Background/Purpose: Chronic rhinosinusitis with nasal polyposis (CRSwP) is a common manifestation of granulomatosis with polyangitis (EGPA), and may represent an invalidating feature of the disease, causing nasal blockage and loss of smell. The aim of this study was to determine the frequency of CRSwP in a series of patients with EGPA and the impact of sino-nasal involvement on the patients’ quality of life.
Methods: Consecutive patients with EGPA (ACR criteria) were prospectively enrolled in this observational cross-sectional study. Patients’ cumulative clinical and serological features were collected including: ANCA status, blood eosinophilia, total IgE, IL-2, IL-4, IL-5 and eosinophil cationic protein levels (ECP). Nasal polyps were graded according to the Lund nasal endoscopy scoring system. To evaluate the impact of the sino-nasal symptoms on the quality of life (QOL), the short form (SF)-36 and the Sino-Nasal Outcome Test (SNOT-22) were used. Correlations between the different variables were analyzed using linear regression and the Spearman coefficient (p < 0.05).
Results: Twenty-six EGPA patients (12F:14M, 57±15yrs, mean follow-up =6±5yrs) were enrolled in the study. About one third of the patients (32%) was allergic to one or more common aero-allergen and high levels of IgE were found in 10/26 EGPA patients; 3/26 patients referred aspirin hypersensitivity and 3/26 patients were current smokers. Endoscopic intranasal evaluation identified: CRSwP in 14/26 cases, chronic rhinosinusitis (CRS) in 5/26, non-allergic rhinitis (NAR) in 4/26 and allergic rhinitis (AR) in 2/26 patients. One patient had a normal nasal endoscopy examination. The diagnosis of sino-nasal involvement preceded the diagnosis of EGPA of a mean period of 23±21 yrs. Surgery was needed in 13/26 cases, with 5/13 patients undergoing polypectomy, 2/13 septoplasty and 6/13 functional endoscopic sinus surgery. Polyps recurred in 9/13 EGPA patients over the follow-up. No correlation was found among CRSwP or Lund scores and ANCA status, blood eosinophilia, total IgE, IL-2, IL-4, IL-5 and ECP. Significant correlations were observed among CRSwP, LUND score and chronic use of nasal corticosteroids and between SNOT-22 and SF-36 questionnaire. There was no correlation between Lund and SNOT-22 scores.
Conclusion: Nasal polyps may represent the initial feature of EGPA, and may have a great impact on the patients’ quality of life. The Lund score correlates well with CRSwP severity and chronic use of nasal corticosteroids but measures a different aspect of disease to “subjective” symptom scores. This demonstrates the strengths and limitations of a commonly used staging system in EGPA and CRSwP.
Disclosure:
C. Baldini,
None;
V. Seccia,
None;
M. Latorre,
None;
P. Iannicelli,
None;
D. Martini,
None;
F. Ferro,
None;
N. Luciano,
None;
A. Tavoni,
None;
S. Sellari Franceschini,
None;
S. Bombardieri,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rhinosinusits-and-nasal-polyps-in-the-diagnosis-and-follow-up-of-patients-with-eosinophilic-granulomatosis-with-polyangitis-ex-churg-strauss-syndrome/