Question explored with the scientific record
Conversation so far
- 1 Is an immunosuppressant shot worth it for a AS?
- 2 Which AS symptoms did trials improve most, pain or stiffness or function?
Answered on this page ↓
Which AS symptoms did trials improve most, pain or stiffness or function?
The short version: pain and function both improve substantially on these drugs, stiffness has the thinnest evidence, and no trial here measured them head to head.
The best comparison comes from a meta-analysis pooling trials of NSAIDs and TNF blockers across symptom domains [1]. On pain, TNF blockers showed a large effect (standardized mean difference −0.90) and NSAIDs an even larger one (−1.07) [1]. On physical function, TNF blockers edged ahead (−0.73 versus −0.54 for NSAIDs) [1]. Morning stiffness had the weakest base: just one TNF trial of 40 patients (−1.04) against four NSAID trials (−0.44) [1].
| Domain | TNF blockers (SMD) | NSAIDs (SMD) |
|---|---|---|
| Pain | −0.90 [1] | −1.07 [1] |
| Physical function | −0.73 [1] | −0.54 [1] |
| Morning stiffness | −1.04 (1 trial, n=40) [1] | −0.44 [1] |
| Spinal mobility | 0.21 [1] | 0.14 [1] |
A placebo-controlled adalimumab trial in juvenile AS showed back pain down 48% and function (BASFI) down 47% [3]. In the ASSERT infliximab trial, function improved significantly over 24 weeks [2]. Mobility barely moved in the meta-analysis [1].
These are group averages from short trials, mostly industry-run. What this retrieval cannot see: any trial directly ranking pain against stiffness against function in the same patients.
My call: pain and function improve most; stiffness is plausible but thinly tested. Confidence: moderate.
Sources used 3
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Evaluation of the treatment effect of NSAIDs/TNF blockers according to different domains in ankylosing spondylitis: results of a meta-analysis
A systematic meta-analysis comparing NSAIDs and TNF blockers in ankylosing spondylitis across multiple clinical domains finds that both therapies provide substantial benefits for pain, function, and global status, with TNF blockers uniquely reducing acute-phase reactants and mob…
DOI: 10.1093/rheumatology/keq078 -
Efficacy and safety of infliximab in patients with ankylosing spondylitis: Results of a randomized, placebo‐controlled trial (ASSERT)
This study evaluates the efficacy and safety of infliximab in patients with ankylosing spondylitis through a randomized, placebo-controlled trial, demonstrating significant improvements in disease activity and physical function over 24 weeks.
DOI: 10.1002/art.20852 -
Phase III, multi-centre, randomised, double blind, Placebo-controlled study for treatment of juvenile ankylosing spondylitis (AS) with Adalimumab
This Phase III clinical trial demonstrates the efficacy of adalimumab in reducing disease activity in juvenile ankylosing spondylitis over a 12-week period compared to placebo.
DOI: 10.1186/1546-0096-9-s1-p201