Background/Purpose:

Granulomatosis with polyangiitis (Wegener’s granulomatosis, GPA) is a systemic vasculitis of unknown etiology. It is characterized by necrotizing granulomatous inflammation and affects predominantly small vessels. Upper respiratory tract is involved in some phase of the disease in about 90% of the patients and most frequently at the beginning of the disease. Median diagnostic delay was reported as 4-17 months and it was most remarkable in patients with head and neck symptoms. Up to now clinical manifestations of GPA were described retrospectively and discriminative ability of nasal history and examination findings was never systematically evaluated before. Therefore we aimed to determine the predictive value of history items and nasal endoscopic examination findings in the diagnosis of GPA. 

Methods: Seventeen GPA patients (12 [67%] male; mean age 49,3 ± 13,9), 29 patients with rheumatologic disease other than GPA (8 [28%] male; mean age 46.8 ± 16.3) and 67 healthy subjects (28 [42%] male; mean age 47,3 ± 15,2) were included in the study. Patients’ history was taken by a physician blinded to diagnosis and each patient was examined with flexible nasal endoscope and nasal endoscopic images are recorded and evaluated blindly. The following history items were noted and graded as present or absent; sneezing, rhinorrhea, nasal obstruction, cough, postnasal drip, facial pain, taste disturbance, decreased smell, epiphora, epistaxis, saddle-nose. Nasal endoscopic findings noted were edema of middle meatus, nasal secretion, polypoid changes of middle meatus mucosa, nasal polyposis, hypertrophy of inferior turbinate, septal perforation, nasal crusting, adhesions, granuloma, hemorrhagic fragile nasal mucosa.  

Results: Regarding the history items univariate analysis revealed that rhinorrhea (p=0,003), postnasal drip (p=0,022), epistaxis (p<0,001), and saddle nose deformity (p=0,046) were statistically significantly different between groups. However in binary logistic regression analysis none of these history items have a statistically significant predictive role in selecting patients with GPA. A univariate analysis demonstrates that the following endoscopic findings demonstrates statistically significant difference; nasal secretion (p=0,003), nasal septal perforation (p < 0,001), nasal crusting (p< 0,001), nasal adhesion (p < 0,001), nasal granuloma (p=0,046), polypoid changes of middle meatus mucosa (p=0,42), and hemorrhagic fragile nasal mucosa (p < 0,001). In regression analysis hemorrhagic fragile nasal mucosa (p< 0,001, OR=41) was the only significant predictor for GPA.  

Conclusion: The results of the present study suggest that patients with hemorrhagic fragile nasal mucosa should alert the physician about the possibility of GPA. The role of the other nasal mucosal findings in the differential diagnosis of GPA needs to be verified by larger studies.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/discriminative-performance-of-nasal-endoscopic-findings-and-history-items-in-patients-with-granulomatosis-with-polyangiitis/