Osteitis Score Research Articles

Sequence of joint tissue inflammation during rheumatoid arthritis development

ObjectiveSubclinical joint inflammation in patients with arthralgia is predictive for progression to rheumatoid arthritis (RA). However, the time course of progression for bone marrow edema (osteitis), synovitis, and/or tenosynovitis is unsettled. This longitudinal study assessed the course of magnetic resonance imaging (MRI)-detected subclinical joint inflammation during progression to RA.MethodsPatients that progressed from clinically suspect arthralgia (CSA) to RA underwent 1.5-T MRI of the metacarpophalangeal (MCP), wrist, and metatarsophalangeal (MTP) joints at presentation with arthralgia and at first identification of synovitis assessed through physical examination (n = 31). MRIs were evaluated for osteitis, synovitis, tenosynovitis, and erosions by two readers, blinded for clinical data and order in time. To estimate changes in MRI scores between the asymptomatic state and CSA onset, scores of MRI features at CSA baseline were compared with scores from age-matched symptom-free persons.ResultsAt presentation with CSA, synovitis and tenosynovitis scores were higher than scores from age-matched symptom-free persons (p = 0.004 and p = 0.001, respectively). Anti-citrullinated protein antibody (ACPA)-positive arthralgia patients also had increased osteitis scores (p = 0.04). Median duration between presentation with arthralgia and RA development was 17 weeks. During progression to RA, synovitis and osteitis increased significantly (p = 0.001 and p = 0.036, respectively) in contrast to tenosynovitis and erosion scores. This pattern was similar in both ACPA subsets, although statistical significance was reached for synovitis and osteitis in ACPA-negative but not ACPA-positive RA.ConclusionIncreased tenosynovitis and synovitis scores at CSA onset and the increase in synovitis and osteitis during progression to RA suggest an ‘outside-in’ temporal relationship of arthritis development, in particular for ACPA-negative RA. For ACPA-positive RA, further studies are needed.

Eosinophilic Mucin Rhinosinusitis in Iranian Patients Undergoing Endoscopic Sinus Surgery.

Eosinophilic mucin rhinosinusitis is a type of chronic rhinosinusitis (CRS). Diagnosis and treatment of this condition play a significant role in reducing the patients' clinical symptoms. This type of rhinosinusitis has a higher relapse rate, compared to the other types. This disease is more resistant to treatment and more dependent on corticosteroid therapy, compared to the other types of rhinosinusitis. Regarding this, the present study was designed to evaluate the frequency of eosinophilic mucin rhinosinusitis in patients undergoing sinus surgery in a tertiary referral center and examine some clinical and laboratory characteristics regarding this type of rhinosinusitis. This cross-sectional observational study was performed on patients over the age of 16 years, who were diagnosed with CRS in the otolaryngology clinic of a referral tertiary-level hospital, and were candidates for endoscopic sinus surgery. Based on the detection of eosinophilic mucin, the subjects were divided into two groups of eosinophilic mucin and non-eosinophilic mucin rhinosinusitis (controls). The groups were compared in terms of sino-nasal outcome test (SNOT-22) scores, Lund-Mackay staging scores, osteitis status, immunoglobulin E (IgE) level, and eosinophilia. In this study, 46 subjects participated, 29 (63%) cases of whom had eosinophilic mucin. The SNOT-22 score and serum IgE level were significantly higher in the eosinophilic mucin group, compared to those in the control group. Osteitis and Lund-Mackay scores were also higher in the eosinophilic mucin group than those in the control group; however, this difference was not statistically significant. Patients with eosinophilic mucin rhinosinusitis showed a more severe clinical involvement. Seemingly, the Iranian patients have a lower and higher frequency of eosinophilic mucin rhinosinusitis, compared to the patients from the Western countries and East Asia, respectively.

To explore the role of CT scan in the diagnosis of eosinophilic chronic rhinosinusitis

Objective:We explored the role of CT scan in the diagnosis of eosinophilic chronic rhinosinusitis (ECRS) in sinus osteitis for a better guidance of clinic and treatment. Method:A total of 127 patients with chronic rhinosinusitis who underwent primary surgery were collected(52 patients were ECRS). Seventy-five patients with NonECRS performed global osteitis scoring scale (GOSS) osteitis score on the patient's preoperative sinus CT. Mamn-Whitney U analysis was used to compare the GOSS osteitis scores between the two groups. A binary logistic regression analysis was performed on the statistically significant indicators to find predictive GOSS osteitis scores. Receiver operating characteristic curve (ROC curve) analysis was performed on meaningful indicators to analyze the relationship among the cutoff values the sensitivity and the specificity to find the best cutoff value. Result:The osteitis evaluation index GOSS osteitis total score,ethmoid osteitis scores(GOSS-E), ethmoid osteitis score compared with the maxillary osteitis score (GOSS-E/M), posterior group ethmoid sinus osteitis score compared with the former group ethmoid sinus osteitis score (GOSS-PE/AE), anterior ethmoid osteitis scores (GOSS-AE), posterior ethmoid osteitis scores (GOSS-PE), sphenoid osteitis scores (GOSS-S), ECRS significantly higher than NonECRS(P<0.05); binary logistic regression analysis and ROC curve analysis were performed. When the cut-off value of the ethmoid osteitis score was >4.5 (area under the curve was 0.690), the corresponding sensitivity and specificity were 62% and 71%, respectively. Conclusion:When the ethmoid sinus CT is used to obtain a ethmoid osteitis score of >4.5,the ECRS can be diagnosed clinically.

Glucocorticoid receptor isoform expression in peripheral blood mononuclear leukocytes of patients with chronic rhinosinusitis.

In several inflammatory disorders, altered peripheral blood mononuclear leukocyte (PBML) glucocorticoid (GC) receptor isoform expression has been associated with GC resistance and disease severity. However, it is unclear if PBML GC receptor isoforms are expressed differentially and are associated with worsened disease severity in chronic rhinosinusitis (CRS). PBMLs were isolated from control (n = 8), CRS without nasal polyps (CRSsNP) (n = 8), atopic CRS with nasal polyps (CRSwNP) (n = 8), non-atopic CRSwNP (n = 8), and allergic fungal rhinosinusitis (AFRS) (n = 8) patients. Demographics, atopic status, asthmatic status, 22-item Sino-Nasal Outcome Test (SNOT-22) scores, Lund-Kennedy nasal endoscopy scores, Lund-Mackay sinus computed tomography (CT) scores, Kennedy Osteitis scores, and GC utilization 6 months postoperatively were collected. Intracellular immunostaining was then performed for functional GC receptor α (GCRα) and nonfunctional GC receptor β (GCRβ), followed by flow cytometry analysis of geometric mean fluorescent intensity (MFI) and the percentage of cells expressing each GC receptor isoform. Compared to controls, each CRS subtype had decreased PBML GCRα and GCRα:GCRβ MFI expression, but no difference in GCRβ expression. Decreasing PBML GCRα in AFRS was associated with increasing Lund-Mackay sinus CT scores (r = -0.880, p =0.004). No significant associations were found between GC receptor isoform expression and other clinical measures. CRS patients have reduced functional PBML GCRα expression and decreased GCRα:GCRβ compared to controls. Reductions in GCRα in AFRS are associated with worsening Lund-Mackay sinus CT scores. The clinical implications of decreased functional GC receptor expression merits further investigation.

The Condemned Sinus: Natural Disease or Surgical Sequela?

Unilateral, mucopurulent drainage from an isolated paranasal sinus may be encountered in patients with a history of surgery for the treatment of chronic rhinosinusitis (CRS). Static mucus is visualized on nasal endoscopy within the sinus lumen but without significant disease in the adjacent sinuses. The reasons for this phenomenon are unknown although an iatrogenic cause is proposed. A case series was prospectively compiled from consecutive patients presenting for evaluation of CRS at a tertiary rhinology practice during a 16-month period. Computerized tomography and nasal endoscopy were performed, and endoscopically directed aerobic and anaerobic bacterial cultures were obtained. Osteitis scores were recorded for diseased and nondiseased sides. Twenty-three of 113 patients (20.4%) had evidence of chronic unilateral drainage from either a maxillary (21) or sphenoid (2) sinus. Mean osteitis scores were higher for the diseased side (P < 0.01). A nonendoscopic transantral approach was reported in 57.1% of cases with chronic maxillary disease, with 52.2% occurring more than 10 years earlier. The most common bacterial isolate was Pseudomonas aeruginosa (6 cases, 26.1%), followed by methicillin-resistant Staphylococcus aureus (5 cases, 21.7%). Six cases (26.1%) were polymicrobial, and 6 (26.1%) were culture-negative. Tobacco use was reported in 8 (34.8%) cases, and chronic obstructive pulmonary disease was present in 6 (26.1%) cases. The condemned sinus is a distinct entity that may represent a sequela of previous non-mucosal-sparing surgery. An association with hyperostosis is observed. Mucopurulent drainage is characterized by polymicrobial infection comparable to that found in diffuse CRS.

AC-CUTE: An Open-Label Study to Evaluate Progression of Structural Joint Damage and Inflammation in Subjects with Moderate to Severe Rheumatoid Arthritis.

Aim Examine the efficacy of once-weekly subcutaneous tocilizumab (SC-TCZ) on joint damage at 24 weeks based on radiography of the hands and feet and magnetic resonance imaging (MRI) of the hand in subjects with moderate to severe rheumatoid arthritis (RA). Methods In this Australian open-label, multicentre, prospective, single-arm study, subjects received 162 mg SC-TCZ weekly. Primary endpoint was change in radiographic Genant-modified Total Sharp Score (TSS) between baseline and Week 24. Secondary endpoints included change from baseline to Week 24 in RA MRI scoring (RAMRIS) of erosions, synovitis, and osteitis and Cartilage Loss Score (CARLOS) in the dominant hand and disease activity score 28 (DAS28). Results 52 subjects were enrolled (80% female, mean (SD) age 57 (12) years). Radiography showed mild but not significant progression of joint damage (mean (SD) change in TSS 0.46 (1.29)). Synovitis reduced significantly on MRI; however, osteitis, erosion, and cartilage loss did not change significantly. DAS28 improved significantly by Week 24; 78% of subjects achieved DAS28 remission. SC-TCZ was generally well tolerated. Conclusion Synovitis and DAS28 decreased significantly; however, no significant change in osteitis or joint damage was observed at Week 24. Trial registration This trial is registered with Clinicaltrials.gov registration number NCT01951170 (ML28703).

Clinical application of modified global osteitis score in chronic rhinosinusitis

Objective:To compare GOSS and a newly proposed modified scoring system for assessment of CRS with osteitis.Method:Seventy-one CRS patients were enrolled prospectively.Their preoperative computed tomography (CT) were assessed for severity and extent of osteitis by two otolaryngologists using OsiriX DICOM Viewer software. The method of measurement was similar with GOSS, which retained scoring maxillary and sphenoid, producing a modified global osteitis score(rang: 0-20). Collected the history and completed VAS, SNOT-22, Lund-Kennedy, Lund-Mackay in preoperative. Postoperative follow-up mounted up to 12 months and evaluating CRS patients' outcome. Compared for test-retest and inter-rater reliability between the modified system and GOSS.Result:There is a significant linear positive correlation between Modified GOSS score and GOSS(r=0.913,P<0.001).And Modified GOSS had more association with pre and postoperative L-M and L-K scores than GOSS (r=0.316, 0.357). The modified GOSS showed the highest inter-rater and test-retest, interclass correlation coefficient (pre-ICC=0.947; post-ICC=0.943).Conclusion:Modified GOSS may be a more suitable and convenient scoring system for clinical practice to grading osteitis.

Efficacy of abatacept in patients with rheumatoid arthritis, as assessed by magnetic resonance imaging of bilateral hands.

To examine the efficacy of abatacept in patients with rheumatoid arthritis (RA) using magnetic resonance imaging (MRI) of bilateral hands. This prospective study included 35 RA patients. MRI of bilateral hands was performed at baseline and after 12months of treatment with intravenous abatacept. MRI images were scored for synovitis, osteitis, erosion and joint space narrowing (JSN) according to the RA MRI Scoring System (RAMRIS). The primary endpoint was the change in RAMRIS score from baseline. Repair of erosion was defined as a negative change in the erosion score that was greater than the smallest detectable changes (SDCs). Thirty-one patients completed the study. Median synovitis and osteitis scores showed statistically significant reductions at Month 12 when compared to baseline (synovitis score, -5.5 [P<0.0001]; osteitis score, -0.5 [P=0.03]). However, median erosion and JSN scores did not significantly change. At Month 12, 83% of patients showed no progression of erosion scores and repair of erosion was observed in 11% of patients. All patients with repair of erosion achieved functional remission (Health Assessment Questionnaire-Disability Index ≤0.5). The Simplified Disease Activity Index response rate at Month 1 was identified as an independent factor predicting changes in the erosion scores at Month 12. Abatacept treatment reduced synovitis and osteitis scores and did not worsen erosion and JSN scores at Month 12. Over 10% of patients experienced repair of erosion.

Obesity and rates of clinical remission and low MRI inflammation in rheumatoid arthritis

ObjectivesObesity has been proposed as a risk factor for refractory rheumatoid arthritis (RA). We evaluated the impact of obesity on achieving clinical and imaging definitions of low disease activity.MethodsThis study...

Short-term changes on MRI predict long-term changes on radiography in rheumatoid arthritis: an analysis by an OMERACT Task Force of pooled data from four randomised controlled trials

ObjectiveIn rheumatoid arthritis (RA), MRI provides earlier detection of structural damage than radiography (X-ray) and more sensitive detection of intra-articular inflammation than clinical examination. This analysis was designed to evaluate...

Relationship of patient-reported outcomes with MRI measures in rheumatoid arthritis

PurposeWe assessed whether MRI measures of synovitis, osteitis and bone erosion were associated with patient-reported outcomes (PROs) in a longitudinal clinical trial setting among patients with rheumatoid arthritis (RA).MethodsThis longitudinal...

MRI and ultrasound in rheumatoid arthritis.

To overview the recent literature on the use of MRI and musculoskeletal ultrasonography (MSUS) in rheumatoid arthritis. Subclinical inflammation has been widely confirmed, even in the earliest phases of rheumatoid arthritis. The presence of osteitis has added benefits to modern diagnostic criteria, and anticitrullinated peptide antibody positive patients have demonstrated higher osteitis scores. A model for prediction of rheumatoid arthritis onset employing usual clinical data and power Doppler ultrasonography has been reported. The presence of tenosynovitis may also be an early finding in rheumatoid arthritis. Modern imaging continues to inform our concept of pathogenesis with reports on the direct relationship of synovitis to cartilage proteoglycan loss using compositional MRI measures. Growing data on the validity of MRI as an important predictor of clinical and radiographic damage endpoints has been reported and reflected in the growing use of this outcome in many contemporary biologic therapy trials. Much work has been presented on improved and validated MSUS scores with reduced and feasible joint counts. The role of ultrasonography in making sensible decisions when monitoring biologic use, and in tapering, has been reported. The recent literature demonstrates improved validity and utility for both MRI and MSUS in diagnosis, prognosis and monitoring of rheumatoid arthritis.

Efficacy of VX-509 (decernotinib) in combination with a disease-modifying antirheumatic drug in patients with rheumatoid arthritis: clinical and MRI findings

ObjectiveTo assess early effects on joint structures of VX-509 in combination with stable disease-modifying antirheumatic drug (DMARD) therapy using MRI in adults with rheumatoid arthritis (RA).MethodsThis phase II, placebo-controlled, double-blind,...

Impact of osteitis and biofilm formation and correlation between both in diffuse sinonasal polyposis in Egyptian adults; a prospective clinical and histopathologic study

BackgroundThe pathogenesis of diffuse sinonasal polyposis is still not completely established, possible explanations are osteitis, aeroallergens, fungal sinusitis and biofilms. There are no reports in Egypt about osteitis and biofilms in those patients. PurposeTo study the incidence and impact of osteitis and biofilms in Egyptian patients on diffuse sinonasal polyposis patients. Patients and methodsFifty patients (22 males, mean age of 30.68±7.24years) submitted to surgery for diffuse sinonasal polyposis. Computerized scan on sinuses ordered and scored by Lund–Mackay staging protocol, severity of Osteitis using the Global Osteitis Scoring Scale. Tissue samples were taken from diseased sinuses to be analyzed histopathologically for osteitis, and with scanning electron microscopy to detect bacterial biofilms. Another ten patients as a control scheduled for septoplasty or turbinectomy with no evidence of sinusitis, and tissue specimens were obtained 1cm behind the anterior end of inferior turbinate and processed in the same manner for biofilm comparison. Study designContemporary prospective cross-sectional cohort study. ResultsIn 70% (35/50) of the polyposis patients, histopathology was positive for osteitis. Biofilms were detected by electron microscope in 39 (78%). Two of controls (20%) were biofilm positive with a significant difference (p=0.035). The mean Lund–Mackay was 19.08±3.67 and mean osteitis score was 18.68±11.99. There was a significant correlation between Lund–Mackay and osteitis score (p<0.001) and between both and histopathologically proven osteitis (p=0.049), biofilms (p=0.005) and postoperative endoscopic healing (p=0.046) where increased soft tissue disease and osteitis and biofilm were associated with bad healing and vice versa. ConclusionOsteitis and bacterial biofilms underlie the majority of Polypoidal chronic rhinosinusitis and both correlated significantly. Scanning electron microscope is a good tool for detecting bacterial biofilms. Sinus surgery with surgical ventilation, mechanical disruption of biofilms and osteitis is a mandatory therapeutic choice with prolonged treatment with antibiotics and nasal wash.

Clinical predictors of neo-osteogenesis in patients with chronic rhinosinusitis.

Neo-osteogenesis of the paranasal sinuses is a radiologic finding of unclear clinical significance. Although current evidence suggests that these bony changes represent an inflammatory response rather than an infectious osteitis, bacteria associated with the sinonasal mucosa may induce inflammatory mediators as a mechanism of neo-osteogenesis. The objectives of this study were (1) to determine whether there is an association between bacteria isolated on sinus culture and neo-osteogenesis, and (2) to identify other predictive factors for neo-osteogenesis. Ninety patients undergoing sinus surgery for medically refractory CRS were recruited. Radiologic evidence of neo-osteogenesis was assessed by the Global Osteitis Scoring Scale (GOSS) and mucosal disease severity was assessed by the Lund-Mackay score (LMS). Bacterial culture was obtained endoscopically at the preoperative office visit or during surgery. Multiple and logistic regression models were used to evaluate the association between the types of bacterial species isolated, number of previous surgeries, and severity of neo-osteogenesis. Thirty of the 90 (33.3%) patients had radiologic evidence of neo-osteogenesis. Pseudomonas aeruginosa was significantly associated with neo-osteogenesis (odds ratio [OR], 3.97; 95% confidence interval [CI], 1.12 to 13.56), whereas Staphylococcus aureus was not. The number of previous surgeries, especially 2 or more previous surgeries, was associated with the extent of neo-osteogenesis (OR, 3.48; 95% CI, 1.14 to 10.51). The LMS was also significantly associated with the extent of neo-osteogenesis. The presence of P. aeruginosa in the sinuses is an independent predictor of neo-osteogenesis, whereas S. aureus is not. The number of previous surgeries and the LMS are also independently associated with the severity of neo-osteogenesis.

MRI assessment of early response to certolizumab pegol in rheumatoid arthritis: a randomised, double-blind, placebo-controlled phase IIIb study applying MRI at weeks 0, 1, 2, 4, 8 and 16

ObjectivesTo identify the first time point of an MRI-verified response to certolizumab pegol (CZP) therapy in patients with rheumatoid arthritis (RA).MethodsForty-one patients with active RA despite disease-modifying antirheumatic drug therapy...

Relationship between biofilms and clinical features in patients with sinus fungal ball.

The presence of bacterial biofilms (BBF) and fungal biofilms (FBF) is associated with greater disease severity in chronic rhinosinusitis. However, researches on biofilms in fungal rhinosinusitis are rare. This study investigated the relationship between biofilms and clinical features in patients with sinus fungal ball (SFB). Sixty-four SFB patients undergoing endoscopic sinus surgery and 21 controls were enrolled in this study. Mucosal samples from nasal sinuses were collected for biofilm detection under confocal scanning laser microscopy (CSLM). The general clinical data, Lund-Mackay computed tomography (CT) score, Lund-Kennedy endoscopy score, Global Osteitis Scoring Scale (GOSS) score, Sinonasal Outcome Test (SNOT)-22 score and visual analog scale (VAS) score were recorded. Associations between these parameters and biofilms were assessed. Under CSLM, the positive rates of BBF and FBF were 45.3 % (29/64) and 21.9 % (14/64), respectively in the SFB group but none in controls. When sub-classified according to biofilm status, the BBF-positive subgroup had significantly higher Lund-Mackay score and GOSS score than the BBF-negative one, but there were no differences in demographic characteristics, health-related quality-of-life and endoscopic inflammatory severity. BBF and FBF coexisted on the sinus mucosa of the patients with SFB. BBF was associated with more severe disease, but the distribution of FBF did not affect the severity of SFB.

SAT0046 Extensive MRI Osteitis is Associated with RAPID Radiographic Progression in Early but not Advanced Rheumatoid Arthritis

BackgroundPredictor for rapid radiographic progression (RRP) is still unknown. It has been reported that MRI osteitis is a strong independent predictor for radiographic joint damage (RJD) especially in early rheumatoid...

OP0030 Mri Results from the AVERT Study: A Randomized, Active-Controlled TRIAL to Evaluate Induction of Remission and Maintenance of Drug-Free Remission Using Abatacept in Combination with Methotrexate or as Monotherapy in Patients with Early RA

BackgroundAVERT (Assessing Very Early Rheumatoid arthirits Treatment) is a Phase IIIb, randomized, active-controlled trial to evaluate the efficacy and safety of abatacept (ABA) in combination with methotrexate (+ MTX) in...

OP0155 Ustekinumab Effectively Reduces Active Inflammation as Detected by Magnetic Resonance Imaging in Patients with Active Ankylosing Spondylitis: Results of A 28-Week, Prospective, Open-Label, Proof-Of-Concept Study (TOPAS)

BackgroundUstekinumab – a fully human monoclonal antibody against interleukins 12 and 23 – has been shown to be effective in reduction of symptoms of active ankylosing spondylitis (AS) in a...