COXITIS IN ANKYLOSING SPONDYLITIS: COMPARISON OF CLINICAL MANIFESTATIONS WITH ULTRASOUND STUDY DATA

Objective: to compare the clinical manifestations of coxitis with the data of HJ ultrasound study (USS) on inpatient samples.

Subjects and methods. This cross-sectional study enrolled 220 AS patients meeting the modified 1984 New York criteria who had been consecutively admitted to the clinic of the V.A. Nasonova Research Institute of Rheumatology in 2012–2013. A specially designed schedule was filled out for each patient. Disease activity was measured by the BASDAI and ASDAS and functional status was assessed by the BASFI. Coxitis was diagnosed on the basis of clinical signs, such as HJ pain and/or movement limitations on patient admission to the clinic. All the patients underwent HJ USS.

Results. The clinical signs of coxitis were found in 162 (73.6%) patients. In 107 (66%) of them, pain intensity recorded by the digital rating scale if only in one joint was 4 scores or higher. The patients with and without the clinical signs of coxitis were matched for age and disease duration. However, in coxitis, high disease activity was detected significantly more frequently and BASFI scores were also significantly higher. USS indicated that 119 (54%) patients had joint effusion. HJ effusion was found in 104 (63%) of the 162 patients with clinically manifest coxitis; and among the
119 patients with USS verified coxitis, 87% were seen to have clinical signs of joint injury and 104 (47%) patients had both clinical and ultrasound signs of HJ injury simultaneously. USS revealed no signs of synovitis in 58 patients with the clinical signs of HJ lesion.

Conclusion. Among the patients with AS, the rate of coxitis runs to 51%. The patients with coxitis have higher disease activity and more pronounced functional impairments than those without HJ injury. Coxitis causes considerably diminished working ability. In a number of cases, USS allows, when the clinical manifestations are similar, a differential diagnosis between synovitis and enthesitis located in this area. It is necessary to conduct additional studies to specify the upper limit of the normal range for the neck-capsular distance that is to be kept in mind when diagnosing coxitis by USS.

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