Radiographic entheseal lesions at the hip and pelvic region are more prevalent in patients with ankylosing spondylitis (AS) compared with controls, according to findings of a new study presented at the 2019 American College of Rheumatology (ACR)/Association of Rheumatology Professionals (ARP) Annual Meeting.

Despite a high prevalence of structural and inflammatory ultrasonography lesions of peripheral entheses among patients with AS, little is known about the presence of structural entheseal anomalies at the hip and pelvic regions.

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To study this, the researchers analyzed anteroposterior pelvis radiographs of 214 patients with AS enrolled in the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort study.

Anteroposterior pelvis radiographs from 100 controls—matched for age and gender—were obtained from the Department of Radiology at the University Medical Center Groningen in Groningen, the Netherlands.

The radiographs with blinded sacroiliac joints were randomized and scored by 2 trained readers, who reported anomalies with absolute agreement. The following entheseal sites were scored: the left and right greater trochanter, left and right lesser trochanter, left and right ischium, left and right iliac crest, and symphysis pubis. The following 3 anomalies were scored: cortical irregularities/erosions, calcifications, and enthesophytes.

Reader agreement on the entheseal lesions was overall moderate.

Radiographic entheseal lesions at the hip and pelvic region were found in 160 (75%) patients with AS and 58 (58%) controls. A total of 602 lesions were found, of which 478 (80%) were present in patients with AS.

The most prevalent lesion among both groups was irregularity/erosion, followed by enthesophytes. Most of the lesions were found at the os ischii in both groups.

“These new findings concerning structural entheseal lesions at the pelvis and hip region contribute to the knowledge of entheseal involvement in AS,” the researchers concluded.

—Melinda Stevens

Reference:

Wink F, Diemel T, Arends S, Spoorenberg A. Prevalence of radiographic entheseal lesions at the hip and pelvic region in patients with ankylosing spondylitis versus controls [abstract 608]. Arthritis Rheumatol. 2019;71(suppl 10). Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. https://acrabstracts.org/abstract/prevalence-of-radiographic-entheseal-lesions-at-the-hip-and-pelvic-region-in-patients-with-ankylosing-spondylitis-versus-controls/. Accessed November 7, 2019.