The Risk of Rheumatic Disorders Among Patients With Rhinosinusitis: A Systematic Review and Meta-Analysis

Emerging evidence suggests a possible link between rhinosinusitis and systemic rheumatic diseases; however, no meta-analysis has comprehensively examined this association to date. We aimed to investigate if patients with rhinosinusitis have a predisposition to unmasking rheumatic diseases compared to individuals without rhinosinusitis.

A comprehensive search in MEDLINE, Embase, Cochrane Library, and Web of Science was conducted until February 2025 for studies characterizing rheumatic disease incidence, prevalence, and risk in cohorts of rhinosinusitis patients. The search was limited to records authored in English and involved combining both rhinitis and sinusitis Medical Subject Headings (MeSH) terms. Relative risk and prevalence data were pooled using random-effects models.

Nine studies with 86,081 rhinosinusitis patients were included. Chronic rhinosinusitis (CRS) was significantly associated with increased risk of rheumatoid arthritis (RA) (odds ratio [OR]: 1.70; 95% CI: 1.44-2.00; p < 0.00001), systemic lupus erythematosus (OR: 1.61; 95% CI: 1.25-2.08; p = 0.0002), and ankylosing spondylitis (OR: 1.48; 95% CI: 1.26-1.72; p < 0.00001). Acute rhinosinusitis (ARS) showed weaker associations, notably with seronegative RA. Rheumatic disease prevalence in rhinosinusitis patients was highest for RA (10%, 95% CI: 8.2-13).

Rhinosinusitis, particularly CRS, is associated with several rheumatic diseases. Mechanisms of mucosal immune dysregulation associated with rhinosinusitis may contribute to, or act in parallel with, the pathogenesis of systemic autoimmunity. Management of CRS (surgical or immunomodulatory) may lead to the sentinel presentation and subsequent identification of previously undiagnosed systemic autoimmune conditions. Clinicians should maintain a high index of suspicion for early autoimmune symptoms in rhinosinusitis patients.