Patients with prior sinusitis have greater rheumatic disease risk
Click Here to Manage Email Alerts
Key takeaways:
- Chronic and acute sinusitis were linked to higher risk for APS, Sjögren’s disease and seronegative RA.
- Future studies may examine if upper respiratory multiomics can inform diagnosis and treatment.
Patients with prior sinusitis demonstrate an increased risk for many rheumatic diseases, including antiphospholipid syndrome, Sjögren’s disease and seronegative rheumatoid arthritis, according to data published in RMD Open.
The researchers noted that the risk was most pronounced in cases of sinusitis reported within 5 to 10 years before rheumatic disease onset.
“This helps inform our understanding of where RA and other rheumatic diseases come from — a question we and our patients have all been wondering,” Vanessa L. Kronzer, MD, a rheumatologist at the Mayo Clinic, told Healio. “It also raises ideas for new avenues of research for diagnosing and treating autoimmune diseases.”
To examine whether previous sinusitis increases the risk for later rheumatic disease development, Kronzer and colleagues conducted a case-control study of adults enrolled in the Rochester Epidemiology Project who met rheumatic disease criteria between January 1995 and Dec. 12, 2014. The researchers matched a total of 1,729 patients with rheumatic disease each to three controls, based on sex, age at disease onset and length of EHR history. Cases and controls were required to have at least 7 years of EHR data for inclusion in the study.
Sinusitis was required to have been present for at least 1 year prior to rheumatic disease and was ascertained via ICD codes for acute or chronic sinusitis. The researchers used logistic regression models, adjusted for sociodemographic factors, BMI and smoking status, to estimate ORs for incident rheumatic diseases.
According to the researchers, the median duration from first sinusitis diagnosis to fulfillment of rheumatic disease criteria was 7.7 years (interquartile range = 4.3-10.7). In the multivariable analysis, sinusitis was associated with increased risk for any rheumatic disease (OR = 1.4; 95% CI, 1.2-1.7), particularly antiphospholipid syndrome (OR = 7; 95% CI, 1.8-27), Sjögren’s disease (OR = 2.4; 95% CI, 1.1-5.3) and polymyalgia rheumatica (OR = 1.4; 95%CI, 1-2). Additionally, patients with prior acute sinusitis had an increased risk for seronegative RA (OR = 1.8; 95% CI, 1.1-3.1).
Acute sinusitis was only linked with rheumatic disease development in cases reported 5 to 10 years prior to rheumatic disease onset (OR = 1.6; 95% CI, 1.1-2.3), while chronic sinusitis was implicated in the 1- to 5-year period before onset (OR = 1.9; 95% CI, 1.3-2.7).
The researchers also noted a statistically significant dose-response relationship between the number of sinusitis codes and disease risk, placing individuals with seven or more codes at “strongly elevated risk” for systemic autoimmune rheumatic disease (OR = 4.8; 95% CI, 1.7-13), Sjögren’s disease (OR = 8.7; 95% CI, 1.4-52) and vasculitis (OR = 2; 95% CI, 1.2-3.4).
“Not only was sinusitis associated with RA as we hypothesized, but also with other autoimmune rheumatic diseases such as Sjögren’s disease and anti-phospholipid syndrome,” Kronzer said. “This suggests mucosal inflammation may represent a shared risk factor for many autoimmune rheumatic diseases.
“We are now starting studies looking at upper respiratory multiomics to see if such information can inform novel diagnosis and treatment approaches for RA,” she added. “It would also be great to expand this to other autoimmune rheumatic diseases.”
Collapse
Click Here to Manage Email Alerts