Sinusitis has been linked with a 40% increased risk of a later diagnosis of rheumatoid disease, with the association strongest in the five to 10 years before the latter’s onset.
The findings suggest that sinusitis might be involved in the pathogenesis of rheumatic diseases, and as such represents a potential new target for disease prevention and treatment, according to a paper published in RMD Open.
The population-based, case-control study included a cohort of individuals with rheumatic diseases (n=1,729) and controls (n=5,187) matched on age, sex and length of prior electronic health record history.
Multivariable analysis showed that preceding sinusitis was linked with a heightened risk of several rheumatic diseases, including antiphospholipid syndrome (OR 7.0, 95% CI 1.8 – 27), Sjögren’s disease (OR 2.4, 95% CI 1.1 – 5.3), vasculitis (OR 1.4, 95% CI 1.1 – 1.9) and polymyalgia rheumatica (OR 1.4, 95% CI 1.0 – 2.0).
Acute sinusitis was linked with a 1.8 times higher risk of seronegative arthritis (95% CI 1.1 to 3.1).
Another key findings of the study was that the association between sinusitis and rheumatic disease was strongest in the five to 10 years before onset of symptoms (OR 1.7, 95% CI 1.3 to 2.3), and that this was “especially evident” in Sjögren’s disease, for which the risk was 3.2 times higher as well as for PMR (OR 2.0, 95% CI 1.3 to 3.2).
Also, patients with a greater number of sinusitis episodes (more than seven) were 1.7 times more like to develop rheumatic disease (95% CI 1.3 to 2.4), and the association was also stronger in never smokers, the data showed.
No definitive conclusions on causation could be drawn from the study given that it was observational, and there were several limitations including that the study population was largely white.
However, the findings “point towards a role for sinus inflammation in the presentation, and possibly pathogenesis, of rheumatic disease,” the authors concluded.
One possible explanation for the association is that the pathogenic organisms involved in sinusitis have a causal role in the development of rheumatic disease, they said.
“Indeed, both Staphylococcus and more recently Corynebacterium were implicated in pathogenesis of ANCA-associated vasculitis, whereas Ruminococcus gnavus was associated with lupus nephritis, rheumatoid arthritis and spondyloarthritis. Furthermore, sinusitis is associated with accelerated atherosclerosis, further supporting its potential inflammatory effects,” according to the paper.
As such, further studies “should replicate the observed association between sinusitis and rheumatic diseases, search for additional causative organisms and determine whether preventing or treating sinusitis can prevent and/or treat rheumatic diseases,” the researchers noted.