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Arthritis Research & Therapy Sep 2020The anterior chest wall (ACW) involvement is characteristic of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, yet little research has focused...
BACKGROUND
The anterior chest wall (ACW) involvement is characteristic of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, yet little research has focused on its magnetic resonance imaging (MRI) findings.
PURPOSE
To characterize the MRI features of the ACW in patients with SAPHO syndrome.
METHODS
Seventy-one patients with SAPHO syndrome and ACW involvement evidenced by bone scintigraphy were recruited in this cross-sectional study. The ACW region was scanned using sagittal, axial, and oblique coronal Dixon T2-weighted sequences and axial Dixon T1-weighted sequences. The characteristics of both active inflammatory and chronic structural lesions were evaluated.
RESULTS
The ACW lesions exhibited an asymmetrical distribution and a predilection for the sternocostoclavicular region (93.0%). Notably, 91.5% of the patients had lesions in the area of the anterior first ribs. Bone marrow edema (BME) was observed in 63 (88.7%) patients, which mainly affected the sternocostal joints (87.3%) and the manubrium sterni (84.5%). All of the BMEs were distributed under the articular surface or the bone cortex, consistent with the distribution of the ligaments and joint capsules. Synovitis was detected in 64 (90.1%) patients, with a predilection for the sternoclavicular joints (76.1%). A soft tissue mass or infiltration was found in all the patients who had bone marrow edema. Thirteen (18.3%) patients showed venous stenosis. Structural changes included bone bridge formation (80.3%), hyperostosis (43.7%), and fat infiltration (39.4%). Four common patterns of involvement were observed: the first rib area, the sternoclavicular area, the sternal angle area, and the areas of the second to sixth sternocostal joints.
CONCLUSION
The ACW lesions of SAPHO syndrome demonstrated a triad of enthesitis, synovitis, and osteitis, suggesting complex interactions among the ligaments, synovium, and bones in the region. The inflammatory changes in the first rib area were highlighted in SAPHO syndrome.
Topics: Acquired Hyperostosis Syndrome; Cross-Sectional Studies; Humans; Magnetic Resonance Imaging; Osteitis; Thoracic Wall
PubMed: 32928273
DOI: 10.1186/s13075-020-02309-6 -
Annals of the Rheumatic Diseases Mar 2017We assessed whether MRI measures of synovitis, osteitis and bone erosion were associated with patient-reported outcomes (PROs) in a longitudinal clinical trial setting... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
We 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).
METHODS
This longitudinal cohort of 291 patients with RA was derived from the MRI substudy of the GO-BEFORE randomised controlled trial of golimumab among methotrexate-naïve patients. Correlations between RAMRIS scores (synovitis, osteitis, bone erosion) and physical function (Health Assessment Questionnaire (HAQ)), pain and global patient scores were determined at 0, 12, 24 and 52 weeks. Correlations between interval changes were also assessed. Multivariable regression models using robust generalised estimating equations evaluated associations over all time-points and their relationship to other clinical disease activity measures.
RESULTS
Greater synovitis, osteitis and bone erosion scores were positively associated with HAQ at all time-points (all p<0.05) and with pain and patient global scores at 24 and 52 weeks. Over all visits, synovitis was associated with HAQ, pain and patient global scores (p≤0.03) independent of clinical disease activity measures. Improvements in synovitis and bone erosion were also associated with improvements in PROs. Less improvement in synovitis and progression in MRI erosion at 52 weeks were both independently associated with worsening in all PROs at 52 weeks while progression on X-ray was not associated. Similar associations were observed across treatment groups.
CONCLUSIONS
MRI measures of inflammation and structural damage correlate independently with physical function, pain and patient global assessments. These observations support the validity of MRI biomarkers.
TRIAL REGISTRATION NUMBER
NCT00264537; Post-results.
Topics: Adult; Antibodies, Monoclonal; Antirheumatic Agents; Arthralgia; Arthritis, Rheumatoid; Biomarkers; Female; Health Status; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Male; Middle Aged; Osteitis; Pain Measurement; Patient Reported Outcome Measures; Radiography; Surveys and Questionnaires; Synovitis
PubMed: 27432355
DOI: 10.1136/annrheumdis-2016-209463 -
Arthritis and Rheumatism Dec 2011To evaluate the effects of golimumab on inflammation/structural damage detected by magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA). (Randomized Controlled Trial)
Randomized Controlled Trial
Significant improvement in synovitis, osteitis, and bone erosion following golimumab and methotrexate combination therapy as compared with methotrexate alone: a magnetic resonance imaging study of 318 methotrexate-naive rheumatoid arthritis patients.
OBJECTIVE
To evaluate the effects of golimumab on inflammation/structural damage detected by magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA).
METHODS
Methotrexate (MTX)-naive RA patients (n = 637) were randomized to placebo plus MTX, golimumab 100 mg plus placebo, golimumab 50 mg plus MTX, or golimumab 100 mg plus MTX (subcutaneous golimumab every 4 weeks). Of these, 318 patients participated in an MRI substudy. MRIs (contrast-enhanced; 1.5T) of the wrist and second through fifth metacarpophalangeal joints of the dominant hand were obtained at baseline and weeks 12 and 24. MRIs were scored by 2 independent readers (blinded to image sequence/chronology, patient identity, and treatment group) for synovitis, bone edema/osteitis, and bone erosions using the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) system. Radiographs (hands, wrists, forefeet at baseline and week 28) were scored by 2 other readers (blinded as above) using the modified Sharp/van der Heijde (SvdH) scoring system. Changes from baseline were compared between treatment groups (two-sided analysis of variance on van der Waerden normal scores).
RESULTS
At weeks 12 and 24, combined therapy with golimumab plus MTX versus placebo plus MTX significantly improved RAMRIS scores for synovitis (mean -1.92 versus 0.14 [P < 0.001] at week 12; -2.45 versus -1.04 [P < 0.001] at week 24), osteitis (mean -1.82 versus 0.56 [P < 0.001] at week 12; -2.27 versus -0.32 [P < 0.001] at week 24), and bone erosion (mean -0.40 versus 0.24 [P = 0.016] at week 12; -0.40 versus -0.24 [P = 0.010] at week 24). Results of sensitivity analyses (no missing doses/data and using linear extrapolation) were generally consistent with results of the primary analyses. Changes in SvdH scores among the MRI substudy patients at week 28 showed no significant difference between golimumab plus MTX therapy and placebo plus MTX (mean 0.49 versus 0.92; P = 0.19). Radiographic SvdH scores demonstrated inhibition of structural damage progression by treatment with golimumab plus MTX as compared with placebo plus MTX in the overall study population but required double the number of patients (637 versus 318) and double the length of followup (28 versus 12 weeks) as needed for MRI to demonstrate this.
CONCLUSION
Improvements in inflammation (synovitis and osteitis) and erosions with golimumab plus MTX therapy exceeded those with placebo plus MTX therapy from week 12 onward, confirming the overall clinical/radiologic findings. MRI was more sensitive than conventional radiography in detecting the progression of erosions.
Topics: Adult; Antibodies, Monoclonal; Antirheumatic Agents; Arthritis, Rheumatoid; Bone Resorption; Disease Progression; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Magnetic Resonance Imaging; Male; Metacarpophalangeal Joint; Methotrexate; Middle Aged; Osteitis; Synovitis; Treatment Outcome; Wrist Joint
PubMed: 22127693
DOI: 10.1002/art.30592 -
Archives of Disease in Childhood Dec 1980During a 10-year period 217 cases of acute haematogenous osteitis were treated. In 131 patients the diagnosis was confirmed either radiologically or bacteriologically,...
During a 10-year period 217 cases of acute haematogenous osteitis were treated. In 131 patients the diagnosis was confirmed either radiologically or bacteriologically, but in the other 86 the diagnosis was based on clinical examination. Either cloxacillin or lincomycin proved to be effective if given before bacteriological diagnosis. Frequent clinical examination, assessing both local signs and the child's general state, will decide which child requires surgery (which should be reserved for the toxic child, the child with concomitant medical disorders lowering host resistance, and the child who does not respond to, or has a lesion which flares up after, initial conservative treatment). Constant vigilance is required by clinicians looking after children with this disease in order to reduce the disabling long-term sequelae.
Topics: Acute Disease; Child; Child, Preschool; Female; Humans; Infant; Male; Osteitis; Sepsis
PubMed: 7458395
DOI: 10.1136/adc.55.12.953 -
Dermatology (Basel, Switzerland) 1993
Topics: Acne Vulgaris; Bone and Bones; Humans; Hyperostosis; Joint Diseases; Osteitis; Psoriasis; Skin; Syndrome
PubMed: 8453138
DOI: 10.1159/000247336 -
Orphanet Journal of Rare Diseases Nov 2020Mandible osteomyelitis can occur in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, a rare chronic inflammatory disease; however, few studies...
BACKGROUND
Mandible osteomyelitis can occur in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, a rare chronic inflammatory disease; however, few studies have explored its characteristics and management.
METHODS
We reviewed the medical records of consecutive SAPHO patients with mandible involvement diagnosed in Peking Union Medical College Hospital from September 2014 to July 2019. Demographic, clinical, laboratory, and imaging data were collected at baseline. Prescription data and follow-up magnetic resonance imaging (MRI) and cone beam computed tomography (CBCT) images were collected from the hospital information system. An electronic questionnaire was distributed to all patients to obtain their latest symptoms.
RESULTS
A total of 26 SAPHO patients with mandibular involvement were involved, all of whom responded to the questionnaire (38.5% male; median age, 28 years; median follow-up duration, 2.1 years). Ten patients (38.5%) had undergone an oral procedure 1 month before the onset of mandibular symptoms. All 14 of the patients who underwent a surgical intervention relapsed within a median duration of 2 months (range 0.25-4.0 months), and 24 patients (92.3%) achieved improvement with conservative treatment. Following bisphosphonate treatment, remission of bone marrow oedema and osteolysis was observed on MRI and CBCT, and 5 patients receiving bisphosphonates with follow-up CBCT after remission did not relapse in 5.4 months (mean 6.0, range 3.2-9.9 months).
CONCLUSION
Mandibular involvement of SAPHO syndrome predominantly occurs in young women. Dental procedures are a possible risk factor. Conservative treatment, especially intravenous bisphosphonates, can lead to oral improvement.
Topics: Acquired Hyperostosis Syndrome; Adult; Diphosphonates; Female; Humans; Male; Mandible; Osteitis; Retrospective Studies
PubMed: 33153463
DOI: 10.1186/s13023-020-01589-0 -
Rheumatology (Oxford, England) Dec 2022Although sustained DMARD-free remission (SDFR; sustained absence of clinical-synovitis after DMARD-discontinuation) is increasingly achievable in RA, prevalence differs...
OBJECTIVES
Although sustained DMARD-free remission (SDFR; sustained absence of clinical-synovitis after DMARD-discontinuation) is increasingly achievable in RA, prevalence differs between ACPA-negative (40%) and ACPA-positive RA (5-10%). Additionally, early DAS remission (DAS4months<1.6) is associated with achieving SDFR in ACPA-negative, but not in ACPA-positive RA. Based on these differences, we hypothesized that longitudinal patterns of local tissue inflammation (synovitis/tenosynovitis/osteitis) also differ between ACPA-negative and ACPA-positive RA patients achieving SDFR. With the ultimate aim being to increase understanding of disease resolution in RA, we studied MRI-detected joint inflammation over time in relation to SDFR development in ACPA-positive RA and ACPA-negative RA.
METHODS
A total of 198 RA patients (94 ACPA-negative, 104 ACPA-positive) underwent repeated MRIs (0/4/12/24 months) and were followed on SDFR development. The course of MRI-detected total inflammation, and synovitis/tenosynovitis/osteitis individually were compared between RA patients who did and did not achieve SDFR, using Poisson mixed models. In total, 174 ACPA-positive RA patients from the AVERT-1 were studied as ACPA-positive validation population.
RESULTS
In ACPA-negative RA, baseline MRI-detected inflammation levels of patients achieving SDFR were similar to patients without SDFR but declined 2.0 times stronger in the first year of DMARD treatment [IRR 0.50 (95% CI; 0.32, 0.77); P < 0.01]. This stronger decline was seen in tenosynovitis/synovitis/osteitis. In contrast, ACPA-positive RA-patients achieving SDFR, had already lower inflammation levels (especially synovitis/osteitis) at disease presentation [IRR 0.45 (95% CI; 0.24, 0.86); P = 0.02] compared with patients without SDFR, and remained lower during subsequent follow-up (P = 0.02). Similar results were found in the ACPA-positive validation population.
CONCLUSION
Compared with RA patients without disease resolution, ACPA-positive RA patients achieving SDFR have less severe joint inflammation from diagnosis onwards, while ACPA-negative RA patients present with similar inflammation levels but demonstrate a stronger decline in the first year of DMARD therapy. These different trajectories suggest different mechanisms underlying resolution of RA chronicity in both RA subsets.
Topics: Humans; Arthritis, Rheumatoid; Osteitis; Tenosynovitis; Inflammation; Antirheumatic Agents; Synovitis; Magnetic Resonance Imaging
PubMed: 35583256
DOI: 10.1093/rheumatology/keac294 -
Seminars in Immunopathology Sep 2019The inflammasomes are intracellular protein complexes that are assembled in response to a variety of perturbations including infections and injuries. Failure of the... (Review)
Review
The inflammasomes are intracellular protein complexes that are assembled in response to a variety of perturbations including infections and injuries. Failure of the inflammasomes to rapidly clear the insults or restore tissue homeostasis can result in chronic inflammation. Recurring inflammation is also provoked by mutations that cause the constitutive assembly of the components of these protein platforms. Evidence suggests that chronic inflammation is a shared mechanism in bone loss associated with aging, dysregulated metabolism, autoinflammatory, and autoimmune diseases. Mechanistically, inflammatory mediators promote bone resorption while suppressing bone formation, an imbalance which over time leads to bone loss and increased fracture risk. Thus, while acute inflammation is important for the maintenance of bone integrity, its chronic state damages this tissue. In this review, we discuss the role of the inflammasomes in inflammation-induced osteolysis.
Topics: Animals; Biomarkers; Bone Resorption; Cytokines; Disease Management; Disease Susceptibility; Gene Expression Regulation; Humans; Inflammasomes; NLR Family, Pyrin Domain-Containing 3 Protein; Osteitis; Signal Transduction
PubMed: 31520179
DOI: 10.1007/s00281-019-00753-4 -
Medicina Oral, Patologia Oral Y Cirugia... Dec 2009The objective of this study was to investigate the frequency of idiopathic osteosclerosis (IO) and condensing osteitis (CO) in a Turkish patient population, considering...
OBJECTIVES
The objective of this study was to investigate the frequency of idiopathic osteosclerosis (IO) and condensing osteitis (CO) in a Turkish patient population, considering factors such as age and sex of the population, in addition to shape and localization, as well as the dental relationship between IO and CO lesions.
PATIENTS AND METHODS
A retrospective study was performed using panoramic radiographs of 6,154 patients ranging in age from 5 to 69 years old, who had been subjected to dental treatment. Descriptive characteristics of radiopacities, including shape, localization and dental relationship were recorded. The Chi-squared test was used.
RESULTS
A total of 238 radiopacities were detected, which included 185 IO lesions in 150 (2.44 %) subjects (96 female, 54 male and mean age: 26.2), and 53 CO lesions in 50 (0.81 %) subjects (27 female, 23 male and mean age: 32.8). Both IO and CO lesions were found to be higher in number among females, as compared to males. However, this difference was statistically significant for IO lesions only (p<0.001). The frequency of IO lesions was found to be significantly higher in the 3rd and 4th decades of life (20-39 years) than in other decades (p<0.001). On the other hand, the frequency with which the CO lesions were detected was similar in ages ranging between 20-39 and 40-69 years old, and its frequency in these periods was noted to be statistically higher than in the 1st and 2nd decades of life (p<0.01).
CONCLUSION
Our results point to the low IO and CO frequency among the Turkish population. In addition, our findings support the theory that IO lesions are developmental variations of normal bone architecture unrelated to a local stimulant, whereas CO lesions could be considered reactive formations related to teeth with severe caries, restoration or pulpitis.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Osteitis; Osteosclerosis; Radiography, Panoramic; Retrospective Studies; Turkey; Young Adult
PubMed: 19680185
DOI: 10.4317/medoral.14.e640 -
Brazilian Journal of Otorhinolaryngology 2015Several experimental studies have shown osteitis after the onset of sinusitis, supporting the idea that bone involvement could participate in the dissemination and...
INTRODUCTION
Several experimental studies have shown osteitis after the onset of sinusitis, supporting the idea that bone involvement could participate in the dissemination and perpetuation of this inflammatory disease. However, procedures commonly performed for the induction of sinusitis, such as antrostomies, can trigger sinusitis by themselves.
OBJECTIVE
To evaluate osteitis in an animal model of sinusitis that does not violate the sinus directly and verify whether this is limited to the induction side, or if it affects the contralateral side.
METHODS
Experimental study in which sinusitis was produced by inserting an obstructing sponge into the nasal cavity of 20 rabbits. After defined intervals, the animals were euthanized and maxillary sinus samples were removed for semi-quantitative histological analysis of mucosa and bone.
RESULTS
Signs of bone and mucosal inflammation were observed, affecting both the induction and contralateral sides. Statistical analysis showed correlation between the intensity of osteitis on both sides, but not between mucosal and bone inflammation on the same side, supporting the theory that inflammation can spread through bone structures, regardless of mucosal inflammation.
CONCLUSION
This study demonstrated that in an animal model of sinusitis that does not disturb the sinus directly osteitis occurs in the affected sinus and that it also affects the contralateral side.
Topics: Animals; Disease Models, Animal; Female; Male; Mucous Membrane; Nasal Mucosa; Osteitis; Rabbits; Sinusitis; Surgical Sponges
PubMed: 25959662
DOI: 10.1016/j.bjorl.2015.03.003