THREE-YEAR DYNAMICS OF INFLAMMATORY CHANGES IN THE HIP JOINTS IN AXIAL SPONDYLOARTHRITIS.

BackgroundAlmost half of the patients with axial spondyloarthritis (axSpA) in Russia diagnosed hip joint lesions (HJ), but the causes and rates of progression are not studied. Until now, it remains unclear whether synovitis detected on MRI and ultrasound of hip joint is a predictor of radiological progression of coxitis.ObjectivesTo assess the dynamics of inflammatory changes in the hip joint using instrumental research methods during 3-years observation and their relationship with the activity of axSpA.Methods45 patients (mean age 30,07±7,1 years) with a diagnosed with axSpA (ASAS criteria 2009), which were observed for at least 3 years. Among them, AS according to the modified New York criteria (1984) - 40 (89%) patients and 5 (11%) were diagnosed with nr-axSpA. The median duration of the disease was 36 [19;108] moth, BASDAI 4,3 [3,1;6,8], BASFI 2,0 [0,6;4,7]. All patients underwent clinical, X-ray, ultrasound and MRI examination of the hip joint during the entire observation period. For ultrasound, coxitis was considered an increase in the cervical-capsular distance (CCD) of more than 7 mm. For MRI inflammatory changes were taken as osteitis of the acetabulum and / or femoral head and synovitis in STIR mode.ResultsAt the time of inclusion of 45 patients, clinical signs of hip joint lesions were present in 66 (86%) patients, and after 36 months in 36 (80%) (p>0,05). The median CCD at the time of inclusion was 7,3 [6,6;7,9] mm, and after three years 6,6 [5,9;8,6] mm (p> 0.005). According to ultrasound, at the time of inclusion, 36 (80%) of 45 patients had coxitis, and after 3 years, 26 (58%) (p <0,005). Analysis of MRI changes initially showed the presence of synovitis in 42 (93%), and osteitis in 13 (29%) patients, and after 3 years synovitis persisted in у 25 (56%) (p <0,05), osteitis in 12 (27%) (p>0,005) and in 19 (42%) MRI patients, signs of active inflammation were arrested. Among all examined patients at the beginning of the study, the coincidence of signs of synovitis according to ultrasound and MRI data was noted in 35 (78%) cases. X-ray coxitis at the time of inclusion was detected in 11 (24%) patients, and after 2 years in 32 (68%) (p<0,05). The patients were divided into two groups ΔBASRI hip> 0 and ΔBASRI hip = 0. (Table 1)Table 1.Characteristics of patients with axSpA at the time of inclusion in the study who had X-ray progression of coxitis after 36 months of observation.ParametrsΔBASRI hip=0 n=15ΔBASRI hip >0 n = 30pThe duration of the disease, m., Мe [25;75‰]48 [12;120]30 [24;108]>0,05Age, years, Мe [25;75 ‰]30,5 [23;34]30,5 [25;35]>0,05BASDAI, Мe [25;75 ‰]6,7 [4,2;8,6]4,2 [2,4;5,9]<0,05BASFI, Мe [25;75 ‰]4,4 [1,8;8,1]1,7 [0,6;3,1]>0,05ASDAS (SRP), Мe [25;75 ‰]2,6 [1,6;3,9]2,8 [2,1;4,2]>0,05ESR, mm/h, Мe [25;75 ‰]15 [7;30]14,0 [7;27]>0,05SRP, mg/l, Мe [25;75 ‰]14,8 [10;56,0]22,8 [3,7; 31,8]>0,05Peripheral arthritis, n %11 (73%)20 (67%)>0,05US synovitis n%9 (60%)23 (77%)>0,05Pain in HJ n%28 (85%)38 (86%)>0,05Synovitis in MRI, n%15 (100%)27 (90%)>0,05Osteitis in MRI, n%3 (20%)10 (34%)>0,05Therapy bDMARDs9 (60%)9 (30%)<0,05ConclusionX-ray progression of coxitis in axSpA practically does not depend on the activity of the disease, nor on local signs of inflammation in the HJ, detected by ultrasound and MRI. X-ray progression of HJ lesions is less common in patients receiving bDMARDs therapy.Disclosure of InterestsNone declared