OBJECTIVE To investigate the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on disease activity in patients with stable ankylosing spondylitis (AS) receiving tumor necrosis factor inhibitor (TNFi). METHODS In this retrospective observational study, a total of 189 patients with stable AS receiving TNFi were included. Patients were classified into NSAID withdrawn group (n = 48) and NSAID continued group (n = 141), according to the use of NSAIDs. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured every 3 months, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was measured every 6 months as parameters to evaluate disease activity. ESR, CRP, and BASDAI at each time point, and time-averaged values of each parameter during the observation period of 1 year were compared between the two groups. Repeated-measure ANOVA was performed to compare changes in disease activity parameters during the observation period between the two groups. RESULTS The level of ESR, CRP, and BASDAI at baseline and during the observation period did not differ between the two groups. The time-averaged values of ESR (p = 0.096), CRP (p = 0.136), and BASDAI (p = 0.421), and changes of ESR (p = 0.101), CRP (p = 0.714), and BASDAI (p = 0.613) during the observation period were not significantly different between the two groups. CONCLUSION The continued use of NSAIDs in patients with stable AS receiving TNFi had no additional benefit in controlling the disease activity, as compared to patients who withdrew NSAIDs. Considering the risk of toxicity of long-term NSAID use, withdrawal of NSAIDs in stable AS patients receiving TNFi may be preferable.Key points• There is a lack of supportive evidence whether to continue or withdraw non-steroidal anti-inflammatory drugs (NSAIDs) in patients with stable ankylosing spondylitis (AS) receiving tumor necrosis factor inhibitor (TNFi).• Compared with patients who withdrew NSAIDs, continuing NSAIDs in patients with stable AS receiving TNFi had no additional benefit in controlling disease activity.• The results of the present study provide evidence that supports withdrawal of NSAIDs in patients with stable AS receiving TNFi.

中文翻译：

---

患有肿瘤坏死因子抑制剂的稳定型强直性脊柱炎患者的非甾体类抗炎药：续用与撤用。

目的探讨非甾体类抗炎药（NSAIDs）对接受肿瘤坏死因子抑制剂（TNFi）的稳定型强直性脊柱炎（AS）患者疾病活动的影响。方法在这项回顾性观察性研究中，总共纳入了189名接受TNFi的稳定AS患者。根据NSAID的使用，将患者分为NSAID退出组（n = 48）和NSAID继续组（n = 141）。每3个月测量一次红细胞沉降率（ESR）和C反应蛋白（CRP），每6个月测量一次浴强直性脊柱炎疾病活动指数（BASDAI）作为评估疾病活动的参数。比较两组在每个时间点的ESR，CRP和BASDAI，以及在1年观察期内每个参数的时间平均值。进行重复测量方差分析以比较两组在观察期内疾病活动参数的变化。结果两组之间的基线和观察期ESR，CRP和BASDAI的水平没有差异。ESR（p = 0.096），CRP（p = 0.136）和BASDAI（p = 0.421），ESR（p = 0.101），CRP（p = 0.714）和BASDAI（p = 0.613）在观察期间两组之间没有显着差异。结论与停用NSAIDs的患者相比，在接受TNFi的稳定AS患者中继续使用NSAIDs在控制疾病活动方面没有其他益处。考虑到长期使用NSAID的毒性风险，在接受TNFi的稳定AS患者中撤回NSAIDs可能更可取。