Results of two-year follow-up of patients with coxitis and axial spondyloarthritis. The effect of therapy on the progression of coxitis. Part II
Authors: Agafonova E. M. , Erdes S. 
Published: November 2022

Coxitis is one of the most common causes of early disability in patients with axial spondyloarthritis (axSpA), but the therapy for this condition has not been developed.

Goal. to assess the effect of different treatment regimens on the manifestations of coxitis in patients with axSpA. Material and methods. We analyzed 77 patients with axSpA (ASAS criteria 2009) (23 women and 54 men) followed for at least 2 years with clinical and/or instrumental signs of coxitis. Their average age was 30.8±7.7 years with an average duration of illness of 74.0±90.3 months. Positive for HLA-B27 were 72 (94%) patients. In all patients, the BASRI hip index was assessed for each HJ. The median values of laboratory indicators of inflammation of ESR and CRP were initially high (20.0 mm/h and 14.5 mg/l, respectively), but after 2 years the indicators decreased, including ESR to 8.0 mm/h, and CRP to 5.0 mg/l (p<0.05), what we described in the first message. According to the study design, all patients in the group were divided into three subgroups. In the first subgroup, non-steroidal anti-inflammatory drugs (NSAIDs) were regularly taken in therapeutic doses. The second subgroup included patients who were regularly taking NSAIDs and synthetic basic anti-inflammatory drugs (DMARDs). In the third subgroup, patients were observed with a recommendation to take NSAIDs and regular administration of genetically engineered biological drugs (bDMARDs). In the absence of the effect of therapy and the presence of indications, patients of the studied subgroups were transferred to therapy, which included regular intake of NSAIDs and / or DMARDs in combination with bDMARDs. Results: Baseline, 29 patients were included in the NSAID subgroup, 21 patients received combined therapy with DMARDs and NSAIDs, and 27 patients were treated with NSAIDs+bDMARDs, and 16 of them received them together with DMARDs. Initially, in subgroup 1, radiographic signs of coxitis were present in 6 patients (21%), in subgroup 2 – in 3 (14%), in subgroup 3 – in 10 (37%) patients. Progression of coxitis was noted in 12 (48%), and the number of patients with ssrK≥3 increased from 4 to 40% (p><0.05). By the end of the 2-year follow-up period, only 8 patients out of the initially included 21 patients in the chronic DMARD subgroup continued to be followed up. In this subgroup, a significant decrease in laboratory parameters, such as ESR>< 0.05), what we described in the first message. According to the study design, all patients in the group were divided into three subgroups. In the first subgroup, non-steroidal anti-inflammatory drugs (NSAIDs) were regularly taken in therapeutic doses. The second subgroup included patients who were regularly taking NSAIDs and synthetic basic anti-inflammatory drugs (DMARDs). In the third subgroup, patients were observed with a recommendation to take NSAIDs and regular administration of genetically engineered biological drugs (bDMARDs). In the absence of the effect of therapy and the presence of indications, patients of the studied subgroups were transferred to therapy, which included regular intake of NSAIDs and / or DMARDs in combination with bDMARDs. Results: Baseline, 29 patients were included in the NSAID subgroup, 21 patients received combined therapy with DMARDs and NSAIDs, and 27 patients were treated with NSAIDs+bDMARDs, and 16 of them received them together with DMARDs. Initially, in subgroup 1, radiographic signs of coxitis were present in 6 patients (21%), in subgroup 2 – in 3 (14%), in subgroup 3 – in 10 (37%) patients. Progression of coxitis was noted in 12 (48%), and the number of patients with ssrK≥3 increased from 4 to 40% (p<0.05). By the end of the 2-year follow-up period, only 8 patients out of the initially included 21 patients in the chronic DMARD subgroup continued to be followed up. In this subgroup, a significant decrease in laboratory parameters, such as ESR>< 0.05). By the end of the 2-year follow-up period, only 8 patients out of the initially included 21 patients in the chronic DMARD subgroup continued to be followed up. In this subgroup, a significant decrease in laboratory parameters, such as ESR and CRP (p<0.05), was obtained, but no other differences were obtained. In the NSAIDs+bDMARDs subgroup, during the two-year follow-up, the number of patients increased significantly from 27 to 44, of which 22 received DMARDs. A comparative analysis revealed a significant decrease in BASDAI, BASFI, ASDAS-CRP, ESR and CRP (p><0.05), in this group there was no significant increase in patients with x-ray coxitis (p>0.05).

Conclusion: Therapy with bDMARDs preparations significantly reduces the rate of radiographic progression of coxitis in patients with axial spondyloarthritis in comparison with standard therapy (NSAIDs, sulfasalazine, methotrexate) of this disease.