Rheumatic Diseases and Sinusitis: Epidemiological Features, Immune Mechanisms, and Treatment Challenges

Abstract

Rheumatic diseases are a diverse group of chronic disorders primarily affecting the joints, bones, muscles, and connective tissues, often involving internal organs, blood vessels, and the nervous system. They encompass systemic autoimmune diseases (e.g., systemic lupus erythematosus), inflammatory arthritides (e.g., rheumatoid arthritis), metabolic arthropathies (e.g., gout), degenerative conditions (e.g., osteoarthritis), and infection-related arthritis. In recent years, with the deepening understanding of immune-related diseases, researchers have gradually noticed a possible comorbid relationship between sinusitis and various rheumatic diseases. Sinusitis is considered a disease characterized by mucosal barrier dysfunction, chronic inflammation, and immune dysregulation. These features are also reflected in rheumatic diseases. Moreover, research has shown that patients with rheumatic diseases have a significantly increased risk of developing sinusitis [1]. Based on this epidemiological characteristic, our study delves deeply into the association between RD and sinusitis regarding common immune pathways and molecular mechanisms cross-talk as well as drug treatment aspects, aiming to provide guiding insights for the future diagnosis and treatment of comorbidities between the two diseases, thereby improving the quality of life for patients.

Although the potential link between RD and sinusitis has garnered growing attention, relevant research still faces significant limitations. We reviewed research from PubMed, Web of Science, Embase, Cochrane, and Scope databases and summarized current findings (Figure S1; Table 1; Table S1). The results show new research advances in this field every year (Figure S2A). The published literature predominantly focuses on drug treatment (n = 27), clinical correlation (n = 22), molecular mechanisms (n = 6), diagnostic management (n = 4), physical therapy (n = 2), and spa therapy (n = 1) (Figure S2B). Research on drug treatment and clinical correlation is abundant, yet exploration of molecular mechanisms and drug development remains limited.

Further keyword clustering analysis of the literature in the Web of Science Core Collection (WOSCC) database (Figure S3) revealed that the research hotspots in this field focus on molecular mechanisms (blue cluster), drug treatment and pharmacological mechanisms (green, yellow, and red clusters), and clinical management (purple cluster). Research on molecular mechanisms has received considerable attention. Although some studies indicate that immune dysregulation and chronic inflammation may be common pathological features of RD and sinusitis [2], the specific relationship between their onset and development remains unclear. Identification of specific immune pathways and key molecular markers remains limited.

Drug therapy is the primary focus of this field. Current research examines the effects of traditional Chinese medicine, immunosuppressants, biological agents, and other drugs on sinusitis occurrence in RD patients. However, most research is in its early stages, and the mechanisms by which drugs contribute to comorbidities remain unclear. Additionally, balancing drug therapeutic effects with side-effect-induced comorbidities is a pressing clinical challenge in RD treatment. While current research shows various traditional Chinese medicines' significant efficacy in treating RD and sinusitis, insufficient evidence-based research currently supports this strategy, necessitating further in-depth, systematic studies for stronger scientific evidence. Additionally, developing more specific biological agents is a key research direction for treating RD and sinusitis.

Research on the diagnosis and management in the co-occurrence of RD and sinusitis remains limited. Under immunosuppressive therapy, changes in the immune system of RD patients often lead to atypical clinical manifestations of sinusitis, complicating early diagnosis and timely intervention. Therefore, developing professional diagnostic tools and standards to establish comprehensive management strategies is urgently needed. This study aims to investigate the epidemiological characteristics, immune mechanisms, and therapeutic associations in the comorbidity between rhinosinusitis and rheumatic diseases.

We have explored the multifaceted relationship between RD and sinusitis. Given that RD patients often require immunosuppressive therapy, which may increase their risk of respiratory infections like sinusitis clinicians must closely monitor their conditions and ensure balanced drug selection. Our research shows that investigating common pathogenic and therapeutic pathways offers instructive insights for clinical practice and targeted therapies. Future research should actively explore immunomodulatory therapies targeting specific immune pathways and biomarkers. Furthermore, we recommend a multidisciplinary team (MDT) approach involving otolaryngologists, rheumatologists, and immunologists to develop comprehensive diagnostic and treatment plans. Lastly, traditional Chinese medicine has potential in regulating the internal environment. In the future, there should be a call for enhanced clinical research and collaboration to fill research gaps and better guide clinical practice.

However, this study integrated diverse research types, which introduced some heterogeneity in design due to differences in sample size, subject characteristics, and statistical methods. Potential publication bias may also have impacted the bibliometric analysis, as studies with positive findings are more likely to be published. Additionally, variations in database inclusion criteria may affect the comprehensiveness and accuracy of the analysis. Despite these challenges, rigorous literature screening and quality assessment methods were employed to minimize bias and enhance result reliability. These limitations should be considered in future research to improve homogeneity and reliability in exploring the association between rheumatism and sinusitis.

Our study demonstrates shared epidemiological patterns and common immune mechanisms between RD and sinusitis. Future research should focus on elucidating underlying immune pathways, identifying biomarkers, and developing targeted therapies. Enhanced interdisciplinary collaboration will optimize comprehensive management strategies. Through more in-depth clinical and basic research, we will explore and improve treatment strategies, develop drugs with fewer side effects and more targeted effects, and ultimately improve the quality of life of patients.

Ping-Ting Zhou, Zi-Hui Xie: conceptualization, data curation, formal analysis, investigation, methodology, resources, software, supervision, validation, visualization, writing – original draft, writing – review and editing. Jian-Peng Wang: data curation, formal analysis, investigation, software, supervision. Hai-Feng Pan, Yu-Chen Liu: conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing – original draft and writing – review.

The authors have nothing to report.

The authors declare no conflicts of interest.