Nonsteroidal Anti-Inflammatory Drugs and Cardiovascular Disease Risk in Spondyloarthritis-Spectrum Diseases

Ho So; Lai-Shan Tam


Curr Opin Rheumatol. 2022;34(4):203-208. 

In This Article

Abstract and Introduction


Purpose of Review: Increased cardiovascular (CV) risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs) is well recognized in the general population. This may limit the use of this effective therapy in patients with spondyloarthritis (SpA), a population already at high CV risk.

Recent Findings: Increased CV diseases and their risk factors in patients with SpA were consistently shown in recent population-level data. NSAIDs remained commonly prescribed in SpA, though their structural benefit remained controversial and the dispensing practice was variable in different regions in the world. A previous observation study suggested NSAIDs in SpA might be cardio-protective, possibly via their modulation of the chronic inflammatory state. A recent meta-analysis of nonrandomized studies also revealed no increased risk of a CV event. Interestingly, there is growing evidence that different NSAIDs might impose differential CV risk on patients with SpA.

Summary: Recent evidence suggested NSAIDs were associated with a neutral and possibly lower CV risk in patients with SpA, which provided some reassurance for their use.


Spondyloarthritis (SpA) spectrum diseases are a group of chronic inflammatory disorders present with related yet different manifestations, with ankylosing spondylitis (AS) [currently known as radiographic axial SpA (r-axSpA)] being the prototype.[1] Depending on the predominant clinical features, the major subgroups include axial SpA (axSpA), peripheral SpA, and psoriatic arthritis (PsA).[2] They share similar underlying pathogenic process mediated by pro-inflammatory cytokines particularly tumour necrosis factor (TNF)-α and interleukins 17 and 23, as well as co-morbidities such as cardiovascular diseases (CVD). The CV burden in SpA has been well described with increased CV risk factors, events, and related mortality.[3] Nonsteroidal anti-inflammatory drugs (NSAIDs), the first line and often long-term treatment in SpA, have been recommended to be used with caution in view of their association with increased risk of CV events.[4] It may limit the use of this therapy in patients with SpA. Conversely, through modulation of the chronic inflammatory state, NSAIDs in SpA might be cardio-protective. There is an unmet need to clarify how treatment choices, particularly the use of NSAIDs, impact CV risk in SpA. In the current narrative review, recent studies related to NSAIDs and CVD in SpA spectrum diseases are discussed.