The history of sinus infections can indicate the future development of rheumatic diseases

A history of chronic sinus infections increases the risk of later developing rheumatic diseases that affect the joints, tendons, ligaments and bones, according to new research.

These diseases affect women more often than men, and many of them are autoimmune, meaning that the immune system attacks its own tissues. Symptoms can include pain, stiffness and swelling of the muscular system and bones – and even disorders of the internal organs.

A study published in Rheumatic and Musculoskeletal Diseases in February reinforces the association between sinusitis and rheumatoid diseases. The authors concluded that not only is sinusitis biologically linked to many other conditions, but it could be like a match that lights a fire – inflammation.

The study found that the chances of developing rheumatoid disease were 40 percent higher among those with a history of sinusitis, with the odds increasing for those with multiple infections.

Inflammation—a normal part of the body’s repair process—can be overstimulated, sending out infection-fighting chemicals long after the threat is gone. Abnormal inflammatory responses are a hallmark of autoimmune diseases.

“We’ve realized over the past 50 years that inflammation in mucosal surfaces, such as the lungs, is associated with rheumatoid arthritis,” study author Dr. Vanessa Kronzer of the Mayo Clinic told The Epoch Times in – an email. “What is newer, in the last 10 years, is that other mucosal surfaces can be involved, such as the upper respiratory tract.”

There is other evidence to support the new finding, including a study showing that sinus surgery had an impact on overall pain and a recent study linking COVID-19 infections and increased risk of autoimmune inflammatory rheumatic diseases.

Link exploration

The authors are not exactly sure how inflammation of the upper respiratory tract leads to these autoimmune diseases. Dr. Kronzer said he is currently planning follow-up studies.

The study mentioned that a probable explanation is represented by pathogenic microbes linked to sinus infections that could also lead to rheumatic diseases.

Examples that support this are:

• Ruminococcus gnavus (R. gnavus) associated with lupus nephritis, inflammation that affects the kidneys and can lead to kidney failure, as well as rheumatoid arthritis and spondyloarthritis, an arthritis that affects the spine and nearby joints. R. gnavus can break down mucin and is linked to chronic sinus problems, allergies, and several immune-mediated conditions.
• Staphylococcus and Corynebacterium are involved in the development of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, an inflammation of the blood vessels associated with rheumatoid arthritis. Research from 2019 indicated that Staphylococcus aureus is associated with persistent and severe chronic sinus infections as well as nasal polyps. In addition to having a depleted sinus microbial community, chronic sinusitis patients also had an abundance of Corynebacterium tuberculostearicum, according to a 2012 study.

Further research is needed to discern whether other microbes might be at play in both sinusitis and rheumatoid disease. The authors stated that future studies should also test the hypothesis by “determining whether preventing or treating sinusitis can prevent and/or treat rheumatic diseases.”

“The fact that it was so strongly associated with Sjögren’s disease and APS (non-RA rheumatic diseases) is a novel finding and one that requires more research,” said Dr. Kronzer.

Those who had sinusitis 5-10 years before the onset of the disease were three times more likely to develop ANCA-associated vasculitis and Sjögren’s disease, characterized by dry mouth and eyes.

COVID and rheumatoid diseases

Severe infections with COVID-19 may be another indicator of hidden rheumatoid disease, according to a study published March 5 in the Annals of Internal Medicine.

The study examined patient databases from Japan and South Korea and found that more severe cases of COVID-19 infection had an increased risk of rheumatic diseases up to 12 months after infection with COVID-19. Additionally, the authors pointed to a study that found patients had a 42.6 percent higher risk of autoimmune disease after experiencing a COVID-19 infection.

“I wouldn’t be surprised if this were true, because COVID causes inflammation in the respiratory mucosa, which we know from dozens and dozens of studies is associated with an increased risk of RA (rheumatoid arthritis),” Dr. Kronzer said. .

However, at least one expert has raised concerns about the COVID-19 study — primarily because RA disease takes considerably longer to diagnose because of the often extensive lab tests, imaging and biopsies.

That’s the opinion of Dr. Amr H. Sawalha, director of rheumatology and professor of pediatrics and medicine at UPMC Children’s Hospital in Pittsburgh, who commented publicly on the study. He questioned whether the long-term COVID signals in the study were “immune-mediated post-infectious manifestations, rather than well-defined autoimmune rheumatologic diseases, which are chronic by definition.”

Those vaccinated appeared to be less at risk, according to the authors, unless they had a severe infection. The study was conducted before the discovery of the omicron variant.

However, a 2023 study that specifically looked at post-COVID conditions after omicron infections noted that those who already had rheumatic diseases tended to be more prone to long-term symptoms.

Hope for both problems

While the causation of rheumatic diseases may require further exploration, endoscopic sinus surgery appears to be a viable solution for relieving body pain and sinus symptoms. This removes blockages in the sinuses that cause pain and affect breathing.

A meta-analysis reviewing 11 studies found that the endoscopic sinus surgery procedure helped improve pain, which was described in a press release as similar to the pain experienced by a 75-year-old person, despite the fact that the average age of the patients was 43 years.

The press release, based on information from a paper presented at the 2008 annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, highlighted in particular that pain is much more common in patients with sinus problems than in the average the population. This is similar to cases of osteoarthritis or depression, the report said.