Impact of baseline clinical and radiological features on outcome of chronic rhinosinusitis in granulomatosis with polyangiitis

Abstract

Background Granulomatosis with polyangiitis (GPA) causes a recurring inflammation in nose and paranasal sinuses that clinically resembles chronic rhinosinusitis (CRS) of other aetiologies. While sinonasal inflammation is not among the life-threatening features of GPA, patients report it to have major negative impact on quality of life. A relatively large proportion of GPA patients have severe CRS with extensive damage to nose and sinus structures evident by CT, but risk factors for severe CRS development remain largely unknown. In this study, we aimed to identify clinical and radiological predictors of CRS-related damage in GPA. Methods We included GPA patients who had clinical data sets from time of diagnosis, and two or more paranasal sinus CT scans obtained ≥12 months apart available for analysis. We defined time from first to last CT as the study observation period, and evaluated CRS development across this period using CT scores for inflammatory sinus bone thickening (osteitis), bone destructions, and sinus opacifications (here defined as mucosal disease). In logistic regression, we applied osteitis as main outcome measure for CRS-related damage. Results We evaluated 697 CT scans obtained over median 5 years observation from 116 GPA patients. We found that 39% (45/116) of the GPA patients remained free from CRS damage across the study observation period, while 33% (38/116) had progressive damage. By end of observation, 32% (37/116) of the GPA patients had developed severe osteitis. We identified mucosal disease at baseline as a predictor for osteitis (odds ratio 1.33), and we found that renal involvement at baseline was less common in patients with severe osteitis at last CT (41%, 15/37) than in patients with no osteitis (60%, 27/45). Conclusions In this largely unselected GPA patient cohort, baseline sinus mucosal disease associated with CRS-related damage, as measured by osteitis at the end of follow-up. We found no significant association with clinical factors, but the data set indicated an inverse relationship between renal involvement and severe sinonasal affliction.

The Nasal Microbiome in ANCA-Associated Vasculitis: Picking the Nose for Clues on Disease Pathogenesis

“…Clinical manifestations of GPA include necrotizing granulomatous inflammation of the upper and lower airways and glomerulonephritis. In GPA, the majority of patients initially present with sinonasal involvement presenting as nasal obstruction and rhinitis, which in more than 60% of patients persists during disease remission [ 7 ]. In contrast to GPA, patients with MPA often present with non-granulomatous glomerulonephritis and pulmonary involvement.…”

Associação entre polimorfismos de nucleotídeo único de OPG e RANKL e rinossinusite destrutiva em pacientes com granulomatose com poliangiíte

“…Necrose fibrinoide de pequenos vasos, granulomas epiteliais e necrose óssea avascular já foram aventados como partes importantes do processo 9 . Em uma grande coorte norueguesa de pacientes com GPA, doença mucosa no inicial, expressa pelo escore de Lund-McKay, foi o único dado associado à osteíte após 5 anos 10,11 . Não há evidência, até o momento, de forma de manifestação, achados laboratoriais, positividade de ANCA ou abordagem terapêutica que possa predizer ou prevenir o dano ósseo.…”