Issues in the treatment of ankylosing spondylitis with non-steroidal anti-inflammatory drugs.

The primary aim of the management of ankylosing spondylitis (AS) is symptomatic relief and prevention of structural changes and functional decline by both pharmaceutical and non-pharmaceutical interventions. NSAIDs are frequently used, but often have adverse effects or may not be effective enough to alleviate complaints. NSAIDs and Coxibs provide comparable symptomatic relief. It has now become clear, however, that these drugs are also associated with increased cardiovascular risk, probably due to imbalance between Cox-1- and Cox-2-inhibition. Limited evidence suggests that continuous use of NSAIDs may retard progression of axial structural changes as compared to 'on-demand' usage of these drugs. A critical appraisal of a recent paper on this topic indicates that more evidence is needed before continuous use of NSAIDs or Coxibs can be recommended taking also into consideration the increase cardiovascular risks of these drugs.