Intravenous Glucocorticoid Pulse Therapy in Active, NSAID Refractory Axial An

Objective: High dose intravenous glucocorticoid (IVGC) pulse therapy is known to effectively reduce inflammatory signs and symptoms in patients with active inflammatory conditions. However, the efficacy of IVGC in ankylosing spondylitis (AS) is not clearly established. Methods: We performed a retrospective analysis with repeated measurements including patients with active, NSAID refractory axial AS (n=15) who underwent high dose IVGC pulse therapy. Parameters of clinical and humoral disease activity were compared to active AS patients (n=14) under continuous anti-TNF treatment. Patients were seen every 3 months and followed up for a total period of 12 months. Results: Both IVGC pulse and anti-TNF therapy lead to a significant and sustained reduction of the mean bath ankylosing spondylitis disease activity index (BASDAI 7.4 ± 1.5 at baseline vs. 5.4 ± 2.1 at 12 months in the pulse group and 6.9 ± 1.2 at baseline vs. 5.0 ± 2.7 at 12 months in the anti-TNF group, p<0.001), CRP (p=0.018), ESR (p=0.028), morning stiffness (p<0.001), and finger-to-floor-distance (p=0.001; within group comparison). Conclusions: Patients with active axial AS treated with one IVGC pulse show a substantial decrease in disease activity over a period of 12 months in this retrospective analysis.