mos) of NSAID on radiographic progression or adverse events. Main outcomes were pain, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, radiographic progression, number of withdrawals because of adverse events, and number of serious adverse events. Risk of bias was assessed.
  
  
  RESULTS
  Thirty-five RCT, 2 quasi-RCT, and 2 cohort studies were included. Twenty-nine RCT and 2 quasi-RCT (n = 4356) were included in pooled analyses [traditional NSAID vs placebo (n = 5), cyclooxygenase-2 (COX-2) vs placebo (n = 3), COX-2 vs traditional NSAID (n = 4), NSAID vs NSAID (n = 24), naproxen vs other NSAID (n = 3), and low- vs high-dose NSAID (n = 5)]. Compared with placebo, both traditional and COX-2 NSAID were consistently more efficacious at 6 weeks and equally safe after 12 weeks. No significant differences in benefits or harms between the 2 NSAID classes and no important differences in benefits or withdrawals because of adverse events between different NSAID were found, especially if studies with high risk of bias were excluded. Single studies suggest NSAID may retard radiographic progression, especially by continuous rather than on-demand NSAID use.
  
  
  CONCLUSIONS
  High-quality evidence indicates that both traditional and COX-2 NSAID are efficacious for treating axSpA, and harms are not different from placebo in the short term. Various NSAID are equally effective.
authors.affiliation: From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center. f.kroon.reum@lumc.nl.
authors.forename: Féline P B
authors.initials: FP
authors.lastname: Kroon
authors.affiliation: From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center.
authors.forename: Lennart R A
authors.initials: LR
authors.lastname: van der Burg
authors.affiliation: From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center.
authors.forename: Sofia
authors.initials: S
authors.lastname: Ramiro
authors.affiliation: From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center.
authors.forename: Robert B M
authors.initials: RB
authors.lastname: Landewé
authors.affiliation: From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.affiliation: From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center.
authors.forename: Louise
authors.initials: L
authors.lastname: Falzon
authors.affiliation: From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center.
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D006801:Humans; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D025241:Spondylarthritis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: ANKYLOSING SPONDYLITIS; AXIAL SPONDYLOARTHRITIS; METAANALYSIS; NONSTEROIDAL ANTIINFLAMMATORY DRUGS; SYSTEMATIC REVIEW