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 rhinitis or systemic disease that affects the nose.3) Apart from nasal crusting or progressive bilateral nasal obstruction, other symptoms of WG include a minor epistaxis, whistling if there is a septal perforation, a reduction in sense of smell, and through this taste.

You do not need any sophisticated equipment to inspect the nasal mucosa. An otoscope with a large speculum allows a good view of the nasal mucosa as long as the patient is asked to breathe through their mouth to avoid condensation on the lens. Alternatively elevate the tip of the nose upwards with your thumb and inspect the anterior third of the nose with the light from a pen torch. …