Rheumatic disorders affecting the head and neck: underestimated diseases

Area of Science:

• Rheumatology
• Otolaryngology
• Immunology

Background:

• Rheumatic disorders can present with isolated head and neck (H&N) symptoms.
• Under-diagnosis of primary rheumatic disorders in the H&N is a significant clinical challenge.

Purpose of the Study:

• To delineate the clinical features of rheumatic disorders manifesting solely in the H&N.
• To introduce and evaluate a novel diagnostic pathway for improving H&N rheumatic disorder detection.

Main Methods:

• Retrospective analysis of 90 patients with isolated H&N rheumatic symptoms (2004-2010).
• Classification of rheumatic disorders using ACR criteria.
• Implementation of a new diagnostic pathway in 2008 to reduce diagnostic delays.

Main Results:

• Sjögren's syndrome (SS), granulomatosis with polyangiitis, and sarcoidosis were the most common diagnoses.
• Frequent symptoms included salivary gland enlargement, sicca symptoms, and cervical lymphadenopathy.
• The new pathway led to a five-fold increase in annual diagnoses of H&N rheumatic disorders.

Conclusions:

• SS, granulomatosis with polyangiitis, and sarcoidosis are key rheumatic causes of H&N symptoms.
• Variability and non-specificity of H&N symptoms contribute to delayed diagnosis.
• The proposed diagnostic pathway aids in reducing undetected H&N rheumatic affections.