Gaps between self-perceived sinonasal symptoms, endoscopic findings, and radiographic damage in patients with granulomatosis with polyangiitis.

BACKGROUND AND

OBJECTIVE

Sinonasal symptoms occur in up to 80% of patients with granulomatosis with polyangiitis (GPA), affecting quality of life. This study aimed to evaluate the association between self-perceived sinonasal symptoms (SNOT-22 questionnaire), and clinical variables, and to describe discrepancies between self-reported symptoms, ENT findings, and radiographic abnormalities.

METHODS

A cross-sectional study was conducted at a tertiary center in Mexico City (November 2024-July 2025). Patients with GPA and a paranasal sinus CT scan within two years were included. Data collection comprised demographic, clinical, laboratory, and treatment variables. Assessments included disease activity (BVAS/GPA), cumulative damage (VDI), patient and physician global assessments (PhGA and PtGA), and PROMs (SNOT-22, AAV-PRO). All patients underwent ENT examination with nasal endoscopy.

RESULTS

Fifty patients were included, 64% women, median age 49.5 years, and disease duration 88.5 months. Most were in remission (median BVAS/GPA 0). The median VDI was 3, PtGA 10.7mm, and PhGA 1.8mm. The median SNOT-22 score was 30.5. Common ENT findings were rhinorrhea (64%), hypertrophic turbinates or hyperemic mucosa (36%), nasal crusts (34%), and septal perforation (20%). CT abnormalities included chronic sinusitis (46%) and sinus destruction (32%). Self-reported symptoms showed moderate-to-strong correlations with AAV-PRO domains and global assessments, but no associations with disease activity, damage, or treatment. Discrepancies were observed between SNOT-22 items and ENT or CT findings.

CONCLUSIONS

Self-reported sinonasal symptoms correlated with PROMs, whereas associations with disease activity or damage were not evident in this cohort. Discrepancies highlight the need for GPA-specific studies integrating PROMs, standardized ENT assessments, and imaging.