Patient‐Reported Sinonasal Symptoms and Risk of Relapse in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

Abstract

ObjectiveRelapses are frequent and difficult to predict in ANCA‐associated vasculitis (AAV), resulting in long‐term use of immunosuppression. Although sinonasal disease is associated with relapse of AAV, detailed characterization of sinonasal symptoms is lacking. Using a patient‐reported outcome, the 22‐item SinoNasal Outcome Test (SNOT‐22), we investigated the relationship between sinonasal symptoms and disease activity in AAV.MethodsThis was a prospective, longitudinal study of AAV and healthy individuals. Relapse was defined as BVAS/WG greater than zero. Higher SNOT‐22 scores indicate worse symptoms. Generalized estimating equation and Cox proportional hazard models evaluated the association between SNOT‐22 and relapse.ResultsThere were 773 visits (106 active disease visits) from 168 patients with AAV and 51 controls. Median SNOT‐22 at remission was higher in AAV vs. controls (20 vs. 5, p<0.001) and higher during active disease vs. remission (p<0.001). In all AAV, and particularly within granulomatosis with polyangiitis, higher SNOT‐22 scores were observed months to years before relapse and were associated with increased risk of relapse (HR 2.7 [95% CI 1.2‐6.2], p=0.02). Similar findings were seen when examining patients with vs. without sinonasal disease and after removing relapses limited to the ear, nose, and throat.ConclusionA patient‐reported outcome measure of sinonasal disease, the SNOT‐22, not only changes with disease activity in AAV, but also is associated with a higher risk of relapse within 2 years. These findings support the possibility that the SNOT‐22 score may enhance prediction of relapse and that persistent sinonasal disease may be important in the pathophysiology of relapse.