Sinusitis Linked to 40% Heightened Risk of Rheumatic Disease Save

The common inflammatory condition sinusitis is linked to a 40% heightened risk of a subsequent diagnosis of rheumatic disease, particularly in the 5 to 10 years preceding the start of symptoms, finds research published in the open access journal RMD Open.

The risks seem to be greatest for:

• Antiphospholipid syndrome (OR 7.0, 95% CI 1.8 to 27)
• Sjögren’s syndrome (OR 2.4, 95% CI 1.1 to 5.3)
• Vasculitis (OR 1.4, 95% CI 1.1 to 1.9)
• Polymyalgia rheumatica (OR 1.4, 95% CI 1.0 to 2.0)
• Seronegative rheumatoid arthritis (OR 1.8, 95% CI 1.1 to 3.1).

This case-control study used data from the Rochester Epidemiology Project (REP), a medical records-linkage system of over 500,000 people resident in Olmsted County, Minnesota at some point between 1966 and 2014.

The study sample included 1729 adults, newly diagnosed with a systemic autoimmune rheumatic disease, such as rheumatoid arthritis, antiphospholipid syndrome, and Sjögren’s syndrome; or vasculitis (blood vessel inflammation), such as giant cell arteritis (temporal artery inflammation) and polymyalgia rheumatica (muscle pain and stiffness). Each of these patients (average age 63; two thirds women) was matched with 3 people (5187 in total) with no rheumatic disease, based on age at diagnosis and sex.

The average time that elapsed between an episode of sinusitis and diagnosis of rheumatic disease was just over 7.5 years, with the most common diagnosis, rheumatoid arthritis (688) and polymyalgia rheumatica (610).  Sinusitis was most associated with any rheumatic disease in the 5–10 years before disease onset (OR 1.7, 95% CI 1.3 to 2.3). Individuals with seven or more codes for sinusitis had the highest risk for rheumatic disease (OR 1.7, 95% CI 1.3 to 2.4).

And the more frequent the episodes of sinusitis, the greater were the chances of a new rheumatic disease diagnosis. For example, those experiencing 7 or more were nearly 5 times as likely to be diagnosed with systemic autoimmune disease, nearly 9 times as likely to be diagnosed with Sjögren’s syndrome, and twice as likely to be diagnosed with vasculitis.

Serial episodes of sinusitis without a previous history also showed a significant dose-response association with seronegative rheumatoid arthritis, rising to a quadrupling in risk for 5 or more episodes.

And overall, the association between sinusitis and rheumatic disease was strongest in people who had never smoked.

This is an observational study, and therefore no definitive conclusions can be drawn about causal factors. The researchers also acknowledge several limitations to their findings, including a predominantly White study population and few cases of certain types of rheumatic disease.

And reverse causation, whereby the rheumatic diseases themselves increase the risk of sinusitis, can’t be ruled out, the authors add.

But bacterial pathogens, such as those involved in sinusitis, might have a role in rheumatic disease, added to which sinusitis is associated with speeding up artery hardening, lending extra weight to its potential inflammatory effects, explain the researchers.

And they conclude: “Overall, these findings point towards a role for sinus inflammation in the presentation, and possibly pathogenesis, of rheumatic disease.”