Background One of the major goals of treatment of spondyloarthrites (SpA) is to prevent or slow the radiographic damage.The results of clinical trials raised expectations that TNFi are effective not only on clinical and biological parameters of the disease but may also have structural effect.
Objectives We assessed whether the baseline Bath Ankylosing Spondylitis Radiology (BASRI) hip index had effect on structural hip progression under TNFα blockers in SpA patients with hip disease.
Methods This was a multicentric longitudinal study including SpA patients (ASAS2009) with hip disease under TNF α blockers. Anteroposterior X-rays of the pelvis obtained at baseline were compared with X-rays obtained after 5 years [3–10] of continuous TNF α blockers treatment. Radiographic progression of the hip was evaluated by the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h), scoring system (min 0 = no change, 1 = focal joint space narrowing, 2 = circumferential joint space narrowing >2 mm, 3 = circumferential joint space narrowing ≤2 mm or bone-on-bone apposition of <2 cm and max 4 = bone deformity or bone-on-bone apposition of ≥2 cm) and the hip joint space width (assessed by the average of measurements at three distinct sites between the acetabulum and femoral head). The median progression of the hip joint space was chosen as cut-off to define the structural evolution, it was 0.3mm. A good response of the hip was defined by a stabilization or a decrease of the hip joint space less than 0.3 mm (RH+).A poor response was defined by a decrease of the hip joint space >0.3mm (RH-).
Results 48 patients were included (81% male). The average age was 40.7±11years. The mean age at the onset of the disease was 25.8±10 years. Hip involvement was bilateral in 77% of cases. At baseline, the mean BASRI hip index was 2±0.8. The BASRI hip score was 1 in 26%, 2 in 51%, 3 in 18% and 4 in 5% of patients. The average of hip joint space width at baseline was 3.4±1.2mm. Infliximab was the most prescribed TNFα blocker (48%) followed by Etanercept (37.5%) and Adalimumab (14.5%).After 5years, the mean BASRI hip index remained stable 2±0.8, the BASRI hip score was 1 in 23%, 2 in 50%, 3 in 14% and 4 in 13% (p=ns). The variation of hip joint space width was-0.294 mm (p=ns). 29 patients were RH+. The BASRI hip index 2±0.8 and 2.1±0.9 in RH+ and RH- patients respectively with no statistically significant difference.
Conclusions According to our study the structural hip joint progression under TNFα blockers is not influenced by the baseline BASRI hip index.
Konsta M,Sfikakis PP, Bournia VK, Karras D, Iliopoulos A.Clin Rheumatol (2013) 32:1229–1232.
Disclosure of Interest None declared
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