CRS is a long-standing inflammation of the sinuses that often requires surgical intervention in severe cases. However, recurrence after functional endoscopic sinus surgery (FESS) remains a challenge. This study aimed to explore whether patients with coexisting rheumatoid arthritis are more vulnerable to severe CRS and postoperative relapse.
The research team conducted a retrospective analysis of 568 patients diagnosed with CRS who underwent FESS. Participants were divided based on RA status and gender, and followed for three years post-surgery. They were categorized into recurrent and non-recurrent groups depending on disease progression.
The following were the key findings of the study:
- A total of 169 patients experienced recurrence of chronic rhinosinusitis (CRS) during the three-year follow-up period.
- Patients with rheumatoid arthritis (RA) had a significantly higher risk of postoperative CRS recurrence compared to those without RA.
- This increased risk of recurrence in RA patients was observed consistently in both male and female subgroups.
- RA patients were generally younger and had a higher body mass index (BMI).
- They were more likely to have nasal polyps and higher baseline symptom severity, as reflected by elevated Visual Analog Scale (VAS), Lund-Kennedy, and Lund-Mackay scores.
- Despite experiencing greater improvements in VAS and Lund-Kennedy scores at the three-year follow-up, RA patients continued to face a higher recurrence risk.
- Logistic regression analysis identified RA, allergic rhinitis, and asthma as independent risk factors for postoperative CRS recurrence.
- RA remained a significant predictor of recurrence even after adjusting for potential confounding variables in both genders.
- Kaplan-Meier survival analysis showed that RA patients had a significantly shorter recurrence-free period compared to non-RA patients.
Despite its valuable insights, the study has certain limitations. It was conducted at a single medical center, which may limit the applicability of its findings to broader populations. Additionally, data on RA disease activity and treatment regimens—such as corticosteroids or biologic agents—were not included, which could influence both systemic and local immune responses. The study period also overlapped with the COVID-19 pandemic, potentially affecting patient follow-up and healthcare access.
The study suggests that RA may exacerbate CRS and significantly elevate the risk of postoperative recurrence, regardless of gender.
"These findings highlight the importance of considering comorbid RA when planning surgical and postoperative care for CRS patients. Further research is needed to clarify the underlying mechanisms and guide tailored treatment strategies," the authors concluded.
Reference:
Zhou X, Wang D, Cao S, Tu Y, Chen R, Huang H, Lou W. Rheumatoid Arthritis Aggravates Disease Severity and the Risk of Postoperative Recurrence in Chronic Rhinosinusitis. J Inflamm Res. 2025;18:9401-9411
https://doi.org/10.2147/JIR.S533652
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