Subjective and Objective Measurements of Sinonasal Manifestations in Patients With Autoimmune Disorders

Abstract

Objectives/Hypothesis A number of autoimmune disorders (ADs) are associated with a spectrum of sinonasal manifestations comparable to chronic rhinosinusitis (CRS). Our objective was to study the subjective and objective measurements of sinonasal manifestations of ADs. Study Design Retrospective cohort study. Methods All patients with ADs referred to our tertiary care rhinology clinic from 2008 to 2019 with sinonasal symptoms were compared to randomly selected cohorts of noneosinophilic CRS without nasal polyps (neCRSsNP) and eosinophilic CRSsNP (eCRSsNP). Demographic data, along with the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Lund‐Kennedy (LK) endoscopy score, Lund‐Mackay (LM) computed tomography (CT) score, nasal crusting, and epistaxis were reviewed at presentation. Results Fifty‐three patients with an AD (26 with sarcoidosis, 14 with systemic lupus erythematosus, 10 with granulomatosis with polyangiitis [GPA], and three with pemphigoid vulgaris) were identified, and compared to 75 randomly selected neCRSsNP patients and 75 eCRSsNP patients. Patients with an AD had an average SNOT‐22 score of 44.4 (confidence interval [CI]: 34.6‐51.2) compared to 25 (CI: 24.4‐25.1) and 29.7 (CI: 20.3‐29.7) for neCRSsNP and eCRSsNP patients, respectively (P < .0001), and an average LK endoscopy score of 5.3 (CI: 4.3‐6.3), compared to 3.4 (P = .005, CI: 2.7‐4) in neCRSsNP and 4.4 in eCRSsNP (P = .2, CI: 3.7‐5). There was no significant difference in the CT score compared to both groups. Patients with an AD also scored significantly worse on all four SNOT‐33 subdomains, nasal obstruction, nasal crusting, and epistaxis. Additionally, patients with GPA had the worst symptomatic and endoscopy scores. Conclusions Patients with ADs presenting with sinonasal symptoms have a more severe subjective and objective presentation than patients with CRS without nasal polyps. Level of Evidence 4 Laryngoscope, 131:255–259, 2021

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

“…Association of AAV type and SNOT-22 scores. At the first remission visit, SNOT-22 total score was higher for patients with AAV compared to healthy controls (median [IQR]: 20 vs 5 [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]; P < 0.001). SNOT-22 total scores at the first remission visit were higher in patients with versus without history of sinonasal involvement before enrollment for all AAV (median [IQR]: 24 vs 14 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]; P = 0.003) (Figure 1).…”

“…1,2,7 In a study of sinonasal disease in patients with autoimmune diseases, including AAV, those with autoimmune disease had more severe subjective and objective disease and scored higher on all SNOT-22 domains compared to those with chronic rhinosinusitis without autoimmune disease. 8 Among patients with GPA, those with sinus involvement reported a lower quality of life compared to those without sinus involvement. 2 Among patients with EGPA, even when systemic vasculitic disease activity was low, SNOT-22 scores indicated high ongoing sinonasal symptom burden with resulting negative impact on quality of life.…”

“…Studies in vasculitis found that SNOT‐22 and Short Form 36 scores correlate and that sinus symptoms have a large impact on quality of life 1,2,7 . In a study of sinonasal disease in patients with autoimmune diseases, including AAV, those with autoimmune disease had more severe subjective and objective disease and scored higher on all SNOT‐22 domains compared to those with chronic rhinosinusitis without autoimmune disease 8 . Among patients with GPA, those with sinus involvement reported a lower quality of life compared to those without sinus involvement 2 .…”

Granulomatosis with Polyangiitis and Nasal Involvement - What Radiological Markers Point the Disease

“…We observe that nodular changes are more typical for another autoimmune disease -sarcoidosis. Makary et al described 53 patients with different autoimmune diseases and compared their sinus changes with chronic rhinusinusitis patients[23]. They found no significant difference in CT scores between the groups but they had only 8 patients with CT scans in autoimmune study group.…”