BackgroundPrevious studies showed that the impairment of hip joints (HJ) - coxitis leads to a hip replacement and it is a frequent cause of early disability in patients (pts) with spondyloarthritis (SpA). Early detection of coxitis have a great clinical importance.ObjectivesTo study the incidence and character of the impairment of HJ involvement in patients with early axial SpA (axSpA).MethodsThe study include 65 patients with axSpA (ASAS 2009) with disease duration <5 years and age at onset <45 years, mean age 28,5 (5,8) y., 32 (49,2%) males, 60 (92,2%) pts were HLAB27-positive, average disease duration was 24,1 (15,4) mo. The following evaluations were made: HJ pain (numerical rating scale – NRS - from 0 to 10), inter-malleolar distance (IMD), radiological HJ changes (BASRI-hip), ultrasound examination (US) and pts who had US evidence or/and clinical coxitis - MRI of hip joints. For 2 years pts taking NSAIDs at therapeutic doses. The dosages of NSAIDs accounted by the ASAS NSAID index.ResultsAfter 2 years follow-up reduce HJ functional limitations and pain in the left HJ (Table 1). There were no statistical differences between MRI symptoms of the impairment HJ and US symptoms of coxitis at baseline and after 2 years (Table 2).Table 1.Clinical characteristics of imparment HJ at baseline and after 2 yearsBaselineAfter 2 yearsP Bilateral HJ pain, % pts22 (33,8%)17 (26,1%)0,2Pain in the right HJ, % pts6 (9,2%)5 (7,6%)0,5Pain in the left HJ, % pts32 (49,2%)8 (12,3%)0,000003HJ funcional limitations, % pts13 (20,0%)3 (4,6%)0,007Bilateral HJ funcional limitations, % pts8 (12,3%)3 (4,6%)0,1IMD, mean (s.d.)110,8 (11,0)110,8 (11,0)1,0Table 2.MRI symptoms of the impairment HJ and US symptoms of coxitis at baseline and after 2 yearsBaselineAfter 2 yearsP MRI symptoms of the defeat HJ, % pts22 (68,7%)14 (43,7%)0,08Bilateral synovitis, % pts17 (77,2%)10 (71,4%)0,5One-side synovitis, % pts4 (18,1%)2 (14,2%)0,5Bilateral swelling of bone marrow in femoral head, % pts1 (4,5%)00,5One-side swelling of bone marrow in femoral head, % pts2 (9,0%)00,2Bilateral swelling of acetabular roof, % pts2 (9,0%)3 (21,4%)0,3One-side swelling of acetabular roof, % pts01 (7,1%)0,5US symptoms* of coxitis, % pts14 (21,5%)11 (16,9%)0,3Bilateral US symptoms of coxitis, % pts2 (14,2%)4 (28,5%)0,3One-side US symptoms of coxitis, % pts12 (85,7%)7 (50,0%)0,9*The distance between the anterior joint capsule and the femoral neck, capsular-neck distance CND >7 mm.Radiographic progression (BASRI-hip≥1 stage) after 2 years follow-up founded in 7 (31,8%) pts with MRI symptoms of the impairment HJ. There are radiographic progression from normal HJ to bilateral stage 1 in 5 (71,4%) pts, from bilateral stage 1 to bilateral stage 2 in 2 (28,6%) pts. Mean NSAID index in pts with radiographic progression (31,8%) amount 62,2%, while in pts without radiographic progression – 72,5% (p=0,2).Conclusions1. In patients with early axial spondyloarthritis in two years of observation radiographic progression observed in 31,7% patients despite on regular intake of NSAIDs. 2. Fur...
Background:The use of medications during pregnancy remains a challenge for both rheumatologists and patients. The lack of compelling evidence of the safety of a line of different drugs, as well as the traditional idea of the incompatibility of therapy and gestation that is common view in Russia, lead to unjustified withdrawal of drugs by both pregnant women and rheumatologists.Objectives:to describe the frequency of drug usage in pregnant women with AS, to determine the relationship of AS activity and pregnancy complications.Methods:49 pregnant women with confirmed AS (modified New York criteria, 1984) were included for prospective observation. 50 pregnancies in total were traced. The average age of the patients was 31.6±4.9 years, the duration of the disease was 134.4±85.8 months. The visits were conducted at 10-11, 20-21, and 31-32 weeks of pregnancy. The BASDAI in the month of conception and in the trimesters of pregnancy was: 1,4[0,6; 3,3]; 2,3[1,2; 4,4]; 2,8[1,4; 4,2] and 2,2[1,6; 4,0], respectively. 48 pregnancies ended with the birth of alive children at an average of 39±1.1 weeks, the height of newborns-51.6±2.1 cm, weight-3397.3±433.1 g. 8 (16.3%) newborns had malformations, 7 of them - minor heart development anomalies, 1 - hydronephrosis. Pregnancy complications: early toxicosis - 18% of pregnant women, threatening of early abortion - 10%, threatening of late abortion-4.1%, threatening of early preterm birth - 6.3%; premature birth – 3 (6.3%) at 36.8±0.1 weeks.Results:NSAIDs. After inclusion in the study, the drug of choice was ibuprofen, which was canceled for all women no later than the 32-nd week of pregnancy. At the time of conception and in the first, second and third trimesters of pregnancy, NSAIDs were taken by 23 (46%), 20 (40%), 30 (60%) and 21 (43.8%) women, respectively. No effect of NSAIDs on the activity of AS was revealed.Sulfasalazine (SS) was taken for 3 months before pregnancy by 11(22%) women, during pregnancy – 6 (12%) at a dose of 1.25±0.25 g because of arthritis. The withdrawal of SS was not associated with the recurrence of arthritis.Glucocorticoids (GC) at a dose of 7.5±2.5 mg 3 months before pregnancy and in the trimesters of pregnancy were taken: 1 (2%), 4 (8%), 8 (16%) and 10 (20.8%) women, of whom 1 patient had arthritis and 1 had inflammatory bowel disease. The remaining patients received GC due to the high activity of AS due to axial manifestations and the unavailability of bDMARDs) intake. Against the background of taking GC, the AS activity did not decrease: BASDAI in the 2nd and 3rd trimesters was 5.5±0.6 and 5.8±1.3 (p>0.05).bDMARDs. TNF inhibitors for 3 months before pregnancy and on trimesters were received by 11 (22%), 7 (14%), 6 (12%) and 2 (4.2%) patients, of which 1 woman in the second trimester obtained firstly initiated therapy with certolizumab pegol due to the recurrence of uveitis. In those who canceled bDMARDs therapy (both independently and due to the recommendation of a rheumatologist), an increase in AS activity was noted on the eve of pregnancy; BASDAI in the month of conception and in the I, II, and III trimesters was: 2,7 [0,8; 3,5]; 5,1[3,1; 5,9]; 5,5 [5;6] and 6,7 [5,3; 7;3], p<0,05 compared to the month of conception. Undoing the bDMARDs in the month of conception is a risk factor for high activity as (BASDAI>4) in the second trimester (OR OF 30.4; 95% CI 1,5-612,3; p=0.03) and in the third trimester (OR A 32.7; 95% CI 1,6-662,2; p=0.02).The relationship between pregnancy complications, malformations of the newborns and the used medications was not revealed.Conclusion:NSAIDs and GC in low doses do not reduce the activity of AS. Withdrawal of TNF inhibitors on the eve of pregnancy is a predictor of high AS activity. It is necessary to increase the knowledge of rheumatologists and patients about the therapeutic possibilities during pregnancy to avoid unjustified drug withdrawal.Disclosure of Interests:None declared.
Сongenital posterior urethroperineal fistula (CUPF) - are extremely rare. This article provides an analysis of 26 cases described in English literature and reported a clinical case illustrating the algorithm of diagnostics and tactics of treatment.
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