A history of chronic sinus infections increases your risk of later developing rheumatic diseases that affect joints, tendons, ligaments, and bones, new research finds.
These diseases affect women more often than men and many of them are autoimmune, meaning the immune system attacks its own tissues. Symptoms can include pain, stiffness, and swelling of the musculoskeletal system—and rheumatic diseases can also affect internal organs.
A study published in Rheumatic and Musculoskeletal Diseases in February strengthens the association between sinusitis and rheumatoid diseases. The authors concluded that not only is sinusitis biologically linked to many other conditions, but it could be like a match lighting an inflammatory fire.
The population-based research found the odds of developing any rheumatoid disease were 40 percent higher among those with a history of sinusitis, with the chances rising among those with multiple infections.
Inflammation—a normal part of the repair process in the body—can be overstimulated, sending out chemicals that fight infection long after the threat has subsided. Abnormal inflammatory responses are a hallmark of autoimmune diseases.
“We have been realizing for the past 50 years that inflammation at mucosal surfaces like the lungs is associated with rheumatoid arthritis,” study author Dr. Vanessa Kronzer of the Mayo Clinic told The Epoch Times in an email. “What is newer in the last 10 years is that other mucosal surfaces may also be involved, such as the upper respiratory tract.”
There’s other evidence that bolsters the new finding, including a study showing sinus surgery had an impact on overall achiness and a recent study linking COVID-19 infections and increased risk for autoimmune inflammatory rheumatic diseases.
Exploring the Link
The authors aren’t exactly sure how upper respiratory inflammation leads to the onset of these autoimmune diseases. Dr. Kronzer said they are currently planning follow-up studies.
The study article noted that a likely explanation is pathogenic microbes linked to sinus infections that could be leading to rheumatic diseases, as well.
Examples that support this are:
- Ruminococcus gnavus (R. gnavus) associated with lupus nephritis, inflammation affecting the kidneys and possibly leading to kidney failure, as well as rheumatoid arthritis and spondyloarthritis, an arthritis affecting the spine and nearby joints. R. gnavus can break down mucin and is linked to chronic sinus issues, allergies, and several immune-mediated conditions.
- Staphylococcus and Corynebacterium are implicated in the development of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, an inflammation of blood vessels associated with rheumatoid arthritis. Research in 2019 pointed to Staphylococcus aureus being associated with persistent and severe chronic sinus infections, as well as nasal polyps. In addition to having a depleted sinus microbial community, chronic sinusitis sufferers also had an abundance of Corynebacterium tuberculostearicum, according to a 2012 study.
Additional research is needed to discern whether additional microbes might be at play in both sinusitis and rheumatoid diseases. The authors said future studies should also test the hypothesis by “determining whether preventing or treating sinusitis can prevent and/or treat rheumatic diseases.”
“The fact that it was so strongly associated with Sjogren’s and APS (non-RA rheumatic diseases) is a new finding and one that calls for more research,” Dr. Kronzer said.
Those who had sinusitis 5–10 years prior to their disease onset were three times more likely to develop ANCA-associated vasculitis and Sjogren’s disease, characterized by dry mouth and dry eyes.
COVID and Rheumatoid Diseases
Severe COVID-19 infections may be another indicator of lurking rheumatoid disease, according to a study published March 5 in the Annals of Internal Medicine.
The population-based study examined databases of patients in Japan and South Korea and found more severe cases of COVID-19 infections increased the risk of rheumatic diseases up to 12 months after COVID-19 infection. Additionally, the authors pointed to a study that found patients had a 42.6 percent increased risk of autoimmune diseases after experiencing a COVID-19 infection.
“I would not be surprised if this was true, as COVID causes inflammation in the respiratory mucosa, which we know from dozens and dozens of studies is associated with increased RA (rheumatoid arthritis) risk,” Dr. Kronzer said.
However, at least one expert raised issues with the COVID-19 study—primarily because diagnosis of RA diseases takes considerably more time due to often extensive laboratory, imaging, and biopsy testing.
That’s according to Dr. Amr H. Sawalha, director of rheumatology and professor of pediatrics and Medicine at UPMC Children’s Hospital of Pittsburgh, who publicly commented on the study. He questioned whether the long-COVID complaints in the study were “post-infectious immune mediated manifestations rather than well-defined autoimmune rheumatologic diseases, which are chronic by definition.”
Those vaccinated appeared less at risk, according to the authors, unless they had a severe infection. The study was conducted before the discovery of the omicron variant.
However, a 2023 study specifically examining post-COVID conditions after omicron infections noted that those who already had rheumatic diseases tended to be more likely to suffer long-term symptoms.
Hope for Both Problems
While the causation of rheumatic diseases may require more exploration, endoscopic sinus surgery appears to be one solution able to alleviate body pain and sinus symptoms. It removes blockages in the sinuses that cause pain and impair breathing.
A meta-analysis review of 11 studies noted endoscopic sinus surgery helped improve pain, which was described in a news release as similar to pain more common for a 75-year-old, despite the average age of patients being 43.
The news release, based on information from a presentation of the paper at the 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation annual meeting, particularly highlighted that pain is far more common in patients with sinus problems than in the average population. It is similar to those with osteoarthritis or depression, it said.