Anti-Tumour Necrosis Factor therapy is a risk factor for certain sub-types of Chronic Rhinosinusitis
C.G. Leonard1, C. Masih2, S. McDonald2, G. Taylor1, N. Maiden2, P.J. Leyden1
1Department of Otorhinolaryngology, Craigavon Area Hospital, Craigavon, Northern Ireland 2Department of Rheumatology, Craigavon Area Hospital, Craigavon, Northern Ireland
Chronic Rhinosinusitis (CRS), which is an inflammatory rather than an infective process, is frequently seen in Otorhinolaryngology outpatients. We have seen increasing numbers of patients on Anti-TNF presenting to ENT with the symptoms of CRS.
The role of Anti-TNF on CRS has not been investigated in depth. Discussion has focused on the therapeutic benefit of Anti-TNF in CRS with nasal polyposis. Our experience points to a detrimental effect in overall prevalence of CRS. We performed a telephone survey to assess the prevalence within our patient group.
We identified Rheumatology patients receiving Anti- TNF treatment. Participants were contacted by telephone, and asked to participate using a standard wording of the survey. Participants reported age, sex and smoking history prior to answering the GA2LEN CRS screening survey based on the EP3OS diagnostic criteria.
120/234 patients agreed to participate in the survey. The prevalence of CRS in the sample (Anti-TNF) population was 20% (95 %CI 12.84 – 27.16). Anti-TNF is a risk factor for CRS when compared using a one-sample test of proportions with prevalence in the population as reported by GA2LEN for our nearest centres London 10% (8.5 – 11.7%) (p= 0.0003) and Southampton 11.2% (8.8 – 14.3%) (p= 0.0022).
This study shows that rates of CRS increase in patients treated with Anti-TNF. Limitations include sample size and potential confounding factors. The findings are of potential significance to clinicians responsible for the use of anti-TNF therapy and also clinicians treating patients with CRS. It also raises questions regarding the spectrum of conditions we diagnose as CRS.