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Nasal manifestations of rheumatic diseases
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What should a rheumatologist know about nasal disorders? In a significant minority of patients with rheumatological disorders nasal symptoms and signs are part of the picture and can help in establishing a diagnosis.
To illustrate this point, over 50% of patients with Wegener's
granulomatosis (WG) have nasal symptoms and signs at presentation and
these have a positive predictive value of 63%, while a positive nasal
biopsy has a positive predictive factor of 100%.1 The most common nasal symptoms in these patients are nasal obstruction and
discharge but it is the unusual symptom of crusting that should alert
the clinician and helps differentiate these patients from those with
other more common rhinological conditions. (This is important as
approximately 19% of most populations have nasal symptoms and nasal
obstruction as part of their rhinosinusitis.2 The majority
have seasonal allergic rhinitis (16%) while the remainder have
perennial allergic rhinitis, chronic infective rhinosinusitis, idiopathic
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