Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Hip involvement is the most frequent extraspinal arthritic manifestation of Ankylosing Spondylitis (AS) and a common cause of disability. It is present in 24% to 36% of AS patients, leading to total hip replacement (THR) in 5%. The purpose of this study was to examine the prevalence of hip arthritis in AS, to identify predictors of its development and possible gender differences.
Methods: 241 consecutive AS patients (162 men, age: 48.6±11years (mean±SD), disease duration: 23.6 ±11.2 years) were included in this cross-sectional study. The patients received initially: etanercept (n=117), adalimumab (n=89) infliximab (n=25), or golimumab (n=10). Anteroposterior X-rays of the pelvis, obtained before anti-TNF treatment initiation (i.e. baseline), were scored according to BASRI-hip scoring system. In parallel, the lateral x-rays of cervical and lumbar spine were scored using the mSASSS. The patients’ disease activity and functional limitation, prior entering anti-TNF treatment, were recorded by BASDAI, ASDAS-CRP/ESR, BASFI and BASMI. Mann-Whitney, two-sample t-test and logistic regression analysis were applied. The groups averages are expressed as mean±SD, or median(IQR) according to the normality of data.
Results: Hip involvement was assessed both clinically (as pain, reduced range of motion and intermalleolar distance) and radiographically, as BASRI-h score ≥ 2 at baseline anteroposterior pelvis X-rays. Definite hip involvement was detected in 85/241(35%) patients. Bilateral THR and unilateral THR underwent 10/241(4%) and 6/241(2.5%) patients respectively. No gender difference was observed (females: 25/85(30%) vs. males 54/156(35%). The patients with hip arthritis had significantly higher BASDAI-scores (6.1± 1.7 vs. 5.4± 1.9, p=0.03), ASDAS-CRP (3.9± 0.8 vs. 3.4± 0.9, p<0.0001), CRP [12.4(4.2-32) median(IQR) vs. 7(2.5-21), p=0.001], ESR [26(8-39) vs. 14(7-30), p=0.006], compared to those without. Additionally, the aforementioned patients had higher BASFI-score (6.2±1.9vs. 4.8± 2.3, p<0.0001), BASMI-score (5±2.3vs. 3.3± 1.9, p<0.0001) and reduced intermalleolar distance (88±23 vs. 104±19 cm, p<0.0001). AS patients with hip arthritis had also higher mSASSS-scores [13.5 (2- 38.5) vs. 3(0-14), p<0.0001] and increased percentage of presence of syndesmophytes [52/84 (62%) vs.58/153 (38%), p=0.001] and peripheral arthritis [48/83 (58%) vs. 66/155 (42%), p=0.001). According to multivariate logistic regression analysis, independent risk factors for hip arthritis in AS are: ASDAS-CRP (OR:1.8, CI: 1.2-2.8), presence of syndesmophytes (OR: 2.4, CI: 1.2-5) and intermalleolar distance(OR: 0.97, CI: 0.95-0.9).
Conclusion: The prevalence of hip arthritis in AS is very high (1/3) and related to high disease activity and a high mSASSscore. No gender difference in prevalence of hip arthritis was found. Considering the large impact on function, this manifestation might need more attention.
To cite this abstract in AMA style:Konsta M, Nurmohamed M, van Denderen JC, Visman I, Van der Horst - Bruinsma IE. High Prevalence of Hip Arthritis in Patients with Ankylosing Spondylitis Treated with TNF Inhibitors [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/high-prevalence-of-hip-arthritis-in-patients-with-ankylosing-spondylitis-treated-with-tnf-inhibitors/. Accessed November 29, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-prevalence-of-hip-arthritis-in-patients-with-ankylosing-spondylitis-treated-with-tnf-inhibitors/