Lupus is an autoimmune disease that causes inflammation throughout the body. It can affect many different organs and systems, including the sinuses. Sinusitis, or inflammation of the sinuses, is a common complaint among people with lupus. In this article, we’ll take a close look at the connection between lupus and sinus problems. We’ll cover the causes, symptoms, diagnosis, and treatments for sinusitis in lupus patients.
What is lupus?
Lupus is an autoimmune disease where the immune system attacks the body’s own healthy cells and tissues. This leads to widespread inflammation that can affect joints, skin, kidneys, blood cells, brain, heart, and lungs. The most common type is systemic lupus erythematosus (SLE). Around 1.5 million Americans have some form of lupus, with SLE accounting for 70% of cases. Nine out of 10 lupus patients are women.
Lupus causes symptoms like fatigue, fever, joint pain, and rash. The disease follows a pattern of flares (active periods) and remissions (quiet periods where symptoms improve). Flares can range from mild to severe. Lupus has no cure, but medications can help control symptoms and minimize organ damage. Early diagnosis and treatment are important to prevent complications.
What are the sinuses?
The sinuses are empty air-filled spaces in the bones around the nose. There are four pairs of sinuses:
– Maxillary sinuses – Located under the eyes, in the cheek area
– Frontal sinuses – Located above the eyes, in the brow area
– Ethmoid sinuses – Located between the eyes, behind the bridge of the nose
– Sphenoid sinuses – Located behind the ethmoids, deeper in the skull
The sinus cavities are lined with mucous membranes. Tiny hairs called cilia sweep mucus out of the sinuses. This helps keep the sinuses clean and working properly. Air and mucus are able to flow freely through the sinuses and drain through small openings into the nose.
Can lupus affect the sinuses?
Yes, lupus can definitely affect the sinuses. Studies show that up to 72% of lupus patients experience sinusitis. Sinusitis simply means inflammation of the sinus cavities. Several factors contribute to the high rate of sinus problems among lupus patients:
Weakened immune system
Lupus weakens the body’s immune defenses, making people more prone to infections. The sinuses are especially vulnerable to bacteria, viruses, and fungi. Infections can easily take hold and trigger sinus inflammation.
Lupus causes inflammation throughout the body, including the sinus linings. This makes the sinuses more irritated and swollen. It also impairs mucus drainage, leading to congestion.
Corticosteroids like prednisone are often prescribed to reduce lupus inflammation and immune activity. But these drugs also weaken the immune system, increasing the risk of sinus infections. Other lupus drugs like methotrexate can thin nasal/sinus tissues.
Many lupus patients struggle with dry mouth and eyes due to inflammation. This dryness often extends to the nasal passages and sinuses as well. When the sinuses are dry, mucus can stagnate and promote sinusitis.
Lupus increases the risk of abnormal blood clotting. Blood clots in the veins that drain the sinuses can block sinus drainage. This leads to congestion and infection.
The nose may be damaged in lupus patients who experience nosebleeds, sinus surgery, or nasal trauma from a mask or ventilator. This can obstruct sinus drainage.
Smoking irritates the sinus passages. Since some lupus patients smoke, this adds to their risk of sinus inflammation.
What are the symptoms of sinusitis in lupus patients?
Sinusitis symptoms can include:
– Congestion and blockage – Feeling of obstruction, pressure, tightness, and nasal stuffiness.
– Facial pain/pressure – Aching pain or pressure centered around the inflamed sinuses. Cheeks, brow, between eyes, upper teeth may hurt.
– Headache – Dull, throbbing headache originating from the sinus region. Worsens with sudden head movement or straining.
– Discolored discharge – Thick, yellow or green mucus from the nose indicates pus and infection.
– Loss of smell – Inflammation restricts airflow, impairing the sense of smell.
– Fatigue – Sinus infections can induce extreme tiredness.
– Cough – Postnasal drip can cause cough, sore throat, and bad breath.
– Fever – Moderate fever sometimes accompanies acute sinusitis.
– Toothache – Dental pain from maxillary sinus pressure.
Since lupus causes similar generalized symptoms like fatigue, headache, and pain, sinusitis symptoms may be erroneously blamed on a lupus flare. It’s important to investigate the specific source of these complaints. Let your doctor know if symptoms are focused in the sinus areas.
How is sinusitis diagnosed in lupus patients?
To check for sinusitis, the doctor will:
– Review symptoms – Characterize the nature, severity, location and duration of symptoms.
– Check sinuses – Palpate and percuss the face over the sinuses to identify tender spots.
– Examine nose – Use a scope to look into the nasal passages for swelling, polyps, discharge.
– Tap sinuses – Gentle pressure elicits pain over inflamed sinus(es).
– Conduct imaging – CT scans give detailed views of sinus anatomy and problems.
– Take cultures – Infectious sinusitis may be confirmed by mucus cultures.
– Assess for complications – Look for spreading infection or cysts in sinus cavities.
It’s important to identify factors that may promote sinusitis in a lupus patient, like nasal dryness, trauma, smoking, or immune-suppressing drugs. The doctor also needs to rule out whether apparent sinusitis is actually a lupus flare or manifestation in sinonasal tissue.
How is sinusitis treated in lupus patients?
Treatment aims to open obstructed sinuses, resolve any infection, reduce inflammation, and prevent recurrence.
Salt water sprays help flush mucus and shrink tissues. Steroid nasal sprays like Flonase decrease inflammation. Other options include decongestant sprays and antihistamines.
For bacterial sinus infections, a course of antibiotics like amoxicillin kills the organisms. Antibiotic choice depends on severity and suspected bacteria.
Steroids like prednisone help control widespread sinus inflammation in chronic or severe cases. Long term use requires caution due to side effects.
Rinsing the nasal passages daily with a saline solution removes mucus plugs and irritants. Special bulb syringes or pulsatile irrigation devices are commonly used.
Oral decongestants like pseudoephedrine (Sudafed) narrow blood vessels in the nose and sinuses. This shrinks tissues, opens passages, and improves drainage.
Added moisture in the air helps thin mucus secretions and prevent dry nasal passages that worsen congestion.
Allergy testing and immunotherapy (allergy shots) may be warranted if allergies are aggravating sinonasal inflammation.
Those with severe recurrent sinusitis may need surgery to widen sinus openings and promote drainage. The type of surgery depends on the extent of sinus damage.
Alternative therapies like acupuncture, irrigation, or herbal remedies may provide relief for some but lack evidence for sinusitis. It’s important to avoid unnecessary immune suppression in lupus patients and closely monitor the response to any treatment approach.
What self-care tips help sinusitis in lupus?
Lupus patients with sinus troubles should try these self-care measures:
– Stay hydrated – Drink lots of fluids to thin mucus.
– Apply warm compresses – Moist heat helps soothe sinus congestion and pain.
– Use OTC nasal sprays – Saline spray and steroid nasal sprays can be used safely.
– Take OTC pain relievers – Acetaminophen, naproxen, and ibuprofen help sinus pain and pressure.
– Try a Neti pot – Use sterilized water to irrigate the nasal passageways.
– Use a humidifier – This adds needed moisture to the nasal and sinus linings.
– Sleep with head elevated – This facilitates mucus drainage from the sinuses.
– Avoid irritants – Cigarette smoke, chemicals, air pollution can worsen inflammation.
– Monitor for infection – Seek medical care if you suspect a sinus infection.
– Ask about immunizations – Pneumonia and flu vaccines help prevent respiratory infections.
Lupus patients are advised to avoid antihistamines and decongestants unless directed by their physician, as these can have immune-suppressing effects. Always check with your doctor before taking any over-the-counter sinus remedies. Report worsening sinus congestion, pain, or headaches promptly.
What complications can arise from sinusitis in lupus patients?
Sinus infections should be treated quickly in lupus patients to prevent dangerous complications like:
Bacteria or fungi can spread from the sinuses to the eye sockets, facial bones, or brain. This can cause blindness, tissue damage, or meningitis.
A sinus abscess forms when pus gets trapped in the sinus cavities. Abscesses show up on CT scans and require drainage.
Chronic or recurrent sinusitis can lead to osteomyelitis, which is infection and inflammation in the facial or cranial bones around the sinuses. This requires intravenous antibiotics.
Obstruction of sinus drainage can cause mucus to pool in cysts called mucoceles. Large mucoceles exert pressure on surrounding structures.
Sinus vein thrombosis involves blood clot formation in sinus veins. This can occur due to lupus-related hypercoagulation. IV blood thinners are needed to break up clots and restore sinus drainage.
Chronic sinus inflammation often causes noncancerous polyps to grow on the sinus linings. Large or widespread polyps require removal through sinus surgery.
Decreased quality of life
Frequent sinus troubles can greatly impact quality of life. Ongoing fatigue, pain, congestion, and illness take a major toll on lupus patients. Proper treatment and preventive strategies are essential.
Sinusitis is a common problem in lupus patients, affecting up to 72% at some point. Several factors like a weakened immune system, medications, and nasal dryness increase susceptibility to sinus infections and inflammation. Symptoms include congestion, facial pain and pressure, headache, and discolored mucus discharge.
It’s important for doctors to evaluate sinus complaints thoroughly in lupus patients. This includes assessing for predisposing factors and ruling out a lupus flare. Treatment aims to open the sinuses, resolve infection, reduce swelling, and prevent recurrence. Lupus patients should practice good sinus hygiene and follow up promptly if symptoms worsen or persist.
Left untreated, sinusitis in lupus can cause grave complications like spreading infection to the eyes or brain. Other risks include abscess, bone infection, blood clots, polyps, and a greatly reduced quality of life. With proper medical care and vigilant self-care, lupus patients can effectively manage sinus problems and maintain their health.