Impact of Paranasal Sinus Surgery in Granulomatosis With Polyangiitis: A Longitudinal Computed Tomography Study

Abstract

Objectives/Hypothesis Severe chronic rhinosinusitis (CRS) in patients with granulomatosis with polyangiitis (GPA) failing medical therapies can be treated with paranasal sinus surgery. Whether this surgery protects from progressive sinonasal damage remains unknown. Here, we aimed to analyze time‐dependent relations between sinus surgeries and computed tomography (CT) imaging features in the CRS of GPA. Study Design Longitudinal observational study. Methods We assessed CRS features including bone thickening by global osteitis scoring scale, bone erosions, and mucosal thickening by Lund‐Mackay scores in serial paranasal sinus CT scans (742 CT scans in total) from a cohort of 127 well‐characterized GPA patients. Data on sinonasal surgical procedures were from a mandatory national registry and from chart review. We defined the time from baseline CT to last CT as the study observation period in each patient. Datasets were analyzed by linear mixed models. Results We found that 23/127 cohort patients had one or more paranasal sinus surgical procedures, and 96% of these (22/23) had osteitis by CT after surgery. In patients with nasal surgery alone or no surgery, we identified osteitis in 7/11 (64%) and 45/93 (48%), respectively. During the observation period of a median of 5 years, 38 patients had progression of their sinus osteitis, with the highest annual osteitis progression rates observed around the time of surgery. Conclusions In this cohort, paranasal sinus surgery was associated with prevalence, severity, and progression rate of sinus osteitis, indicating that sinus surgery does not reduce the bone damage development in the CRS of GPA. Level of Evidence 4 Laryngoscope, 130: E460–E468, 2020

Impact of Baseline Clinical and Radiological Features on Outcome of Chronic Rhinosinusitis in Granulomatosis with Polyangiitis

“…We have previously shown that sinus surgery associates with osteitis development in GPA (13). Consistently, we found a large difference in osteitis outcome between GPA patients with or without a history of sinus surgery (Figure 3).…”

“…We have described details on the GPA patient cohort in previous paranasal CT studies [12,13]. Briefly, the cohort included all the GPA patients from the Norwegian systemic vasculitis and connective tissue disease registry (NOSVAR), a consentbased patient registry run by the Department of Rheumatology at Oslo University Hospital, who met the following pre-specified inclusion criteria: (I) clinical ANCA vasculitis classifiable as GPA according to the European Medicines Agency (EMA) algorithm [14], (II) at least two sets of archived sinus CT scans available for analysis, with minimum one year between time of baseline CT and time of last CT.…”

“…Recently, we developed and applied methods suitable for evaluation of serial paranasal sinus CT scans of GPA patients. We used these methods to assess time-dependent CRS changes, with thickening of the bones of the sinus walls as the main surrogate marker for sinus damage [12,13].…”

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

“…We have described details on the GPA patient cohort in previous paranasal CT studies [12,13]. Briefly, the cohort included all the GPA patients from the Norwegian systemic vasculitis and connective tissue disease registry (NOSVAR), a consentbased patient registry run by the Department of Rheumatology at Oslo University Hospital.…”

“…Recently, we developed and applied methods suitable for evaluation of serial paranasal sinus CT scans of GPA patients. We used these methods to assess time-dependent CRS changes, with thickening of the bones of the sinus walls as the main marker for sinus damage [12,13].…”