Background Dry nose is reported quite frequently by patients affected by primary Sjögren's syndrome (pSS) in daily practice. However, a clear definition of nasal involvement in pSS is not available.
Objectives a) to explore clinical presentation of nasal involvement in pSS analyzing key symptoms, objective findings at the inspection of the external and inner nose and nasal cytology b) to investigate any associations/correlation between nasal involvement and other clinical-serological disease manifestations c) to assess the overall impact of nasal involvement on patients reported outcomes (PROs).
Methods Consecutive pSS patients (AECG 2002) were seen by a team of rheumatologists and ENT specialists. In addition to a standard rheumatologic evaluation, all the patients underwent a complete ENT evaluation. Nasal symptoms (i.e dry nose, nasal stuffiness, crusting, hyposmia) were collected by an “ad hoc questionnaire” and scored by the patients on visual analogique scales. Inspection of the external and inner nose, endoscopy of the nasal cavity and nasal cytology were performed as well. Allergy testing were also carried out when indicated. The following tools were used to assess PROs: ESSPRI, SF-36 and SNOT-22.
Results Forty-six pSS patients were included in the study [M:F =45:1; median age (IQR):64 (53–70); median disease duration (IQR): 66 months (24–120)]. Nasal symptoms ranged from: dryness in the nose (56.5%), crusting 10/46 (21.7%), nasal stuffiness 20/46 (45.5%) and hyposmia 7/46 (15.2%). Thirteen patients did not present signs of nasal involvement, whereas 21 patients (45.7%) presented rhinitis sicca (RS), 6 (13%) allergic rhinitis (AR), 4 (8.7%) chronic rhinosinusitis (CRS) and 2 (4.3%) non-allergic rhinitis (NAR). Patients with nasal involvement were more frequently seronegative (p=0.04) and presented significantly higher SNOT-22 scores (p=0.008) when compared to patients without nasal involvement; no additional demographic or clinical differences between the two groups. Allergy testing were more frequently positive in patients with RS and AR. Nasal cytology showed that the rates of the cells (eosinophils and neutrophils) in patients without nasal involvement were negligible whereas they were significantly increasead in pSS patients with RS and AR. The SNOT-22 (r=-.433, p=0.02) and the scores assigned to the VAS of nasal dryness (r=-.755, p=0.003) and crusting (r=-.794, p=0.001) strongly correlated with SF-36 questionnaire. SNOT-22 also correlated with the ESSPRI (r=.399, p=0.04), whereas we did not find a correlation between VAS scores assigned to nasal dryness and VAS scores of oral and ocular dryness. PROs related to nasal symptoms were significantly influenced by a concomitant diagnosis of fibromyalgia.
Conclusions Rhinitis sicca was the most common clinical presentation of nasal involvement in pSS patients, especially in seronegative patients. Apparently, nasal symptoms correlated weakly with ocular and oral dryness. PROs exploring nasal symptoms revealed that nasal involvement impact significantly on patients quality of life.
Disclosure of Interest None declared