Relationship between different methods of visualization of hip joint lesions in patients with axial spondyloarthritis during a two-year observational study

Almost half of the patients with axial spondyloarthritis (axSpA) in Russia have hip joint lesions (HJD), but the causes and rates of its progression have not been studied.
Aim. To assess the relationship of X-ray progression with MRI data of hip joint examination in patients with axial spondyloarthritis during a two-year follow-up.
Material and methods. We analyzed 77 patients (23 women and 54 men) with axSpA (ASAS criteria, 2009), followed for at least 2 years with clinical and/or instrumental signs of coxitis. After 2 years, the patients underwent a complete clinical, laboratory and instrumental examination (MRI and radiography of the hip joint) again. Their average age was 30.8±7.7 years, with an average disease duration of 74.0±90.3 months. 72 (94%) patients were HLA-B27 positive. In all patients, the BASRI-Hip index was assessed for each hip joint. The median values of laboratory parameters of inflammation – erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level – were initially high (20.0 mm/h and 14.5 mg/l respectively), but after 2 years the indicators decreased: ESR – down to 8.0 mm/h, and CRP – down to 5.0 mg/L (p<0.05). The median values of the BASDAI also decreased over 2 years of active observation from 4.5 to 2.2 (p<0.05). The value of the ASDAS-CRP index was high and corresponded to 3.1±1.1 and after 2 years also decreased down to 1.94±1.0 (p<0.05). Pain in the hip joint was detected in 66 out of 77 patients (86%) at the time of inclusion, and 2 years later – in 48 (62%) (p<0.05). As for other clinical manifestations of the disease at the time of inclusion in the study, among 77 patients, 75% had peripheral arthritis, and after 2 years – only about 39% (p<0.05). The patient’s functional index (BASFI) was initially 3.3, and after 2 years it decreased down to 1.3 (p<0.05).
Results. At inclusion in the study, 59 patients had no radiological changes in the hip joint (BASRI-hip<2). 2 years after the start of follow-up, the number of patients with radiological changes in the hip joint was 48 (62%). Initially, according to MRI, synovitis was detected in 75 (97%), and osteitis – in 23 (30%), chronic changes were present in 2 (3%) patients. After 2 years, synovitis persisted in 46 (60%) (p<0.05), bone marrow edema – in 17 (22%) (p>0.005), and the number of chronic changes increased up to 29 (38%). In 25 (32%) MRI patients, signs of active inflammation were arrested, while only two (13.3%) of them showed the development of chronic changes. To assess the relationship between X-ray progression and MRI signs of inflammation of the disease, patients were divided into two groups according to the total stage of radiographic coxitis (ΔtsrC=0 and ΔtsrC>0). The group with ΔtsrC=0 included 33 patients (22 men and 11 women), and the group with ΔtsrC>0 included 44 patients (32 men and 12 women) (p>0.05). The groups did not differ in clinical parameters such as disease duration, patient age, BASDAI, ASDAS-CRP, BASFI, ESR and CRP (p>0.05). According to MRI, the signs of inflammation (osteitis, synovitis) of the groups also did not differ.
Conclusion. The progression of coxitis did not depend on the activity of the disease, on the gender of the patients, and on MRI signs of inflammation in the hip joint.

1. Volnukhin EV, Galushko EA, Bochkova AG, Smirnov AV, Erdes SF. Clinical diversity of ankylosing spondylitis in the real practice of a rheumatologist in Russia (Part 1). NauchcnoPrakticheskaya Revmatologia = Rheumatology Science and Practice. 2012;50(2):44-49 (In Russ.). doi: 10.14412/1995-4484-2012-1272

2. Podryadnova MV, Balabanova RM, Urumova MM, Erdes SF. Coxitis in ankylosing spondylitis: Comparison of clinical manifestations with ultrasound study data. NauchcnoPrakticheskaya Revmatologia = Rheumatology Science and Practice. 2014;52(4):417-422 (In Russ.). doi: 10.14412/1995-4484-2014-417-422

3. Agafonova EM, Dubinina TV, Rumyantseva DG, Demina AB, Smirnov AV, Erdes S. Coxitis in early axial spondyloarthritis. Modern Rheumatology Journal. 2019;13(4):41-47 (In Russ.). doi: 10.14412/1996-7012-2019-4-41-47

4. Agafonova EM, Dubinina TV, Erdes SF. Diagnosis and treatment of coxitis in patients with ankylosing spondylitis. NauchcnoPrakticheskaya Revmatologia = Rheumatology Science and Practice. 2018;56(4):500-505 (In Russ.). doi: 10.14412/1995-4484-2018-500-505

5. Carette S, Graham D, Little H, Rubenstein J, Rosen P. The natural disease course of ankylosing spondylitis. Arthritis Rheum. 1983;26(2):186-190. doi: 10.1002/art.1780260210

6. Smirnov AV, Erdes ShF. Optimization of X-ray diagnosis of ankylosing spondylitis in clinical practice: Importance of a plain X-ray film of the pelvis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2015;53(2):175-181 (In Russ.) doi: 10.14412/1995-4484-2015-175-181

7. Vander Cruyssen B, Muсoz-Gomariz E, Font P, Mulero J, de Vlam K, Boonen A, et al.; ASPECT-REGISPONSERRESPONDIA working group. Hip involvement in ankylosing spondylitis: Epidemiology and risk factors associated with hip replacement surgery. Rheumatology (Oxford). 2010;49(1):73-81. doi: 10.1093/rheumatology/kep174

8. Nystad TW, Furnes O, Havelin LI, Skredderstuen AK, Lie SA, Fevang BT. Hip replacement surgery in patients with ankylosing spondylitis. Ann Rheum Dis. 2014;73(6):1194-1197. doi: 10.1136/annrheumdis-2013-203963

9. Amor B, Dougados M, Mijiyawa M. Critères de classification des spondylarthropathies [Criteria of the classification of spondylarthropathies]. Rev Rhum Mal Osteoartic. 1990;57(2):85-89.

10. Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, BurgosVargas R, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: A guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68(Suppl 2):ii1-ii44. doi: 10.1136/ard.2008.104018

11. Dubinina TV, Dyomina AB, Smirnov AV, Erdes ShF. Diagnosis of coxitis in ankylosing spondylosis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2015;53(6):624-631 (In Russ.). doi: 10.14412/1995-4484-2015-624-631

12. Dubinina TV, Gaidukova IZ, Godzenko AA, Lapshina SA, Rebrov AP, Rumyantseva OA, et al. Guidelines for the assessment of disease activity and functional status in patients with ankylosing spondylitis in clinical practice. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2017;55(4):344-350 (In Russ.). doi: 10.14412/1995-4484-2017-344-350

13. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: The Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21(12):2286-2291.

14. Agafonova EM, Erdes S, Dubinina TV, Rumyantseva DG, Smirnov AV. Assessment of coxitis progression in early axial spondyloarthritis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2020;58(2):160-164 (In Russ.). doi: 10.14412/1995-4484-2020-160-164

15. Agafonova EM, Dubinina TV, Demina AB, Smirnov AV, Erdes SF. Instrumental diagnosis of coxitis in ankylosing spondylitis in real clinical practice. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2018;56(6):716-721 (In Russ.). doi: 10.14412/1995-4484-2018-716-721

16. Bochkova AG, Levshakova AV, Tyukhova EYu, Rumyantseva OA, Smirnov AV, Pushkova OV, et al. Magnetic-resonance imaging for early diagnosis of coxitis in patients with spondyloarthritis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2012;50(5):56-63 (In Russ.). doi: 10.14412/1995-4484-2012-1183