Background Hip involvement is a severe prognostic factor and may lead to a worse functional outcome.
Objectives To assess clinical and radiological progression in patient with hip involvement and to assess the impact of TNF inhibitors treatment in this population with severe prognostic factor.
Methods Axial Spondyloarthritis (AS) patients (satisfying ASAS criteria 2009) with hip involvement with at least two sets of Antero-posterior X-rays of the pelvis at a minimum gap of 2 years were included. Demographic, clinical, radiographic, and laboratory data were collected and analyzed. Radiographic severity was assessed by the modified Stokes Ankylosing Spondylitis Spine Score (mSASSS) and BASRI (Bath Ankylosing Spondylitis Radiologic Index).
Results 84 patients were evaluated, the median age of onset of the disease was 25 years [16-54ans], HLA B27 was positive in 50% of cases. Forty six patients received TNF inhibitors (infliximab 48%, Adalimumab 14% and Etanercept 36%), 27 patients received csDMARDs and 46 NSAID. Sixty four patients had bilateral hip involvement. At baseline: the median BASDAI and BASFI scores were respectively 5,4 and 5,5. The average ESR and CRP were respectively 47 and 33. The average BASRI spine was 3, the median BASRI hip was 2 and the median mSASSS was 15. At 2years: The median BASDAI and BASFI scores were respectively 3,4 and 3,6. The average ESR and CRP were respectively 34 and 15. the average BASRI spine was 3,7, the median BASRI hip was 2 the median mSASSS was 19. After an average of 5years: The median BASDAI and BASFI scores were respectively 2,9 and 3,8. The average ESR and CRP were respectively 32 and 20. When we compared TNF inhibitors patients versus TNF naïf, there were no significant difference in age of onset, HLA B27, ESR, CRP, BASRI and mSASSS at baseline between the two groups, however TNF inhibitors patients had a higher BASDAI and BASFI scores. At 2 years: TNF inhibitors patients had a significantly lesser BASDAI and BASFI scores. At an average of 5years: TNF inhibitors patients had significantly lesser BASDAI, BASFI and BASRI hip scores. TNF inhibitors have a protective effect on radiographic hip progression OR 5.07 [IC1.86-13.8]
Conclusions Contrary to what has been reported in several studies on the effectiveness of TNF inhibitors on radiological spine progression, this has not been proved in our study, however TNF inhibitors patients showed a less trend for radiological hip progression.
Disclosure of Interest None declared