From the Guidelines
Patients with sinus erosion due to autoimmune disorders, such as granulomatosis with polyangiitis (GPA), should be treated with immunosuppressive therapy, including corticosteroids and steroid-sparing agents, to prevent permanent damage and improve quality of life, as recommended by the 2021 American College of Rheumatology/Vasculitis Foundation guideline 1.
Treatment Approach
The treatment approach for GPA involves a combination of immunosuppressive therapies, including:
- Corticosteroids, such as prednisone, starting at 0.5-1 mg/kg/day
- Steroid-sparing agents, such as methotrexate (15-25 mg weekly), rituximab (375 mg/m² weekly for 4 weeks), or cyclophosphamide (1-2 mg/kg/day)
- For acute flares, methylprednisolone pulse therapy (500-1000 mg IV for 3 days) may be necessary
Monitoring and Prevention
Regular monitoring of inflammatory markers (ESR, CRP), complete blood counts, and kidney function is essential. Patients should also receive:
- Prophylaxis against opportunistic infections
- Bone protection with calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily)
Multidisciplinary Management
Management by a multidisciplinary team, including rheumatologists, otolaryngologists, and pulmonologists, is recommended to ensure comprehensive care and prevent complications.
Quality of Life
The Sinonasal Outcome Test-22 (SNOT-22) demonstrated the significant effect of sinonasal involvement on general health-related quality of life (QOL) in GPA patients, highlighting the importance of prompt diagnosis and treatment 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Sinus Erosion Autoimmune Disorder
- Sinus erosion can be a symptom of various conditions, including autoimmune disorders [ 2 ]
- Autoimmune inner ear disease is a condition that can cause hearing loss and has been linked to autoimmune disorders [ 3 ]
- Systemic corticosteroids have been shown to be effective in treating acute sinusitis, but their effectiveness in treating autoimmune-related sinusitis is unclear [ 4, 5 ]
- Immunodeficiency can play a role in chronic sinusitis, and identifying underlying immunodeficiencies can help guide treatment [ 2, 6 ]
Treatment Options
- Systemic corticosteroids may be used to treat acute sinusitis, but their effectiveness in treating autoimmune-related sinusitis is unclear [ 4, 5 ]
- Immunoglobulin replacement therapy may be used to treat common variable immunodeficiency (CVID) [ 6 ]
- Methotrexate and azathioprine combination therapy may be effective in treating relapsing autoimmune inner ear disease [ 3 ]
Diagnosis and Evaluation
- An immunologic workup should be performed to evaluate for underlying immunodeficiencies in patients with recurrent or chronic sinusitis [ 2 ]
- Allergic disease should be evaluated and treated early in the process [ 2 ]
- Uncommon causes of sinus inflammation should be addressed to reduce inflammation and improve surgical outcomes [ 2 ]