Dynamic of radiographic and ultrasonographic indices of hip joints in patients with ankylosing spondylitis under treatment with tumor necrotic factor ― alpha inhibitors

Background. Inflammation of the hip joints in ankylosing spondylitis (AS) is a frequent and severe manifestation of the disease, which in 7–8 % of patients is accompanied by the requirements of hip joints prosthesis. In the treatment of hip arthritis associated with AS non-steroidal anti-inflammatory drugs (NSAIDs), sulfasalazine (SSZ) and tumor necrosis factor-alpha blockers were used. However, the influence of these treatment on the dynamics of structural changes in hip joints is not studied.

Purpose. To evaluate the dynamics of clinical, radiologic and ultrasonographic indices of hip joints in patients with AS who take different treatment methods for 12 months: NSAIDs, SSZ and adalimumab (ADA).

Materials and methods. Dynamic monitoring of 78 patients with AS (corresponding to the New York modified criteria of 1984), who also had clinical, ultrasonographic and radiographic signs of inflammation of hip joints. The patients were divided into three groups: patients of the group 1 (n = 25) were been receiving NSAIDs; patients of group 2 (n = 26) had started to take SSZ (2–3 grams per day) on background of NSAIDs; patients of group 3 (n = 27) were started to take ADA (subcutaneously, 40 mg once every 2 weeks) on the background of NSAID. In addition to the generally accepted clinical and laboratory studies, all patients were being underwent by X-ray examination with an evaluation of the BASRI-Hip index and ultrasonography of hip joints during 12 months of follow-up.

Results and discussion. In patients of group 2 treatment with SSZ during 12 months had been resulted in a decrease in the severity of pain from the visual analogue scale (VAS) at hip joint motion (26.1 [13.9, 42.7] vs 69.3 [56.8, 79, 3]), CRP (4.4 [1.5, 6.9] mg/L vs 15.2 [8.3, 21.8] mg/L) and a decrease in the thickness of the hip synovial membrane (6.7 [5.8, 8.5] mm vs 9.6 [7.9, 11.8] mm) compared with the initial data. In patients of the group 3 treatment with ADA had been lead to decreasing of pain VAS (14.2 [5.2, 26.7], vs. 72.1 [65.3, 89.1], BASDAI and ASDAS_CRP (1.7 [1.1, 3.1] and 1.4 [1.1, 2.2] vs. 7.5 [5.9, 8.6] and 3.1 [2.6, 3.9]), CRP (2.7 [0.2, 5.8] mg/L vs. 24.3 [17.4, 35.9]) and decrease in the thickness of hip synovial membrane (6.3 [5.0, 7.7] mm vs. 9.9 [8.1, 12.6] mm) and an increase of the thickness of the hyaline cartilage covering the head of the femur in comparison with group 1 (0.15 [0.09; 0.22] mm vs. —0.08 [–0.12, —0.04] mm). The effect of both drugs on the dynamics of the radiographic index BASRI-Hip and the formation of new osteophytes in hip joints was not noted.

Conclusion. Inclusion of SSZ and ADA in a complex of treatment of patients with hip arthritis associated with AS leads to a decrease of synovitis of hip joints. Usage of ADA is accompanies by ultrasonographic signs of the restoration of hip joints cartilage.

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