SAT0394 The impairment of hip joints in patients with early axial spondyloarthritis (corsar cohort) based on the results of the two-year observation

Abstract

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...

Coxitis in early axial spondyloarthritis

“…По данным отечественных исследований, поражение тазобедренных суставов (ТБС) встречается у половины больных АС [3]. За исключением нашего двухлетнего наблюдения [4], работ, посвященных изучению коксита у пациентов с ранним аксСпА, практически не проводилось. До сих пор неизвестно, какие факторы вызывают развитие коксита при аксСпА, отсутствует общепринятый алгоритм диагностики данного состояния, особенно на ранней стадии.…”