ABSTRACT
BACKGROUND: Chronic rhinosinusitis has many risk factors; however, the effect of anti-tumour necrosis factor therapy has not been investigated in depth. Our experience points to a detrimental clinical effect in overall prevalence of chronic rhinosinusitis, despite its benefit in certain subtypes. METHOD: A telephone survey was performed to parallel the findings of the Global Allergy and Asthma European Network chronic rhinosinusitis screening survey. This was itself based on the widely recognised European Position Paper on Rhinosinusitis and Nasal Polyps criteria. RESULTS: A total of 120 patients responded to the survey. The prevalence of chronic rhinosinusitis in the anti-tumour necrosis factor therapy population was 20 per cent (95 per cent confidence interval = 12.84-27.16). When compared using a chi-square test, for a two-by-two contingency table, this finding was significant against the prevalence recorded in the normal population. CONCLUSION: This is the first observational study indicating increased prevalence of chronic rhinosinusitis in patients treated with anti-tumour necrosis factor therapy. These clinical findings require investigation in greater depth to clarify the nature of pathologies currently diagnosed and treated as chronic rhinosinusitis.
Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Psoriatic/drug therapy , Arthritis, Rheumatoid/drug therapy , Rhinitis/epidemiology , Sinusitis/epidemiology , Spondylitis, Ankylosing/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adult , Arthritis, Psoriatic/epidemiology , Arthritis, Rheumatoid/epidemiology , Chronic Disease , Female , Humans , Male , Middle Aged , Prevalence , Risk Factors , Smoking/epidemiology , Spondylitis, Ankylosing/epidemiologyABSTRACT
Between June 1996 and May 1997, 92 patients underwent haematopoietic stem cell transplantation (HSCT) for haematological malignancies. To participate in a prospective single-centre trial to evaluate oto-rhino-laryngological (ORL) related problems, 43 of these patients (27 male, 16 female, median age 38) signed an informed consent. A questionnaire about ORL related problems was assessed before and after HSCT. Only 21 of the patients (49%) could be fully examined after transplantation because of overall mortality and follow-up realised by other health care centres. In the deceased patients, however, a close review of the patients' notes was carried out. An ORL focus was not identified as the cause of death in any of the deceased. Pre-transplant examination revealed 15 patients with ORL relevant infectious foci. To make urgent HSCT possible, surgical pre-transplant ablation of chronic ORL infection sites took place in four patients only. In this cohort, pre-transplant ORL pathology was not amplified after HSCT. None of the 11 patients presenting ORL foci before transplantation experienced enhancement of ORL disease. These data suggest that the indication for surgical intervention with regards to ORL infection prior to HSCT should be regarded cautiously. However, the potential risk of dissemination of a pre-existing fungal infection from an ORL site should be considered and treated on a case-by-case basis.
