FRI0407 TWO-YEAR ULTRASOUND CONTROLLED STUDY OF HYALINE CARTILAGE AND SYNOVIAL LAYER STRUCTURE OF HIP JOINTS IN PATIENTS WITH ANKYLOSING SPONDYLITIS DURING TREATMENT WITH ADALIMUMAB
Authors: Andriy Petrov, Anife Gaffarova, Aleksey Petrov, Jana Shevnina
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The impairment of hip joints has significant prognostic value on functional status of patients with Ankylosing spondylitis (AS) [1]. One of possible yearly marker of hip joints structure damage in patients with AS may be changing in volume of hyaline cartilage [2]. Objectives. <h3>Objectives</h3> To investigate changes in width of hyaline cartilage and synovial layer of hip joints in patients with coxitis, associated with AS under treatment with adalimumab (ADA) during 2 years. <h3>Methods</h3> The 28 patients with AS and clinical, ultrasound and radiographic signs of coxitis (21 male, 7 female, average age is 35.4 years old, duration of disease is 12-132 month) were included into study. All patients were being treated by NSAIDs at least 3 months before they started to take ADA (40 mg subcutaneously every 2 weeks). Treatment with ADA was continued during 24 months. Patients were observed at month 0, 12 and 24 months of treatment including measurements of pain visual analog scale (VAS) in hip movements, maximal distance between ankles, pelvic X-ray and sonography of hip joints by 10-18 MHz probe. BASRI-Hips index was applied for radiographic estimation of structural damage of hip joints [3]. During sonography width of hip joint capsule and hyaline cartilage were measured. The Mann-Whitney-U test was used for comparison of changes in clinical and sonographic data between two groups of patients. <h3>Results</h3> It was determined that pain VAS at hip movements was decreased (23.1 [12.3; 32.3] mm at month 12 and 19.7 [11.8; 32.9] mm at month 24 vs 73.7 [59.5; 82.6] mm at month 0, p&lt;0.05) and maximal distance between ankles was increased (112.5 [94.7; 122.2] mm at month 12 and 116.2 [91.2; 125.0] mm at month 24 vs 78.7 [63.4; 98.5] mm at month 0, p&lt;0.05) in observed patients under treatment with ADA. It was also found that ultrasound measured width of hip joint capsule was decreased from 11.8 [10.3; 12.7] mm at month 0 to 8.7 [8.1; 9.4] mm at month 12 (p&lt;0.05) and 7.5 [6.6; 8.5] mm at month 24 (p&lt;0.05). The ultrasound measured width of hyalinic cartilage in observed patients was increased from 0.8 [0.6; 1.1] mm at month 0 to 1.0 [0.8; 1.2] mm at month 12 (p&gt;0.1) and 1.2 [1.0; 1.7] mm at month 24 (p&lt;0.05) under treatment with ADA. The BASRI-Hips index had not changed in observed patients at the end of 24-months period. The differences in changes of hip cartilage width between patients with joint capsule width at month 24 less than 9 mm and more than 9 mm was determined (p&lt;0.05): +0.6 [0.3; 0.8] mm vs +0,1 [-0.1; 0.2] mm. <h3>Conclusion</h3> Treatment with ADA leads to decrease of clinical and sonographic signs of coxitis in patients with AS and improves of hyaline cartilage structure. The increase of width of hip hyalinic cartilage was observed in patients with absence of ultrasound signs of hip joints synovial inflammation in patients with AS. MRI-controlled studies are needed to confirm ability of THFα inhibitors to restore cartilage volume in patients with coxitis, associated with AS. <h3>References</h3> [1] Baraliakos X., Braun J. Hip involvement in ankylosing spondylitis: what is the verdict?Rheumatology2009;49(1):3–4. [2] Maksymowych W.P. Ankylosing spondylitis – at the interface of bone and cartilage. J Rheumatol2000;27(10):2295–301. [3] MacKay K, Brophy S, Mack C, et al. The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the bath ankylosing spondylitis radiology hip index. J Rheumatol. 2000;27:2866–72. <h3>Disclosure of Interests</h3> None declared