Objective — to define more precisely the potential of magnetic-resonance imaging (MRI) in the early diagnosis of coxitis in patients with spondyloarthritis (SpA). Material and methods. Hip (coxofemoral) joint (HJ) MRI (in T1 and T2Fat Sat; 1,5 T modes) was performed in 60 patients with ankylosing spondilitis (AS) and SpA: clinical signs of coxitis were present in 37 patients, while remaining 13 patients without coxitis were included into the control group while 10 healthy subjects without SpA made formed a healthy control group. The following parameters were monitored: pain intensity — by the numeric rating scale (NRS 0—10), distance between the ankles, radiographic changes (RCh) by BASRI index, presence of intraar-ticular exudate by US-examination. Active coxitis was defined as pain (during active and/or passive movement and/or pain at rest) in hip joint after exclusion of enthezitis-related pelvic or greater trochanteric pain. Results. Cases of AS and SpA aged younger than 20 y.o. predominated in the cohort patients with coxitis (55,2%). Bilateral coxitis was diagnosed in 81% patients. Median (Me) of disease duration was 12 [25th; 75th percentiles — 1; 132] months. Pain intensity in hip joint measured by NRS was 3 [2; 5]. RC were not found (BASRI-hip=0) in 20 (29,8%) affected joints, 47 joints met the criteria of I—III BASRI-hip stage. RCh were not present in patients without coxitis (BASRI-hip=1) in 9 (28,7%) joints. The most prevalent inflammatory changes (ICh) in patients with coxitis following MRI data were: exudation in the articular space >7 Ml (54%), bone marrow edema (BME) in the acetabular region (39%), cysts of the acetabular roof (32%), capsule thickening (25,5%), BME of the femoral head (13,4%), cysts of the femoral head (10%). There was a significant correlation between pain intensity measured by NRS and prevalence of ICh (Spearman's rank correlation R=-0,29; t=-2,46; p=0,01). BME of the femoral head and/or of the acetabular roof were seen significantly more often in patients with RCh (in 64 and 25% joints, respectively; p=0,0005). BME of the acetabular roof was 3-fold more common than BME of the femoral head (39 and 13,4%; p=0,001). Femoral head cysts were detected in 15% of joints in the subgroup of patients with RCh, and in 8,5% of joints in the subgroup of patients without RCh (p=0,4). Acetabular roof cysts were seen only in patients with RCh (32%). Overall ICh were detected in 55 (82%) joints in patients with coxitis and in 4 (12,1%) — without coxitis (BME — 1; exudation — 3). In patients without SpA and AS exudation was detected in 5 joints. Conclusion. ICh in hip joint can be detected by MRI before the development of structural damage. The most common area for detection of early inflammatory changes, i.e., BME is the subchondral space of acetabular roof.

Objective: to study the clinical picture of ankylosing spondylitis (AS), the association of its manifestations with the degree of disability in the real practice of a rheumatologist in Russia. Subjects and methods. The investigation enrolled 464 patients with AS, who had consecutively visited rheumatologists for 4 months in 24 cities and towns of the Russian Federation. A specially designed clinical card was filled out for all patients. Later on, the diagnosis of the disease was verified at the Research Institute of Rheumatology, Russian Academy of Medical Sciences, according to the 1984 modified New York criteria and pelvic survey X-ray films were assessed by two independent experts in a blind fashion. Results. The valid diagnosis of AS was confirmed in 330 (71.1%) out of all 464 patients included into the study; their mean age was 39.7±10.2 years; the mean duration of disease was 14.6±2.6 years; 86% were men and 14% were women. About half (47%) of the patients had peripheral arthritis and 56% had clinical signs of coxitis. The mean BASDAI and BASFI scores were 4.8±2.1 and 4.3±2.6, respectively. 61% of the patients had a BASDAI score of >4.0. Uveitis was the most common extravertebral manifestation (22%). One third of the patients did not work because of health reasons; 45% of the patients changed their work activities due to disease. Conclusion. In Russia, AS is characterized by its high activity, frequent involvement of hip joints and poor functional status in the patients on average 15 years after the onset of the disease. Loss of working capacity was observed in one-third of the patients. In the country, AS is diagnosed very late, on average 9 years after the disease onset.

The duration of continuous use of infliximab is more than 8 years in patients with ankylosing spondylitis (AS). The efficiency of the drug persists in most patients during its long-term regular therapy.Objective. To evaluate the effectiveness and safety of long-term infliximab therapy in patients with AS, particularly in those with a treatment interruption of ≥16 weeks, and to analyze the effect of the drug on various clinical manifestations of AS.Subjects and methods. The follow-up included 62 patients with a valid diagnosis of AS (New York criteria 1984) who received long-term (≥1 year) regular infliximab therapy in the Anticytokine Therapy Room, Research Institute of Rheumatology, Russian Academy of Medical Sciences. The dose of infliximab was 5 mg/kg. The following parameters: BASDAI and BASFI indices, global AS activity, the number of inflamed joints, enthesitis, and erythrocyte sedimentation rate were estimated in all the patients before therapy and each infusion. Improvement was determined by the ASAS criteria. Effectiveness was ascertained based on the maximum ASAS improvement that was observed per at least 75% of visits. Account was taken of the following clinical manifestations of AS: spondylitis, peripheral arthritis, coxitis, dactylitis, heel enthesitis, psoriasis, and inflammatory bowel diseases. A subgroup of 17 patients who had a forced increase in infliximab infusion intervals from 16 weeks to 3 years was separately identified in the study group.Results. The mean age of all the patients was 32.7 years; the mean duration of AS was 13.4 years; the mean therapy duration was 2.5 years. The therapy was performed for more than 3 and more than 5 years in 13 and 22 patients, respectively. According to therapy response, all the patients were divided into 3 groups: 1) those with ASAS improvement; 2) those with partial remission; 3) those with secondary inefficiency. Partial remission was observed in 35 (57%) patients; ASAS 40 improvement was seen in 15 (24%); secondary inefficiency developed in 12 (19%) patients. Peripheral arthritis was significantly less common in the group of patients who had achieved partial remission versus those who had achieved 40% improvement and those who had developed secondary inefficiency (p 16- week interruption, it is expedient to use cetirizine for 5 days and/or premedication with GC (prednisolone in a dose of 50 mg or dexaven in a dose of 8 mg).