CLINICAL HETEROGENEITY OF EARLY AXIAL SPONDYLOARTHRITIS: ANALYSIS OF CLINICAL AND RADIOLOGICAL FINDINGS IN CRIMEA’S PATIENTS

Abstract

Ankylosing spondylitis (AS) is characterized by considerable variation in the rate of development of structural changes in the vertebral column and joints. As of now, the clinical and laboratory predictors of progression of undifferentiated axial spondyloarthritis (SpA) to AS have not been adequately explored. Objective: to study the clinical features of early axial SpA in view of radiographic changes in the sacroiliac and hip joints and spinal column. Subject s and methods. The rate of different clinical syndromes of axial SpA was analyzed in 162 patients. The study included less than 35-year-old patients with a 2-to-5-year history of axial SpA that was first diagnosed according to the 2009 ASAS criteria, by excluding psoriatic and reactive arthritis and inflammatory bowel diseaserelated arthritis. Result s and discussion. The examinees were diagnosed with undifferentiated SpA (52.5%), advanced AS (43.2%), and late AS (in the presence of syndesmophytes) (4.3%). 38.3% of patients had peripheral arthritis (PA), 8.6% – dactylitis, 28.4% – enthesitis , and 4.9% – uveitis. The patients with advanced AS had higher C-reactive protein (CRP) levels (38.7 [22.3; 45.8]) and lower rates of PA (27%) than those with undifferentiated axial SpA (14.4 [4.2; 18.6] mg/l and 48%, respectively; p < 0.05). The patients with late AS had more commonly enthesitis (71.4%) and HLA-B27 (100%) than those with undifferentiated axial SpA (31.4 and 78.8%) and those with advanced AS (22.3 and 81.4%, respectively; p < 0.05). Radiographic narrowing of the hip joint space was accompanied by increases in the rate of enthesitis up to 56.2% and HLA-B27 up to 93.7% (the remaining patients exhibited 24.6 and 79.5% increases, respectively (p < 0.05). Conclusion. High CRP levels, presence of enthesitis and HLA-B27 may be regarded as predictors for rapid progression of structural changes in patients with early axial SpA. DOI: http://dx.doi.org/10.14412/1995-4484-2015-139-142