AB0827 Hip arthritis remain free from radiographic progression for 24 months following treatment of ankylosing spondyloarthritis with tnf-Α inhibitors: a prospective study
Authors: A. Djebbari, S. Bouakkaz, S. Bennedjma, S. Oulebsir, M. Houbi, R. Boutefnouchet, A. Beguiret, S. Bounihi, F.Z. Naiji, A. Abiayed
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Hip involvement is the most frequent extra-spinal arthritic manifestation of ankylosing spondyloarthritis (AS). It can be severe and may worsen outcomes for patients. There is a large body of high quality evidence for clinical efficacy of TNF-α inhibitors at treating this condition. However, their structural hip benefit remains unknown. <h3>Objectives</h3> In this prospective study undertaken in Algeria, we aimed to evaluate clinical and structural efficacy of TNF-α inhibitor therapies on non-synostosante hip involvement in AS, for a 24 months period. <h3>Methods</h3> This study pursued a follow-up of patients SA using modified New York criteria or ASSAS criteria. Patients were TNF-α inhibitors naïf diagnosed with SA, with hip involvement (identified using clinical and/or radiological findings). Patients were treated with one of the following: adalimumab, infliximab or etanercept. Exclusion criteria were: history of tuberculosis, serious infections, hepatitis, neoplasms, other inflammatory conditions, and hip involvement due to any other causes. The following data were collected: clinical rating of hip involvement using the Harris Hip scoring system, biological characteristics (CRP), and radiological characteristics of hip lesions using Bath Ankylosing Spondylitis Radiology Index of the hip (BASRI hip). Specific disease indexes such as BASDAI and BASFI were also collected. Follow up was undertaken at the following time periods in months: 0, 3, 6, 12 and 24. Statistical analysis of findings was performed using SPSS 11.0 software <h3>Results</h3> The study recruited a total of 30 patients, 22 males and 8 females. Mean age was (24,1±3,1 years). Bilateral and unilateral hip involvements were identified in 67% and 33% of patients, respectively. Mean time for appearance of hip lesions was (3,9±2,1 years). HLAb 27 was present in 30% of this study population. Baseline characteristics of hips examined have shown an altered function (Harris Hip mean score of 56,1±5,1) and a relatively advanced structural score (BASRI hip mean score 2,4±1,1). These scores correlated with high disease activity (BASDAI mean score 5,5±1,2) and a poor mean BASFI score (5,4±2,0). This was accompanied by a mean CRP score of 22,1±8,1. Non-steroidal anti-inflammatory drugs were ineffective. During the 24 months treatment period using TNF-α inhibitors, there was a statistically significant improvement in hip scores from the third month onwards with mean Harris Hip scores of 70,3±21,5 (p&lt;0,001), and 81,3±11,5 (p&lt;0,001) at months 3 and 6, respectively. This was maintained until the end of the study period at 94,2±10,5 (p&lt;0,001). There have also been statistically significant improvements in BASDAI and BASFI scores as well as CRP (all p&lt;0,001). Mean BASRI score, however, remained unchanged after 24 months. Treatment was well tolerated, and no significant complications (e.g. serious infections or tuberculosis) were observed. No prosthesis was indicated for any patient <h3>Conclusions</h3> Hip involvement is associated with severe and rapidly evolving AS. In this study, we have demonstrated improved outcomes and stability of radiographic lesions of hip arthritis for a period of 24 months, when SA was treated with TNF-α inhibitors. <h3>Disclosure of Interest</h3> None declared