早期SpA患者髋关节的受累发生率

早期SpA患者髋关节的受累发生率

EULAR2015,
PresentID: FRI0236

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How often are hip joints involved in patients with early spondyloarthritis? T. Dubinina1,*, E. Gubar1, A. Demina1, O. Rumyantseva1, S. Shubin1, S. Krasnenko1, R. Balabanova1, M. Urumova1, S. Erdes1 1VA NASONOVA RESEARCH INSTITUTE OF RHEUMATOLOGY, RUSSIA, MOSCOW, Moscow, Russian Federation Background: Previous studies showed that patients with coxitis have higher disease activity and more pronounced functional impairments. Following these findings early detection of coxitis is of great clinical importance. Objectives: To study the incidence of HJ involvement in patients with early spondyloarthritis (SpA). Methods: The study included 130 patients (mean age 28,7±7,5 y): 77 (59,2%) with axial SpA (axSpA, ASAS 2009) and 53 (40,8%) with peripheral SpA (pSpA, ASAS 2011), 56,9% – females, 83,7% - HLAB27-positive. Average disease duration in axSpA was 19,7±14,8 mo, in pSpA – 8,9±8,8 mo. The following evaluations were made: BASDAI, ASDAS-CRP, ASDAS-ESR, BASFI, HJ pain (numerical rating scale – NRS -  from 0 to 10), inter-malleolar distance (IMD), radiological HJ changes (BASRIhip), ultrasound examination  (US) and MRI of hip joints. Results: 74 (56,9%) out of 130 patients suffered pain in HJ (the majority of them (73 %)  met axial SpA criteria). 67,6% out of 74 patients had pain in the right HJ, 85,1 % -  in the left HJ, while 52,7% - had pain in both HJ.  Mean pain score in the right HJ was 5,5±7,8, in the left HJ – 4,6±6,0. Mean duration of HJ pain was  9,1±10,9 mo. HJ funcional limitations were documented in 27 patients (36,5%), bilateral were found in  66,7%. IMD was  90,4±15,5 cm. Functional limitations lasted for 8,7±9,4 mo in average. HJ radiological changes were documented in 20 (27,0%)  out of 74 patients:  in 9 cases - BASRIhip =2, in 11 cases – BASRIhip=1. US symptoms of coxitis  (the distance between the anterior joint capsule and the femoral neck, capsular-neck distance CND >7 mm) were found in 32 joints (on the right  – 14 (CND 8,4±5,9 mm), on the left – 18 (8,3±1,5 mm)). Inflammatory MRI symptoms were found in 41 joints (on the right – 20 (swelling of bone marrow in femoral head – 3, swelling of acetabular roof – 5, synovitis – 20), on the left – 21 (swelling of bone marrow in femoral head – 6, swelling of acetabular roof – 7, synovitis – 21). Patients with early SpA and HJ involvement had higher disease activity vs patients without HJ involvement (BASDAI (4,3±2,1 vs 3,2±1,8), ASDAS-CRP (2,8±1,3 vs 1,8±1,2), ASDAS-ESR (2,7±1,4 vs 1,9±1,4)), although without any difference in functional impairment by BASFI. Conclusions: 1. HJ involvement is more common in patients with axSpA.Pain and functional limitation in HJ in early SpA patients were found in 56,9% and 36,5% cases, respectively, and they were bilateral in the majority of cases. Radiological changes were found in 27,0%  of cases despite short-standing HJ pain in the studied sample.US and MRI changes were found in 32 and 41 HJs, respectively. Patients with HJ involvement demonstrated higher disease activity as compared to SpA patients without HJ involvement. 2. Further studies are warranted to gain better insight into HJ involvement in early SpA to identify potential predictors of radiological progression and role instrumental modalities in early detection of coxitis.

背景：以往的研究表明，合并有髋关节炎的患者有较高的疾病活动度，功能损伤更明显。正是有这些发现，早期诊断髋关节炎就有了非常重要的临床意义。 目的：研究早期脊柱关节炎患者的髋关节受累发生率。 方法：纳入130例患者(平均年龄28.7±7.5岁)，其中77例(59.2%) axSpA (ASAS 2009)，53例(40.8%)外周SpA(ASAS 2011)，女性比例56.9%，83.7%患者HLA-B27阳性。axSpA的平均病程为19.7±14.8月，外周SpA的平均病程为8.9±8.8月。观察以下指标：BASDAI、ASDAS-CRP、ASDAS-ESR、BASFI、髋关节疼痛(采用NRS格式的视觉模拟尺(0-10))、踝间距(IMD)、髋关节放射学变化(BASRIhip)、髋关节超声(US)与磁共振(MRI)。 结果：130例患者中，有74例(56.9%)患者有髋关节疼痛(其中73%符合axSpA分类标准)。74名患者中67.6%右侧髋关节疼痛，85.1%左侧髋关节疼痛，52.7%双侧髋关节疼痛。右侧髋关节疼痛平均评分为5.5±7.8，左侧髋关节疼痛平均评分为4.6±6.0。髋关节疼痛平均病程为9.1±10.9月。27例(36.5%)患者存在髋关节功能受限，66.7%为双侧受限。踝间距(IMD)为90.4±15.5cm。功能受限平均持续8.7±9.4月。74名患者中有20例(27.0%)有髋关节放射学改变：9例患者BASRIhip=2分，11例患者BASRIhip=1分。超声发现骶髂关节炎(定义为前关节囊及股骨颈的距离即囊颈距离(CND)>7mm)：有32个关节受累(右侧受累14个，CND: 8.4±5.9mm，左侧受累18个，CND: 8.3±1.5mm)。MRI发现41个关节有炎症表现，右侧20个(3个股骨头骨髓水肿，5个髋臼顶骨髓水肿，20例滑膜炎)，左侧21个(6个股骨头骨髓水肿，7个髋臼顶骨髓水肿，21例滑膜炎)。早期脊柱关节炎合并髋关节受累的患者较无髋关节受累患者的疾病活动度更高(BASDAI (4.3±2.1 vs 3.2±1.8)，ASDAS-CRP (2.8±1.3 vs 1.8±1.2)， ASDAS-ESR (2.7±1.4 vs 1.9±1.4))，而功能评分BASFI无明显差异。 结论：1. 髋关节受累多见于中轴型脊柱关节炎患者。早期脊柱关节炎患者有髋关节疼痛及功能受限的比例分别为56.9%和36.5%，大部分病例是双侧受累。有27%的患者有放射学改变。超声和MRI分别发现32个和41个关节有变化。与无髋关节受累的患者相比，有髋关节受累的SpA患者表现出更高的疾病活动度。2. 未来有必要进一步研究早期SpA的髋关节受累，以识别放射学进展的潜在预测因子以及髋关节炎的早期诊断工具。