Clinical Study On The Radiotherapy Of Hip Involvement In Patients With Ankylosing Spondylitis

Objective To evaluate the efficacy of X-ray radiotherapy on the hip involvement in the patients with ankylosing spondylitis (AS) and the safety.Material and Method Among the 242 AS patients admitted to the department of rheumatology from 1999 to 2001, 137 cases had hip joint diseases, among which 65 cases were treated with drug only, and 72 cases were treated with drug combined with X-ray radiotherapy. Of them, 52 drug controls patients (control group, CG) were matched with 52 X-ray radiotherapy recipients (radiotherapy group, RG). The average hospital stay was 18.7±1.9 days. Patients in the CG were treated with NSAID combined with sulfasalazine and/or methotrexate, while patients in the RG were treated with X-ray radiotherapy for one course in addition to the drug therapy. The total irradiation dose of a single hip joint was 15.4±3.5 Gy, divided into 6~15 times, once daily. Drug therapy remained in both groups after discharged. The observation includes symptoms, signs, BASDAI, BASFI, hip joint function score, the CT staging of hip joint involvement, inflammation marker, laboratory test and clinical side effect. SPSS statistics software was used to analyze the data.Results In the RG, 47, 40, 32 cases have completed one-year, two-year, three-year follow-up, respectively, with 46, 38, 31 cases in the CG.. Average follow-up was 1.87 years in the RG and 1.86 years in the CG. Clinical assessmentHip pain The rate of hip pain relief in the RG was significantly higher than that in the CG (82.7% vs. 63.5%, P=0.0271) when discharged.Hip joint function score When admitted, there was no significant difference between the 2 groups (65.1±9.4 for RG vs. 58.1±8.3 for CG, P=0.2876). When discharged, no significant difference was found yet (65.1±9.4 for RG vs. 64.5±8.6 for CG, P=0.3235). And there were significant differences for the score of the RG and the CG compared with those when admitted, respectively. At the end of first year, the score of the RG (69.3±10.5) was higher than that of the CG (66.4±7.2, P=0.0347). There were notable differences for the score of RG and CG compared with those when admitted, respectively. At the end of second year, the score of the RG (64.4±9.8) was higher than that of the CG (62.5±7.9, P=0.0447), and the score of the 2 groups was higher than those when admitted (P equals 0.0368,0.0423, respectively). At the end of third year, there was no difference between the 2 groups (61.3±9.2 for RG vs. 60.6±8.9 for CG, P=0.3221). The hip joint function of the 2 groups was better than those when admitted, respectively (P equals 0.0386 vs. 0.0486).CT staging of hip joint involvement In the RG, there were no significant differences in the first year follow-up (stageⅠ36.3%,stageⅡ63.7%), the second year follow-up (stageⅠ34.6%%,stageⅡ65.4%) and the third year follow-up (stageⅠ31.3%%,stageⅡ68.7%) compared with those when admitted (stageⅠ37.4%%,stageⅡ62.6%), respectively , and so was in the CG. There were also no notable differences for the time when admitted, the first year follow-up, the second year follow-up and the third year follow-up between the 2 groups. There were no stage Ⅲ changes in both groups.Low back pain The low back pain of the RG patients was much better for the time when discharged (73.1%), the first year follow-up (55.3%), the second year follow-up (40.0%) and the third year follow-up (28.1%) compared with that when admitted (88.5%, P<0.05), and so did the CG patients. There were no significant differences for the time when admitted, when discharged, the first year follow-up, the second year follow-up and the third year follow-up between the 2 groups.Morning stiffness (minutes) The durance of morning stiffness of the RG patients was much shorter than that when discharged (22.4±6.2 min), the first year follow-up (18.2±5.9 min), the second year follow-up (16.0±3.8 min) and the third year follow-up (15.9±8.0 min) compared with that when admitted (30.7±9.3 min, P<0.05), and so did the CG patients. There were no significant differences for the time...