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In Russia, coxitis is one of the most common extra-axial manifestations of ankylosing spondylitis (AS). However, many issues regarding its early diagnosis remain unresolved.Objective: to compare the clinical manifestations of coxitis with the data from an instrumental examination of CoRSAR cohort (Cohort of Early Axial Spondyloarthritis) patients.Patients and methods. Examinations were made in 175 patients (mean age, 28.2±5.7 years) diagnosed as having axial spondyloarthritis (axSpA) with inflammatory back pain lasting up to 5 years, which occurred at the age of ≤45 years. There was non-radiographic axSpA (nraxSpA) in 69 patients and AS in 106 patients. 87% of patients were HLA-B27-positive. The median disease duration was 23.8 [1–60] months; BASDAI was 3.3±1.94. Regardless of complaints, all the patients underwent hip X-ray and ultrasound studies and 54 more patients had magnetic resonance imaging (MRI).Results and discussion. The clinical signs of coxitis were present in 95 (54%) patients, of them 60% were diagnosed with AS and 40% had nraxSpA. According to the numerical pain rating scale (NPRS), the median hip joint pain was 4 [3; 7]. Limited joint movement was observed in 6 (3.4%) patients. The level of hip joint pain correlated with BASDAI (r=0.53) and ASDAS (r=0.30). The ultrasound signs of coxitis were detected in 42 (24%) patients; of them 26 (62%) had the clinical manifestations of hip joint injury, and such changes were absent in 16 patients. The patients with ultrasound signs of coxitis were noted to have a higher disease activity; peripheral arthritis and enthesitis were more common. According to MRI, coxitis was diagnosed in 39 (72%) of the 54 examinees, while the disease was asymptomatic in 10%.Conclusion. Different diagnostic methods used in patients with early axSpA could reveal coxitis in 33% of cases. The patients with coxitis show higher laboratory disease activity than those without hip joint injury. It is necessary to include MRI and ultrasound in the mandatory examination of patients with axSpA.

Coxitis is one of the most common extra-axial manifestations of ankylosing spondylitis (AS). Most Russian studies consider hip joint (HJ) involvement in AS patients as a major factor of poor prognosis in this disease. All detected hip joint changes are characterized by one term «coxitis». Until recently, there has been no clarity on inflammation of which structures of HJ leads to its destruction. This problem can be solved by prospective studies. A start was made by the V.A. Nasonova Research Institute of Rheumatology on the study of the evolution of coxitis in AS in 2013. This communication is devoted to the results initially identified by various imaging techniques for detecting HJ changes.Objective:to study the characteristics of HJ injury in AS, which have been detected by different imaging techniques.Subjects and methods.The investigation enrolled 125 AS patients, including 84 men (a male/female ratio of 2:1). The mean age of the patients was 31.4±9.1 years; the mean age at disease onset – 24.6±4.4 years; the median duration of AS at the time of examination – 96 (12–444) months. The HLA-B27 antigen was present in the majority of patients (94%). AS activity defined by ASDAS-CRP and BASDAI was high; BASFI scores averaged 3.4±2.1. All the patients underwent the following instrumental examinations: plain pelvis radiography, HJ ultrasound and magnetic resonance imaging (MRI).Results and discussion.The clinical, ultrasound, and MRI signs of coxitis were found in 82, 75, and 88% of cases, respectively; coxitis was radiologically confirmed only in 50% of patients. This disease was diagnosed by several techniques in the vast majority of cases. The diagnosis of coxitis was based only on clinical signs in only three (2%) patients. In approximately every sixth (16%) patients with AS, who had clinical signs of coxitis, the latter was verified only by one of the instrumental techniques (ultrasonography, radiography, or MRI). Our findings demonstrated that more than half of patients had high coxitis activity, and more prolonged coxitis was responsible for higher X-ray HJ changes and functional limitations.Conclusion.Our study has showed that the instrumental techniques used to diagnose coxitis are not equivalent in evaluating HJ injury. To decide which of them is more effective in screening and predicting the course of coxitis, there is a need for further prospective investigations.

Background The association between MRI inflammation and bone loss in early axial spondyloarthritis (axSpA) patients is not sufficiently studied. Objectives Establishing the association between MRI inflammation of sacroiliac joints (SIJs), lumbar spine (LS) and hip joints (HJs) and bone loss in the nearby bone-joint system in early axial axSpA patients. Methods 73 patients (33 men and 40 women) with early axSpa were examined: mean disease duration 19.9±14.4 months. Patients fulfilled ASAS criteria. Mean age 28.3±6.4 years, mean BASDAI 4.1±1.9; mean ASDAS-CRP 2.7±1.3; mean ESR 21.9±17.6; mean CRP 29.0±38.5; 66 (90.4%) patients were HLA-B27 positive. MRI of SIJs, LS and HJs (in case of hip joint involvement) was performed on Signa Ovation 0.35 T scanner (matrix 288x192). BMD was measured using dual energy x-ray absorptiometry (DXA) of the femoral neck (FN) and lumbar spine (LS) (L2–4). BMD reduction was defined as T score ≤−1. Results MRI inflammation of SIJs and/or LS and/or HJs has been found in 62 (84.9%) patients. Among the 62 patients of this group 44 (71.0%) had BMD reduction in FN and/or LS. And in the group of patients without MRI inflammation (n=11) nobody had bone loss (p=0.0001). MRI sacroiliitis (SI) was observed in 53 (72.6%) patients: 37 (69.8%) of them had BMD reduction in FN and/or LS, and 16 (30.2%) patients of this group had normal BMD values (p=0.007). MRI SI has been found in 32 out of 37 (86.5%) patients that had BMD reduction in the LS; in the group of patients without bone loss in the LS (n=36) MRI SI was observed in 21 (58.3%) patients (p=0.007). MRI SI has been found in 21 out of 27 (77.8%) patients that had BMD reduction in the FN; in the group of patients without bone loss in the FN (n=46) MRI SI was observed in 32 (69.6%) patients (p=0.45). Conclusions Correlation has been detected between inflammatory lesions in SIJs and/or LS and/or HJs and bone loss in FN and/or LS. There is an association between existence of active MRI SI and BMD reduction in the LS. This demonstrates that in patients with early axSpA bone loss is a result of inflammation. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2435