Features of coxitis in spondyloarthritis

According to an epidemiological study, hip joint involvement was detected in 12–56% of patients with axial spondyloarthritis (axSpA) in Russia. Data on the incidence of coxitis in patients with axial psoriatic arthritis (axPsA) are lacking.

The aim of the study was to compare radiographic changes in the hip joints in patients with axial spondyloarthritis and axial psoriatic arthritis and to evaluate the relationship between coxitis and disease activity.

Material and methods. The study included 222 patients with a mean age of 35.7±12.7 years. The first group included 108 patients who met the 2009 ASAS (Assessment of SpondyloArthritis International Society) criteria for axSpA or the 1984 criteria for ankylosing spondylitis (AS); The second group included 114 patients with axPsA who met the CASPAR (ClASsification for Psoriatic ARthritis) criteria. Signs of axial involvement in psoriatic arthritis (PsA) were determined using instrumental imaging methods. Diagnosis required the presence of radiologically reliable sacroiliitis (SI), i.e., bilateral stage ≥II or unilateral stage ≥III according to Kellgren, or active sacroiliitis according to magnetic resonance imaging. The presence of at least one syndesmophyte (paraspinal ossificate) in the cervical (CS) or lumbar (LS) spine, as well as ankylosis of the facet joints of the CS, were also taken into account. The mean age of disease onset was 26.3±20.3 years; HLA-B27 was detected in 54% of patients. The diagnosis of coxitis was established based on a pelvic X-ray and calculation of the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI hip) for each joint.

Results. Radiographic evidence of coxitis was detected in 52 of the 222 patients included in the study, including 22 patients with AS and 30 patients with axPsA. Patients with axPsA were older than those with axSpA (median age 32 years and 45 years, respectively; p<0.05). Radiographic coxitis was more common among men with axSpA and equally common among men and women with axPsA. The ASDAS (Axial Spondyloarthritis Disease Activity Score) index value was high in both groups; however, it was statistically significantly higher in patients with axPsA than in patients with axSpA (on average, 2.1 and 3.2, respectively; p<0.05). Acute phase indices (C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)) were slightly higher in axSpA than in axPsA (CRP – 5.8 and 4.2 mg/L; ESR – 20 and 17 mm/h, respectively), but these differences were not statistically significant (p>0.05). Functional impairment according to BASFI (Bath Ankylosing Spondylitis Functional Index) was more pronounced in axPsA than in patients with axSpA (p<0.05). Peripheral arthritis was also more common in patients with axPsA (96.6% and 59.0%, respectively; p<0.05).

Conclusion. Radiographic coxitis was detected in 20% of patients with axSpA and 26% with axPsA. In previous studies, the incidence of radiographic coxitis in patients with psoriatic arthritis did not exceed 10%. According to our study, patients with axPsA had high clinical and laboratory indicators of disease activity, as well as significant functional impairment.

1. Korotaeva TV, Gubar EE, Loginova EY, Korsakova YL, Vasilenko EA, Ilyevsky IY, et al. Results of a non-interventional multicenter observational study on the diagnosis and treatment of patients with axial psoriatic arthritis in real-world clinical practice in the Russian Federation (NiSaXPA). Modern Rheumatology Journal. 2024;18(6):14-20 (In Russ.). doi: 10.14412/1996-7012-2024-6-14-20

2. Gran JT, Scomsvoll JF. The outcome of ankylosing spondylitis: A study of 100 patients. Br J Rheumatol. 1997;36:766-771. doi: 10.1093/rheumatology/36.7.766

3. Boonen A, van der Cruyssen B, de Vlam K, Steinfeld S, Ribbens C, Lenaerts J, et al. Spinal radiographic changes in ankylosing spondylitis: Association with clinical characteristics and functional outcome. J Rheumatol. 2009;36(6):1249-1255. doi: 10.3899/jrheum.080831

4. van der Cruyssen В, Vastesaeger N, Collantes-Estevez E. Hip disease in ankylosing spondylitis. Curr Opin Rheumatol. 2013;25:448- 454. doi: 10.1097/BOR.0b013e3283620e04

5. Michet CJ, Mason TG, Mazlumzadeh M. Hip joint disease in psoriatic arthritis: Risk factors and natural history. Ann Rheum Dis. 2005;64(7):1068-1070. doi: 10.1136/ard.2004.022228

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

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

8. 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

9. Bochkova AG, Rumyantseva OA, Severinova MV, Kiseleva NM, Bunchuk NV. Coxitis in patients with ankylosing spondylitis: Clinicoradiologic comparisons. Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2005;43(4):8-13 (In Russ.). doi: 10.14412/1995-4484-2005-610

10. Maejima H, Watarai A, Taniguchi T, Katsuoka K. Onset of psoriatic arthritis at the hip joint without spondylitis. Acta Derm Venereol. 2014;94(1):110-111. doi: 10.2340/00015555-1640

11. Krakowski P, Gerkowicz A, Pietrzak A, Krasowska D, Jurkiewicz A, Gorzelak M, et al. Psoriatic arthritis – new perspectives. Arch Med Sci. 2019;15(3):580-589. doi: 10.5114/aoms.2018.77725

12. Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis. 2009;68(6):777-783. doi: 10.1136/ard.2009.108233

13. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27(4):361-368. doi: 10.1002/art.1780270401

14. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H; CASPAR Study Group. Classification criteria for psoriatic arthritis: Development of new criteria from a large international study. Arthritis Rheum. 2006;54(8):2665-2673. doi: 10.1002/art.21972

15. 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 Revmatologia = Rheumatology Science and Practice. 2015;53(2): 175-181 (In Russ.). doi: 10.14412/1995-4484-2015-175-181

16. 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

17. Gubar EE, Korotaeva TV, Dubinina TV, Korsakova YL, Loginova EY, Vorobyeva LD, et al. Differential diagnosis of axial spondyloarthritis and psoriatic arthritis with axial involvement. Modern Rheumatology Journal. 2025;19(3):64-73 (In Russ.). doi: 10.14412/1996-7012-2025-3-64-73

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

19. Poddubnyy D. Managing psoriatic arthritis patients presenting with axial symptoms. Drugs. 2023;83(6):497-505. doi: 10.1007/s40265-023-01857-w

20. Agafonova EM, Erdes Sh, Dubinina TV, Demina AB, Smirnov AV. Differences in the course of coxitis in men and women with early axial spondyloarthritis. Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2023;61(5):596-601 (In Russ.). doi: 10.47360/1995-4484-2023-596-601