Background The hip disease is a serious complication of spondyloarthritis (SpA), engaging the functional prognosis of patients. TNF alpha inhibitors are a breakthrough for the treatment of SpA and the management of this complication.
Objectives To assess the efficacy of TNF alpha inhibitors on hip involvement in SpA by evaluating the use of intra-articular corticosteroid infiltrations.
Methods Observational cohort study that included 94 SpA patients with hip disease (ASAS2009). Two groups were studied. Group 1 (G1): patients under anti-TNF alpha therapy and Group 2 (G2): TNF alpha inhibitors naive patients. Clinical (BASDAI, BASFI, hip (pain/mobility), index of severity for osteoarthritis for the hip (ISH)), biological (CRP) data were assessed and the use of corticosteroid hip joint infiltration was compared. Evaluations were performed and compared between the 2 groups at baseline (T0), two years (T2) and Tn (greater than or equal to 3 years). The correlation study was made by Pearson test. A correlation was considered statistically significant if p<0.05.
Results Group 1 and 2 included 48 and 46 patients respectively. The socio demographic and clinical characteristics of the disease were comparable between the two groups. Biological and radiological assessments of the two groups were comparable at T0. Group 1 had however a more active disease and a greater functional impairment. NSAIDs were prescribed in 40% of patients in G1 and 86% in G2 (p<0.0001). DMARDS were prescribed in 20 patients in G1 and in 22 patients in G2 (p=0.6). In G1 patients received infliximab, adalimumab and etanercept in 48%, 15% and 37% of cases respectively. Four patients of G1 and three of G2 patients received intra-articular corticosteroid infiltration in the year prior to the initial assessment (p=0.7). Assessment at T2 showed a greater improvement in clinical and biological parameters of the disease in group 1 than in group 2 with Δ (T2-T0) significantly lower in group 1 for the BASDAI (p<0.0001), the BASFI (p<0.0001) and the ISH (p=0.017). The number of painful hip was significantly lower in group 1 (p<0.0001). The evaluation at Tn showed a sustained clinical and biological efficacy of TNF alpha inhibitors in Group 1. The use of corticosteroid injections was significantly higher in group 2. Table 1 summarizes the assessment of different parameters at T2 and Tn.
Conclusions Hip involvement is a marker of severity of spondyloarthritis. Anti-TNF alpha treatment is effective on hip disease. It reduces the use of intra articular injections of corticosteroids.
Disclosure of Interest None declared