Rhinologic Manifestations in Systemic Rheumatic Disease

Sinonasal symptoms are a common early manifestation of several systemic inflammatory diseases and may precede multisystem involvement by days to years. Because nasal obstruction, drainage, epistaxis, crusting, and hyposmia are frequently attributed to chronic rhinosinusitis, diagnoses such as antineutrophil-cytoplasmic antibody-associated vasculitis, immunoglobulin G4-related disease, relapsing polychondritis, and sarcoidosis are often delayed. Recognition of atypical sinonasal symptoms and associated systemic findings is critical to distinguishing these entities from primary sinonasal inflammation. This article focuses on rheumatologic diseases with nasal involvement, highlighting key clinical, radiographic, and histopathologic clues that should prompt systemic evaluation and disease-specific management.