Sarcouncil Journal of Medical Series

Abstract: Background: Rheumatologic and systemic inflammatory diseases often have nasal and sinonasal manifestations that are either early diagnostic manifestations or major disease morbidity. The crossroads between otolaryngology and internal medicine in the treatment of these disorders is under-researched in clinical practice. Purpose: To describe the range of nasal and sinonasal manifestations in patients with known rheumatologic and inflammatory diseases, assess their frequency, clinical relevance, and relationship with the disease activity, and to develop a model of interdisciplinary cooperation between internal medicine and otolaryngology. Methods: The study involved a prospective cross-sectional study that was carried out at the Department of Otolaryngology and Rheumatology between January 2022 and December 2024. Eighty-six (86) patients who had rheumatologic or systemic inflammatory diseases were enrolled. Every patient was thoroughly assessed with otolaryngologic examination of the nasal endoscopy, paranasal sinuses computed tomography (CT), mucosal biopsy in case of need, and approved symptom questionnaires (SNOT-22). Standardized indices such as BVAS (Birmingham Vasculitis Activity Score), DAS28 (Disease Activity Score-28), and SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) were used to measure disease activity. This was done systematically through histopathological analysis, immunological markers, and radiological grading (Lund-Mackay scoring system). Findings: The underlying diagnoses most frequently found in the 86 patients (mean age 47.3 +/- 14.2 years; 58 females, 28 males) were granulomatosis with polyangi The most common symptom was nasal crusting (68.6%), nasal obstruction (62.8%), epistaxis (47.7%), anosmia/hyposmia (38.4%), and saddle nose deformity (15.1%). In 31.4, sinonasal involvement was a precursory of systemic diagnosis. There were also significant correlations between disease activity scores and SNOT-22 scores (r=0.72, p<0.001). The highest mean Lund-Mackay CT scores were in GPA patients (14.8 ± 4.2) and EGPA patients (13.6 ± 3.8). The histopathological results indicated granulomatous. Conclusions: Nasal and sinonasal presentation is very common in rheumatologic and inflammatory diseases and can be used as sentinel symptoms of the disease. Early otolaryngologic screening of suspected or confirmed rheumatologic patients helps in the timely diagnosis, minimizes diagnostic delay, and enhances patient clinical outcomes. The combination of interdisciplinary internal medicine and otolaryngology approach is necessary to treat patients optimally.