K. Maatallah

Reparative radiological changes of hip joint after TNF inhibitors in ankylosing spondylitis

Background: Hip involvement in ankylosing spondylitis (AS) is a common extraspinal arthritic manifestation, which is associated to a worse functional outcome. Little data are available on the effectiveness of conservative treatment strategies. The TNF inhibitors have been proven effective on AS activity parameters. Their structural effect on hip disease however, little is studied. Case presentation: We describe four new cases of reparative changes of a damaged hip joint after treatment with TNF inhibitors. The average of age was 32.5 (27- 36) years. There were 3 men and 1 woman. Hip involvement was bilateral in all cases. Etanercept was prescribed in 3 cases and infliximab in 1 case. At baseline, all patients had a painful and limited hip with high disease activity and an important functional impairment. After an average of 5.5 years of treatment with TNF inhibitors, the BASRI hip evaluated in antero-posterior x-rays of the pelvis remained unchanged at 2.4. The average of mean hip joint space was 2.9mm (2.3-3.6). A widening in hip joint space was observed in all cases with less subchondral cysts. Conclusion: TNF inhibitors seem to be effective on hip joint disease in patients with AS.

THU0373 Use of corticosteroid hip joint injections in spondyloarthritis patients under tnf alpha inhibitors

Background The hip disease is a serious complication of spondyloarthritis (SpA), engaging the functional prognosis of patients. TNF alpha inhibitors are a breakthrough for the treatment of SpA and the management of this complication. Objectives To assess the efficacy of TNF alpha inhibitors on hip involvement in SpA by evaluating the use of intra-articular corticosteroid infiltrations. Methods Observational cohort study that included 94 SpA patients with hip disease (ASAS2009). Two groups were studied. Group 1 (G1): patients under anti-TNF alpha therapy and Group 2 (G2): TNF alpha inhibitors naive patients. Clinical (BASDAI, BASFI, hip (pain/mobility), index of severity for osteoarthritis for the hip (ISH)), biological (CRP) data were assessed and the use of corticosteroid hip joint infiltration was compared. Evaluations were performed and compared between the 2 groups at baseline (T0), two years (T2) and Tn (greater than or equal to 3 years). The correlation study was made by Pearson test. A correlation was considered statistically significant if p<0.05. Results Group 1 and 2 included 48 and 46 patients respectively. The socio demographic and clinical characteristics of the disease were comparable between the two groups. Biological and radiological assessments of the two groups were comparable at T0. Group 1 had however a more active disease and a greater functional impairment. NSAIDs were prescribed in 40% of patients in G1 and 86% in G2 (p<0.0001). DMARDS were prescribed in 20 patients in G1 and in 22 patients in G2 (p=0.6). In G1 patients received infliximab, adalimumab and etanercept in 48%, 15% and 37% of cases respectively. Four patients of G1 and three of G2 patients received intra-articular corticosteroid infiltration in the year prior to the initial assessment (p=0.7). Assessment at T2 showed a greater improvement in clinical and biological parameters of the disease in group 1 than in group 2 with Δ (T2-T0) significantly lower in group 1 for the BASDAI (p<0.0001), the BASFI (p<0.0001) and the ISH (p=0.017). The number of painful hip was significantly lower in group 1 (p<0.0001). The evaluation at Tn showed a sustained clinical and biological efficacy of TNF alpha inhibitors in Group 1. The use of corticosteroid injections was significantly higher in group 2. Table 1 summarizes the assessment of different parameters at T2 and Tn.Table 1. Comparison of Clinical and biological variations between the 2groups at T2 and Tn T2/T0 Tn/T0 G1 G2 p G1 G2 p ΔISH -7,7 [-19, 2] -1,6 [-19, 8] 0,01 -9,3 [-20, 2] 0,1 [-4, 4] 0,005 ΔBASFI -2,7 [-9, 7] 1,1 [-1, 4] <0,0001 -3,2 [-9, 1] 0,2 [-3, 6] <0,0001 ΔBASDAI -3 [-8, 3] 0,4 [-3, 5] <0,0001 -3,4 [-9, 2] -0,9 [-6, 4] 0,001 Hip pain (%) 35 75 <0,0001 20 67 <0,0001 Limitation of hip mobility (%) 71 83 0,2 50 86 <0,0001 ΔCRP (mg/l) -33,6 [-132,69] -6,1 [-72,18] 0,3 -25,5 [-89, 6] -1 [-99,58] 0,04 Corticosteroids hip joint injections (n) 1 3 0,2 0 4 0,04 Conclusions Hip involvement is a marker of severity of spondyloarthritis. Anti-TNF alpha treatment is effective on hip disease. It reduces the use of intra articular injections of corticosteroids. Disclosure of Interest None declared

AB0697 Impact of the baseline bath ankylosing spondylitis radiology hip index on the structural hip joint progression after tnfα blocking therapy in spondyloarthrities patients

Background One of the major goals of treatment of spondyloarthrites (SpA) is to prevent or slow the radiographic damage.The results of clinical trials raised expectations that TNFi are effective not only on clinical and biological parameters of the disease but may also have structural effect. Objectives We assessed whether the baseline Bath Ankylosing Spondylitis Radiology (BASRI) hip index had effect on structural hip progression under TNFα blockers in SpA patients with hip disease. Methods This was a multicentric longitudinal study including SpA patients (ASAS2009) with hip disease under TNF α blockers. Anteroposterior X-rays of the pelvis obtained at baseline were compared with X-rays obtained after 5 years [3–10] of continuous TNF α blockers treatment. Radiographic progression of the hip was evaluated by the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h), scoring system (min 0 = no change, 1 = focal joint space narrowing, 2 = circumferential joint space narrowing >2 mm, 3 = circumferential joint space narrowing ≤2 mm or bone-on-bone apposition of <2 cm and max 4 = bone deformity or bone-on-bone apposition of ≥2 cm) and the hip joint space width (assessed by the average of measurements at three distinct sites between the acetabulum and femoral head)[1]. The median progression of the hip joint space was chosen as cut-off to define the structural evolution, it was 0.3mm. A good response of the hip was defined by a stabilization or a decrease of the hip joint space less than 0.3 mm (RH+).A poor response was defined by a decrease of the hip joint space >0.3mm (RH-). Results 48 patients were included (81% male). The average age was 40.7±11years. The mean age at the onset of the disease was 25.8±10 years. Hip involvement was bilateral in 77% of cases. At baseline, the mean BASRI hip index was 2±0.8. The BASRI hip score was 1 in 26%, 2 in 51%, 3 in 18% and 4 in 5% of patients. The average of hip joint space width at baseline was 3.4±1.2mm. Infliximab was the most prescribed TNFα blocker (48%) followed by Etanercept (37.5%) and Adalimumab (14.5%).After 5years, the mean BASRI hip index remained stable 2±0.8, the BASRI hip score was 1 in 23%, 2 in 50%, 3 in 14% and 4 in 13% (p=ns). The variation of hip joint space width was-0.294 mm (p=ns). 29 patients were RH+. The BASRI hip index 2±0.8 and 2.1±0.9 in RH+ and RH- patients respectively with no statistically significant difference. Conclusions According to our study the structural hip joint progression under TNFα blockers is not influenced by the baseline BASRI hip index. References Konsta M,Sfikakis PP, Bournia VK, Karras D, Iliopoulos A.Clin Rheumatol (2013) 32:1229–1232. Disclosure of Interest None declared

THU0214 Effect of TNF Inhibitors On Radiographic Progression of Sacroiliac Joints in Axial Spondyloarthrities Tunisian Patients

Background Spondyloarthities primarily manifest in the axial skeleton, with a majority of patients having manifestations in the sacroiliac (SI) joints. Objectives To assess the efficacy of TNF inhibitors in reducing sacroiliac (SI) joint progression in patients with Axial Spondyloarthities (AS) Methods AS patients (satisfying ASAS criteria 2009) with at least two sets of Antero-posterior X-rays of the pelvis at a minimum gap of 2 years were included and were divided into two groups: Group1: received TNF-inhibitors and group 2 received non-steroidal antiinflammatory and/or scDMARDs. Radiographic severity was assessed by Forrestier classification at beseline, at 2years and after an average of 5 years. Patients with grade 4 SI joints were excluded. Bath AS Disease Activity Index (BASDAI), BASFI, ESR, CRP, HLA-B27 and age of onset were included in the model Results Group 1 included 46 patients. The median age of onset of the disease was 25 years [16-49ans], HLA B27 was positive in 53% of cases. The median BASDAI and BASFI scores were respectively 5,8 and 5,4. The average ESR and CRP were respectively 49 and 35. Patients received Infliximab 48%, Adalimumab 14% and Etanercept 36%. Twenty two patients received csDMARDs and 24 NSAID. The mean SI joint grade at baseline was 3. Sixty four percent of patients had SI joint grade 3 and 36% had SI joint grade2. Group 2 included 38 patients. There were no significant differences between the two groups for the mean age of onset, the mean CRP and ESR level and SI joint grade at baseline, however BASDAI and BASFI scores at baseline were significantly higher in Group1. In the group of study 30% of patients with SI joint grade 3 progressed to grade 4 and 22% o of patients with SI joint grade2 progressed to grade 3.There were no significant difference between the two groups Conclusions TNF inhibitors do not seem to prevent radiographic progression of the sacroiliac joints. Disclosure of Interest None declared

AB0744 The Progression of Radiological Forms of Hip Disease in Axial Spondyloarthrities Tunisian Patients

Background Hip involvement is the most frequent extra spinal arthritic manifestation of Axial Spondyloarthrities (AS) and a common cause of disability. Objectives To assess the progression of radiological forms of hip disease in AS Tunisian patients and to evaluate the effect of TNF inhibitors on this progression. Methods AS patients (satisfying ASAS criteria 2009) with hip disease and with at least two sets of Anteroposterior X-rays of the pelvis at a minimum gap of 2 years were included. Radiographic forms of hip disease were assessed according to Netter classification (early, condensing, destructive, combined and synostosis forms) at baseline, at 2 years and at an average of 5 years of treatment. Bath AS Disease Activity Index (BASDAI), BASFI, ESR, CRP, HLA-B27, age of onset were included in the model. Results 84 patients were evaluated, The median age of onset of the disease was 25 years [16-54ans], HLA B27 was positive in 50% of cases. The median BASDAI and BASFI scores were respectively 5,4 and 5,5. The average ESR and CRP were respectively 47 and 33. 46 patients received TNF inhibitors (infliximab 48%, Adalimumab 14% and Etanercept 36%), 27 patients received csDMARDs and 46 NSAID. Sixty four patients had bilateral hip involvement. At baseline: 139 hips were evaluated; patients had an early form in 38 hips, condensing form in 4 hips and destructive form in 72 hips. After 2years, 74 hips were evaluated, 16 hips with an early form, four with a condensing form, 33 with destructive form, and 20 had combined form. After an average of 5 years, 96 hips were evaluated; hip involvement was debutant in 14 cases, condensing in 3 cases, destructive in 48 cases, combined in 27 cases and synostosis in 2 cases. Early forms evolved to destructives forms in 8 cases (1 at 2years and 7 at 5years). Destructive forms progressed to combined forms in 8 cases (5 at 2years and 3 at 5years),combined forms progressed to destructives forms in 2 cases and to synostosis forms in 2cases. There was no progression in condensing forms. When we compare patients with TNF inhibitors versus patients TNFnaïf, there were no significant differences between the two groups for the mean age of onset, the mean CRP and VS level and in forms of hips involvement at baseline, however BASDAI and BASFI scores at baseline were significantly higher in TNF inhibitors. When we compare the radiological forms progression between the two groups we found that there is no significant difference in radiographic progression of destructive, condensing and combined forms however there were significantly higher progression in beginning forms in TNF- naïf patients Conclusions The destructive form is the most common radiographic form of hip disease in AS Tunisian patient and TNF inhibitors seem have a protective effect on the hip, especially on the beginning form. Disclosure of Interest None declared

AB0745 Clinical and Radiological Progression in Spondyloarthrities Tunisian Patients with Hip Involvement

Background Hip involvement is a severe prognostic factor and may lead to a worse functional outcome. Objectives To assess clinical and radiological progression in patient with hip involvement and to assess the impact of TNF inhibitors treatment in this population with severe prognostic factor. Methods Axial Spondyloarthritis (AS) patients (satisfying ASAS criteria 2009) with hip involvement with at least two sets of Antero-posterior X-rays of the pelvis at a minimum gap of 2 years were included. Demographic, clinical, radiographic, and laboratory data were collected and analyzed. Radiographic severity was assessed by the modified Stokes Ankylosing Spondylitis Spine Score (mSASSS) and BASRI (Bath Ankylosing Spondylitis Radiologic Index). Results 84 patients were evaluated, the median age of onset of the disease was 25 years [16-54ans], HLA B27 was positive in 50% of cases. Forty six patients received TNF inhibitors (infliximab 48%, Adalimumab 14% and Etanercept 36%), 27 patients received csDMARDs and 46 NSAID. Sixty four patients had bilateral hip involvement. At baseline: the median BASDAI and BASFI scores were respectively 5,4 and 5,5. The average ESR and CRP were respectively 47 and 33. The average BASRI spine was 3, the median BASRI hip was 2 and the median mSASSS was 15. At 2years: The median BASDAI and BASFI scores were respectively 3,4 and 3,6. The average ESR and CRP were respectively 34 and 15. the average BASRI spine was 3,7, the median BASRI hip was 2 the median mSASSS was 19. After an average of 5years: The median BASDAI and BASFI scores were respectively 2,9 and 3,8. The average ESR and CRP were respectively 32 and 20. When we compared TNF inhibitors patients versus TNF naïf, there were no significant difference in age of onset, HLA B27, ESR, CRP, BASRI and mSASSS at baseline between the two groups, however TNF inhibitors patients had a higher BASDAI and BASFI scores. At 2 years: TNF inhibitors patients had a significantly lesser BASDAI and BASFI scores. At an average of 5years: TNF inhibitors patients had significantly lesser BASDAI, BASFI and BASRI hip scores. TNF inhibitors have a protective effect on radiographic hip progression OR 5.07 [IC1.86-13.8] Conclusions Contrary to what has been reported in several studies on the effectiveness of TNF inhibitors on radiological spine progression, this has not been proved in our study, however TNF inhibitors patients showed a less trend for radiological hip progression. Disclosure of Interest None declared